3Current TrendsThe losses for many hospitals’ investment income has caused their executives to look for additional ways to increase net revenue, reduce bad debt and lower cost.Point of service collections no longer an emerging trend – it’s now mainstream for Patient Access best practicesMaximizing point of service collections rank in top 10 CFO priorities– Advisory Board Company 2011Result: rising bad debt and less cash on hand;especially with the continued growth of HSA & High Deductible Health Plans(more financial responsibility put on the patient)
4Growth of HSA / HDHP Enrollment Source: AHIP Center for Policy Research, June, 2011
5Population Trends Self Pay is the fastest growing payer class 50+ million Adult Americans are uninsured (18.7% )25 million Adult Americans are underinsured75 million working-age adults uninsured or underinsuredFastest growing group of uninsured aged 25 – 34 with income > $70KFigures increase significantly when including children or undocumented individualsEmployer-based health coverage continues to decrease200820092010201149.2%46.8%45.8%45.0%
6Unemployment and the Uninsured impact ***1% increase results in 1M new Medicaid/CHIP enrollees and 1.1M uninsuredBureau of Labor and Statistics and the Kaiser Family Foundation
7Increasing patient out-of-pocket Percentage of Covered Workers Enrolled in a Plan with a General Annual Deductible of $1,000 or More for Single CoverageNote: These estimates include workers enrolled in HDHP/SO and other plan types. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,
8Increasing PO$ Collections: Why the Focus? Significantly improve the bottom line of your organization through:Reduce cost to collectReduce uncompensated careReduce self-pay receivablesIncrease overall cash flowImprove patient satisfactionReduce call volumesReduce patient confusion about their bills
9PO$ Collection FactsCost to collect is typically reported between 2-3% of revenueFront-end processes are important … due to increase in patient out-of-pocketPost discharge, cost to collect increases, likelihood of collection decreasesEducating the patient of their financial obligation in advance improves patient satisfaction
10Example Medium size hospital Radiology department with 5,000 visits Average liability $389Potential to collect $1,945,000Result: Without collecting at POS,the hospital can typically lose up to 60%of the potential amount, or $1,167,000
11PO$ Collections – Best Practices, is this possible? OutpatientInpatientSurgeryED(not admitted)TotalAnnualMonthlyTotal Annual Visits52,2004,50013,80027,00097,500% Commercial Visits31%Annual Commercial Visits16,1821,3954,2788,37030,225Average Patient Responsibility$169.00$1,225.00$798.00$122.00Total Collection Opportunity at POS$2,734,758$1,708,8753,413,844$1,021,140$8,878,617$739,885Annual Net Patient Revenue$57,015,738Current Annual Collections at POS$480,000Current Monthly Collections at POS$40,000Current Collections as % of Net Patient Revenue0.84%Current Collections as % of Total Collection Opportunity5%HFMA Best Practice 2-3% of Net Patient RevenueBest Practice Monthly Collections at POSCurrent Monthly CollectionsMonthly Increase from CurrentAnnual Increase from Current% Total OpportunityPOS Collections at 1%47,5137,513$90,156POS Collections at 2%$95,02655,026$660,31211%POS Collections at 3%$142,539102,539$1,230,46816%
13Potential compliance risks while engaging in financial activity HIPAAHealth Insurance Portability and Accountability ActDisclosure of information must be limited to the minimum necessary for the purpose of the disclosurePO$ IMPACTPotential compliance risks while engaging in financial activity
14EMTALA Emergency Medical Treatment and Active Labor Act The hospital cannot delay in providing a medical screening examination or stabilization services in order to inquire about the individual payment method or insurance status.PO$ ImpactCollection activity ONLY AFTER medical screeningexamination and stabilization
15Potential patient liability if not medically necessary Medical NecessitySocial Security Act 1862(a)(1) is defined as:Consistent with symptoms or diagnosis of the illness of injury being treated and not for the convenience of the patient, attending physician, or supplierWithin generally accepted professional medical standards (not exploratory or investigational)PO$ ImpactPotential patient liability if not medically necessary
16ABN / Notice of Non-Coverage Advance Beneficiary Notices or Notice of Non-CoverageBefore services are providedMedicare/select commercial payers will not pay for some or all of the services because they may not be reasonable and medically necessaryPatient/representative must be informed of non-coverage and liability in the event Medicare does not payPO$ ImpactPotential patient liability
17Collection Technology Detailed eligibility – 271 data is not enoughMedical necessity verificationABN notificationFinancial responsibility estimatorOn-line paymentsIntegrated credit card authorization systemATM accessibilityPropensity to pay scoreScripting
18Collection Readiness Training Scripting Policies and procedures Set expectations and accountabilityCommunicate goals and expectationsMeasure potential vs. actual cashDevelop incentive plan
19PO$ Collections Opportunity Areas Registration/EDPre-registrationSchedulingIn-house/DischargeOther ancillary departments
20Scheduling / Pre – Registration / Registration Potentially the first point of contact with the patient!Verify eligibilityConsistent pre-registration processObtain benefits (coverage, co-pay, co-insurance and/or deductible, YTD accumulators)Inform patient of liability in advanceOffer debit/credit card payment option
21Financial CounselingPlays key role in protecting the hospital’s cash flow and exposure to bad debt and collection expenseMedical assistance screeningAlternative state funding application processCharity care screeningCredit scoring (propensity to pay)Establish financial arrangements
22In House / DischargeMake in-house visits to patient rooms for third party coverage, collect patient financial responsibility, and/or payment arrangementsImplement financially focused discharge control process for all point-of-service areasEnsure every account is financially evaluated prior to discharge
23Success Factors Hospital PO$ collections policy Financially focused Patient Access DepartmentFinancial Counseling best practicesMedicaid eligibility vendorPhysician and physician office manager educationStaff education and incentive programConsistency in front end process
24Key Contributors to Success Senior Management buy in; CEO, CFO, CNOCIO supporting integration of technologyPhysician communicationClearly defined policies and expectationsTraining programConsumer education and satisfactionEstablish goals and measure performance
25Best Performers – Hospital wide CFO/CEO communicates organizational efforts to hospital directorsCNO adopts organizational efforts and level set clinical deptsCIO provides access to currently technology and provides resources to implementHR incorporates cash collection responsibilities in job descriptionPatient Access documents Policies and ProceduresScripting and role playingDiscuss and publish goals and expectationsTrack and publish actual vs goals
26Best Performers – Non ER Relationship with physician communityProvides specific information at schedulingProvides insurance information at schedulingProvides maternity listStrong Preadmission deptInsurance eligibilityMedical necessity evaluationGenerates patient liabilityAccess to propensity to pay dataAccess to prior balancesCommunicates and collects patient liabilities
27Best Performers – Non ER cont. Strong Financial Counselor deptEvaluates ER admits, direct admits and transfersEstablished relationship with case managementGenerates and communicates patient estimatesAccess to prior balancesAccess to propensity to pay informationAccess to financial assistance resourcesEstablished prompt payment guidelinesEstablished uninsured discountingDecentralized dept adopt and implement existing polices and procedures
28Best Performers - ER ER: Clear and timely communication of MSE completedClinical team assisting with acuity levelFinancial Counselors and Discharge ProcessCalculate and collect patient liabilitiesInsurance letters with self addressed envelopesEstablished prompt payment and uninsured programs
29Tips to Motivate Payment UseHere are some options for you…Did you know you couldMay I suggest…We have always encouragedAvoidI want you to…I need…We require…Our policy states
30Overcoming Objections #1 Patient Objection “I’ve never been asked to pay before.” Registrar Response “Historically we have encouraged patients to pay their patient responsibility upfront. We now have a program in place that helps patients know their expected patient responsibility upfront. What payment method would you like to use to pay your responsibility?
31Overcoming Objections #2 Patient Objection “Why wasn’t I told in advance that I would have to pay today?” Registrar Response “We do our best to try to inform patients prior to their arrival. If you are not in a position to pay the total amount in full today, we will set up a payment arrangement for the remaining. How much will you be paying today?
32Overcoming Objections #3 Patient Objection“I don’t have any money.”“I can’t afford it right now.”“I am not working. How can I pay if I don’t work?”“I’m going to file bankruptcy.”Registrar Response“I understand. Why don’t I have you talk with our Financial Counselor and complete a Financial Analysis Statement. This will help us determine how we can assist you in resolving your account balance”**Although we want to collect from this patient, it is equally important to help the patient understanding other funding mechanisms. Ensure that all critical data elements are verified and document your account to help the business office.
33Overcoming Objections #4 Patient Objection “I like to wait until my insurance pays, then I’ll pay.” “My insurance pays first and then I pay when I receive the bill.” “I don’t even have a Deductible/Co-Pay –my insurance is wrong.” Registrar Response “As a service to you, we’ve contacted your insurance company and confirmed your eligibility and current. We verified that your annual deductible is $____ and you’ve already met $_____. Your co-insurance percentage is ___% or $____, etc, etc. The great news is, we have a contract with your insurance company which means you receive a discount.
34Overcoming Objections #5 Patient Objection“I don’t have my checkbook/cash/credit cards with me today.”“They told me not to bring valuables with me so I left my purse/wallet at home.”“I just wrote my last check.”Registrar ResponseWe’d like to have your payment method identified prior to your procedure. What method do you expect you’ll be able to use? Is there a way we can obtain that today or later in the week?
35Overcoming Objections #6 Patient Objection“It’s not right to pay for a service before you have it done!”“I’ll stop back at discharge.”Registrar Response“I understand this may be something new for you. We have found that it is best to discuss this upfront so that there are no surprises later on. Also, once you’re finished with your test/procedure, you’ll be ready to go home and you won’t have to worry about stopping back here.
36Overcoming Objections #7 Patient Objection“My ex-spouse is responsible for paying these bills.”Registrar Response“I understand. Unfortunately we cannot become involved in divorce decrees. As the presenting parent you are the responsible party for this account. We do have several payment methods available.”
37Overcoming Objections #8 Patient Objection“I’m always overcharged and it takes forever to get your money back.”Registrar Response“I understand how frustrating that can be. We’ve done our very best to make sure we’ve verified and estimated correctly. If you find that you are due a refund, please call me directly and I will follow up and ensure your credit balance is promptly refunded. My name is ______ and my direct line is _____.
38For additional information regarding Who to Contact:For additional information regardingtoday’s presentation please contactTerry Truman