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EXPERIENCE VALUE RESULTS Up-Front Collections and Today’s Top Collections Technologies The Technologies that are Transforming Up- Front Collections in.

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Presentation on theme: "EXPERIENCE VALUE RESULTS Up-Front Collections and Today’s Top Collections Technologies The Technologies that are Transforming Up- Front Collections in."— Presentation transcript:

1 EXPERIENCE VALUE RESULTS Up-Front Collections and Today’s Top Collections Technologies The Technologies that are Transforming Up- Front Collections in Access Management October XX, 2011

2  Learn the real costs of up-front collection avoidance  Learn how to move the collections process from customer disaster to customer service  Learn the key collections technologies and the application integration required to develop a comprehensive “collections management system” Learning Objectives 2

3  The out-of-pocket (self-pay) share of health care costs has increased significantly for patient in recent years  The cost-to-collect has also risen sharply as self-pay dollars have increased:  It is less costly for healthcare organizations to collect self pay dollars prior to service, at the point of service or at discharge.  If self pay dollars are not collected at the point of service or discharge, the cost-to-collect can be 4.75% - 10% of the balance. The Cost of Collection Avoidance 3

4 FF ailure to collect “self pay” dollars reduces your ability to improve services or invest in new programs to meet community needs.  R esearch has shown: MM ost patients (68%) prefer to know about their financial obligations at or prior to discharge. OO ver one-third want to know about financial obligations prior to admission. UU ncertainty and confusion about financial obligations are a frequent source of customer dissatisfaction. The Cost of Collection Avoidance 4

5 Patients may know very little detail about their health coverage. This is particularly true for healthy patients who haven’t had to use their coverage. Patients often have 2 expectations that can lead to anger and dissatisfaction when they are not met:  1 st Expectation: Having insurance means they are “covered” and won’t have to pay (much!)  2 nd Expectation: Doctors and other providers have checked for coverage before referring them to healthcare organizations. Setting Expectations Is Customer Service 5

6 Uncertainty and confusion about financial obligations are a frequent source of customer dissatisfaction. This uncertainty can cause confusion between:  The healthcare organization and the doctor  The patient and the doctor  The patient and the healthcare organization Effective healthcare organizations understand that communication is the key to decreasing this confusion and improving customer relations. Setting Expectations Is Customer Service 6

7 When does a patient’s responsibility for payment begin? AA patient’s responsibility for payment begins on the date that services are rendered. Successful organizations establish this expectation during the registration process before services are delivered. 7

8  Let Patients Know that Payment is Expected!  While this may seem to be an obvious point, far too many healthcare organizations begin the care process without letting patients know how or when they expect to be paid.  Organizations that are effective in up-front collections manage patient’s expectations by:  Notifying patients that payment is expected when services are delivered  Explaining uncovered amounts to patients before services are delivered  Asking for remaining balances and uncovered amounts Setting Expectations Is Customer Service 8

9  U U p-Front Collections Today: II deally moves all appropriate patient collections from the back-end (Patient Accounts) to the front-end (Patient Access Services) of the Patient Financial Services customer service cycle. SS olidifies our commitment to customer satisfaction, service excellence and performance improvement. RR eflects a practical way for us to demonstrate our organizations values in action. 9

10  Demonstrate Your Values: Let Patients Know that Payment Options are Available!  Most organizations want to provide services to every patient.  While payment is expected at the time of service, financial assistance is available in the form of:  Payment deposits with payment plan arrangements  Discounted services based upon ability to pay  Payment assistance via government or other sponsored programs Setting Expectations Is Customer Service 10

11  Pre-service is the best time to communicate to the patient his or her financial responsibilities. This is the time to let insured patients know if there is a deductible, co-payment or co- insurance amount required and to discuss your facilities expectations for payment of services rendered.  This advance communication with the patient helps alleviate possible future misunderstandings when payment is later expected from the patient, and also helps expedite payment to your facility. It can also help east the patient’s anxiety regarding financial issues associated with healthcare services by enabling you to…… Setting Expectations 11

12 II nform patients up-front of non-covered services and charges. Let them know that they will be obliged to pay these charges if they choose to go forward with the services. RR equest the full amounts that the patient is obligated to pay when requesting payment. Setting Expectations 12

13  Uninsured patients may be responsible for the entire bill. Whether the patient is insured or uninsured, we begin setting expectations by informing the patient of the self-pay portion of our charges so they understand their responsibility for payment.  Effective organizations establish financial policies to address these collection situations. Setting Expectations 13

14 Financial Policies Financial Practices policies of healthcare organizations should clearly state that:  Payment is expected on the date of service  Emergency care will be provided without regard to a patient’s ability to pay and  Financial assistance is available for those who cannot afford services Setting Expectations 14

15 In the current healthcare environment providers constantly look for ways to enhance revenue and reduce cost. As the patient out-of-pocket portion of health care costs has increased significantly in recent years, provider bad debt has also risen sharply. A New Day 15

16 Today, more healthcare organizations recognize that an effective up-front collections program is an important way to reduce those costs. While new technologies have emerged to facilitate this effort, leading organizations are increasingly learning that the thoughtful integration of these technologies can be a key driver of collection efficiency and customer satisfaction. A New Day 16

17  Healthcare organizations are using a plethora of collections technologies to reduce costs and improve service delivery. When implemented as stand-alone applications, these organizations are realizing impressive results. However, when implemented as components of a thoughtful “collection management system”, the overall results can be greater than the sum of the individual parts. A New Day 17

18 Applications have evolved along a fairly predicable path While progress has occurred at every level, transformation of work processes has been elusive Transformed Level 4 (Integration leveraged between all applications) Integrated Level (Integration improves with ADT Application Batched Level (Some Batch and Direct Processing) Niche Application Level (Application Silos are formed) Application Evolution 18

19 19

20 1.Contact Verification 2.Eligibility Verification 3.Payment Estimation 4.Communication Management 5.Propensity-to-Pay Scoring 6.E-Cashiering 7.Financial Assistance Automation 8.Rule based Document Imaging 9.Self-Service Kiosks 10.Rule-based Process Automation Top Collections Technologies 20

21 Contact Verification 21

22  Benefits  Improves billing and statement delivery, thus increasing cash flow  May detect multiple identities or possible fraud - including the identification of social security numbers for deceased persons  Increases staff productivity  Optional batch features often offered (as options) Contact Verification 22

23  The Old Approach  Focus on address verification only  Batch address checking done after the fact  Features To Look For Now: Phone Number Integration Verify non-traditional phone numbers e.g., wireless, non- listed ADT / Practice Management System Integration System highlights real-time discrepancies between verification and host system System allows user to accept or reject changes after real- time discussion with patient Contact Verification 23

24 Eligibility Verification 24

25  Benefits  Verify coverage benefits prior to service delivery  Submit patient information and receive real-time coverage response  Reduce or eliminate timely telephonic verification  Reduce or eliminate cumbersome website verification  Increase upfront collections  Reduce rejections and denials  Increase efficiency and staff productivity (reduce data entry)  Improve patient satisfaction Eligibility Verification 25

26  The Old Approach  Proprietary, payer-specific eligibility formats  Un-integrated website and telephonic verification prevalent  Features To Look For Now: Normalized Benefit Formats Ability to design “standard” and “detailed” benefit screens ADT / Practice Management System Integration Eligibility and benefit information is mapped in X12 and HL7 formats to ADT application Ability to send real-time HIPAA 270 eligibility transactions and receive 271 responses Eligibility Verification 26

27 Patient Payment Estimation Payment Estimation 27

28  Benefits  Reduce bad debt  Increase collections  Accelerate payments  Cut costs for patient collections  Ensure payment accuracy  Increase payment certainty Payment Estimation 28

29  The Old Approach  Collection of co-payments and self-pay deposits only  “Guestimates” rather than estimates  Features To Look For Now: Charge Master/Eligibility System Integration Ability to apply benefits to real charges Charge Master/Contract Management Integration Ability to apply contractual allowances before developing estimates Payment Estimation 29

30 30 Communication Management

31  Benefits  Increase productivity  Reduce denials  Increase successful appeals Communication Management 31

32  The Old Approach  No electronic record of payer communications  Features To Look For Now: Call Management Automated calls, monitored calls, PC calls Fax Management Inbound and outbound faxed documents Web & Electronic Image Management Web-eligibility, , other electronic documents Communication Management 32

33 Propensity to Pay Scoring 33

34  Benefits  Streamline self-pay approvals  Limit unnecessary outsourcing  Identify risky elective encounters  Proactively identify financial assistance candidates Propensity to Pay Scoring 34

35  The Old Approach  Subjective approvals by financial counseling staff  Understated charity care on financial reports  Features To Look For Now: Self-pay Funding Sources Available credit on credit cards Lines of credit and home equity External finance solutions offered by banks and other lenders. Segmentation Analysis Customize scoring profiles to community characteristics Workflow Management Electronically forward accounts to financial counseling process Propensity to Pay Scoring 35

36 Electronic Cashiering 36

37  Benefits  Accelerates and increases collections  Increases speed of payment capture  Saves time by automating manual payment posting  Increases staff efficiency by enabling more employees to accept payments  Improves customer service leading to enhanced customer satisfaction  Provides dashboard reporting of payment activity (ability to track, audit and control all customer payments) Electronic Cashiering 37

38  The Old Approach  Payments collected at only at time of service  Reconciliation manual and cumbersome  Features To Look For Now: Accept payments real-time from any location Any user desktop Patient payment web-portals Accept all forms of electronic payment Credit card, debit card, e-check, ACH transactions Cash Posting and Management Audit, track and control payments User/Department collection efficiency reporting Propensity to Pay Scoring 38

39 Financial Assistance Automation 39

40  Benefits  Proactively identify eligibility to entitlement programs  Reduce unnecessary outsourcing to self-pay vendors  Improve charity/bad debt classification  Improve customer service and community benefit reporting Financial Assistance Automation 40

41  The Old Approach  Manual application and subjective approval processes  Reconciliation manual and cumbersome  Features To Look For Now: Pre-populate applications from ADT information Medicaid applications Financial assistance applications *Integration with propensity-to-pay systems and e-pay systems Pre-define payment plans Presumptive eligibility and approvals Automate financial assistance rules and workflows Financial Assistance Automation 41

42 Rule-Based Document Imaging Rule-based Document Imaging 42

43  Benefits  Reduce unnecessary copying and scanning costs  Reduce denials related to missing referral/authorization forms  Improve customer service Rule-based Document Imaging 43

44  The Old Approach  Repetitive copying and scanning of same documents  Features To Look For Now: Rule-based Scanning Prompt users to scan required documents Drive prompts by document type, last date scanned, etc. Optical Character Recognition Mapping Compare insurance card information to ADT system fields and correct data entry errors Rule-based Document Imaging 44

45 Seated Kiosk Patient Self- Service Kiosks Self-Service Kiosks 45

46  Benefits  Reduced staffing  Reduced check-in time  Improved cash flow and collections  Reduced errors  Improved customer service Self-Service Kiosks 46

47  The Old Approach  Staff check-in areas with increasing FTEs  Inconsistent collection compliance  Features To Look For Now: Date/time stamping of arrival Automated printing, armband generation Real-time payment processing Real-time eligibility verification Debit and Credit Card Processing Electronic signature capture Self-Service Kiosks 47

48 Contact Verification Communication Management Eligibility Verification Payment Estimation Propensity to Pay Scoring Rule-Based Process Automation Electronic Cashiering Financial Assistance Automation Rule-Based Document Imaging Self-Service Kiosks Rule-based Process Automation 48

49  Benefits  Transformation of workflow  Technology acceleration  Vastly increased efficiency  Expanded financial counseling  Improved cash flow and collections  Improved customer service  Eliminate whole categories or errors Rule-based Process Automation 49

50  The Old Approach  Each application functions as a silo  Information is copied or re-keyed into other systems  Features To Look For Now: Full integration between all applications Ability to use multiple integration modes, HL7, scripting Ability to display scripts or registrar guidance Ability to build “action rules”- rules that execute actions based on data from other applications – without registrar intervention or prompts Rule-based Process Automation 50

51 Transformational Performance + = + Technology Accelerators Collections Mgmt. System Vision The Formula for Transformation Integration Between all Applications The New Math 51

52 This presentation has demonstrated that a number of exciting collection technologies have evolved over the last few years and they are already lowering costs and improving services. Conclusion Contact Verification Communication Management Eligibility Verification Payment Estimation Propensity to Pay Scoring Rule-Based Process Automation Electronic Cashiering Financial Assistance Automation Rule-Based Document Imaging Self-Service Kiosks 52

53 However, organizations that hope to move beyond the incremental evolution of the first three generations of applications to the transformation of the fourth generation will need the vision to see the possibilities that now exist and technology accelerators to integrate disparate solutions into the seamless integrated “collections management system” that we have all been waiting for. Contact Verification Communicatio n Management Eligibility Verification Payment Estimation Propensity to Pay Scoring Rule-Based Process Automation Electronic Cashiering Financial Assistance Automation Rule-Based Document Imaging Self-Service Kiosks Conclusion 53

54  In this session, we learned:  The real costs of up-front collection avoidance  How to move the collections process from customer disaster to customer service  The key collections technologies and the application integration required to develop a comprehensive “collections management system” Summary 54

55 Questions Conclusion 55

56 John Thompson, PMP, CHAM Senior Consulting Manager 3 Christy Drive, Suite 100 Chadds Ford, PA (484) (cell) (484) (office) Toll Free: Contact Information 56


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