Improving Collections and Staff Efficiencies Utah Intermountain NextGen Users Group Meeting May 14, 2014 Utah Intermountain NextGen Users Group Meeting May 14, 2014

The “Perfect Storm” Declining Reimbursement Increasing Regulation & Costs Unprecedented Demand Source: Marc Halley, halleyconsulting.com

What is the primary responsibility of a medical practice?

Defining “Collections”  Collections: The act of collecting (money) in an effort to ensure financial viability/ profitability of a practice.  Three Payer System  Patients  Insurance Companies  Government  Medicaid  Medicare  Marketplace  Other  Collections: The act of collecting (money) in an effort to ensure financial viability/ profitability of a practice.  Three Payer System  Patients  Insurance Companies  Government  Medicaid  Medicare  Marketplace  Other

Patient Collections  Automated Procedures  “Cash Only” Status  Small Balance  Auto-Draft Budget Plans  Point of Service Collections  Coming Soon... Credit Card on File  Some Final Thoughts  Automated Procedures  “Cash Only” Status  Small Balance  Auto-Draft Budget Plans  Point of Service Collections  Coming Soon... Credit Card on File  Some Final Thoughts

Patient Collections – Automated Procedures  Automated Collections Process  De-personalizes it  More reliable  Faster  Automated Collections Process  De-personalizes it  More reliable  Faster The 1-Touch Patient Collections Process

Patient Collections – “Cash Only”  Patient has earned “Bad Credit Rating” with your practice.  Use Patient Status to automatically alert staff as to the patient’s status.  Require patient to pay as if they are a Self Pay Patient with no discount until bad debt is resolved.  Require Bankruptcy patients to pay as if Self Pay Patient for at least 1 year. Refund them or use their credit for future visits until they have established good credit with you again.  Approach this Sensitively with the patient, be sure to set expectations up front.  I don’t recommend this approach for Medicare or Medicaid patients  Next Step – Cash Only Warned…  Patient has earned “Bad Credit Rating” with your practice.  Use Patient Status to automatically alert staff as to the patient’s status.  Require patient to pay as if they are a Self Pay Patient with no discount until bad debt is resolved.  Require Bankruptcy patients to pay as if Self Pay Patient for at least 1 year. Refund them or use their credit for future visits until they have established good credit with you again.  Approach this Sensitively with the patient, be sure to set expectations up front.  I don’t recommend this approach for Medicare or Medicaid patients  Next Step – Cash Only Warned…

Patient Collections – Small Balance  Send 1 statement and generate task for balances less than $25  Send 2 statements and generate task for balances less than $50  Write off the amount as a “Small Balance – Collect L8R”  Put Alert on the Account with the Small Balance Amount  Advise patient upon scheduling as to Small Balance Due, either collect at this time or have them prepared to pay at check-in.  When collected add Tracking Description of “Small Balance”  Pull a report daily or weekly of all payments posted with “Small Balance” tracking description, reverse the adjustment and expire the alert.  Send 1 statement and generate task for balances less than $25  Send 2 statements and generate task for balances less than $50  Write off the amount as a “Small Balance – Collect L8R”  Put Alert on the Account with the Small Balance Amount  Advise patient upon scheduling as to Small Balance Due, either collect at this time or have them prepared to pay at check-in.  When collected add Tracking Description of “Small Balance”  Pull a report daily or weekly of all payments posted with “Small Balance” tracking description, reverse the adjustment and expire the alert.

Patient Collections – Auto-Draft Budget Plans  If the patient needs to make payment arrangements (i.e. can not pay you in full today) establish set parameters.  All staff can set up a budget plan with a minimum payment of $25 / month for up to 4 months.  Supervisors can set up a plan with a minimum payment of $25 / month for up to 10 months.  Budget plans can only be made if the patient agrees to an auto-draft from a bank account or credit card (set up through Transfirst Web Portal)  Establish a Charity Care / Financial Assistance Determination Procedure for those patients who truly can not meet these minimum requirements and write off balances as a Charity if they qualify.  If the patient needs to make payment arrangements (i.e. can not pay you in full today) establish set parameters.  All staff can set up a budget plan with a minimum payment of $25 / month for up to 4 months.  Supervisors can set up a plan with a minimum payment of $25 / month for up to 10 months.  Budget plans can only be made if the patient agrees to an auto-draft from a bank account or credit card (set up through Transfirst Web Portal)  Establish a Charity Care / Financial Assistance Determination Procedure for those patients who truly can not meet these minimum requirements and write off balances as a Charity if they qualify.

Patient Collections – Point of Service  RTS eligibility and benefits allow for collections expectations to be set - Prior to Appointment time  Collect a minimum amount on High Deductible Patients (take out government plans and find the lowest allowable for – collect at least this amount)  Script your Staff and Role Play  Train your Staff  RTS eligibility and benefits allow for collections expectations to be set - Prior to Appointment time  Collect a minimum amount on High Deductible Patients (take out government plans and find the lowest allowable for – collect at least this amount)  Script your Staff and Role Play  Train your Staff

The Patient’s Propensity to Pay WillingUnwilling Able Available Funds Financially Engaged Most likely to be Current Available Funds Slow to Pay Likely Needs a “Plan” Unable Limited Funds Financially Engaged Needs a “Program” Few Funds Available Likely Charity or Medicaid Limited Credit History VERY LOWLOW Financial Risk Profile MEDIUM HIGH Source: Decision Health

Likelihood of collection diminishes rapidly…

Patient Collections – Credit Card on File (CCOF)  Coming Soon...  Establish authorization with the patient to automatically draft up to $xxx.xx within xx days of the date of service on their credit/debit card (much like securing your reservation at a hotel).  Set expectations up front and “over-notify” patients of need / policy.  Train front office staff extensively, including role-playing and scripting.  Select a qualified and helpful vendor to ensure security and ease of use.  Create your documentation – Patient Agreement and suggested Estimates Form, this form must read “Estimate Only” Decision Health On –Demand Webinar, “Spend Less, Collect More: How to run a credit card on file program at your practice.” October 29, $199  Coming Soon...  Establish authorization with the patient to automatically draft up to $xxx.xx within xx days of the date of service on their credit/debit card (much like securing your reservation at a hotel).  Set expectations up front and “over-notify” patients of need / policy.  Train front office staff extensively, including role-playing and scripting.  Select a qualified and helpful vendor to ensure security and ease of use.  Create your documentation – Patient Agreement and suggested Estimates Form, this form must read “Estimate Only” Decision Health On –Demand Webinar, “Spend Less, Collect More: How to run a credit card on file program at your practice.” October 29, $199

CCOF Sample Agreement “I, ____________________________, AUTHORIZE (Practice Name) TO CHARGE MY CRE3DIT/DEBIT CARD LATER FOR UP TO $ FOR ANY UNPAID PORTIONS OF TODAY’S BILL THAT IS NOT COVERED BY MY INSURANCE. $ WILL BE PRE-APPROVED TODAY, but my account will be charged only after (Practice Name) receives official statement from my insurance detailing my financial obligations. I WILL NOT RECEIVE A BILL BEFORE MY CARD IS CHARGED. However, I will expect a bill via mail for additional charges only if my uncovered balance exceeds $ This authorization expires in 90 days.”

Sample Estimate Worksheet Patient Name: _______________________ Service Date: _____________________ Account #: _______________________ Policy #: __________________________ Insurance Company: ______________________________________ Deductible: $xxxx.xx / $xxxx.xx Deductible Met: $xxxx.xx / $xxxx.xx Out of Pocket Max: $xxxx.xx / $xxxx.xx Co-Pay: $xxx.xx Co-Insurance: xxx.xx% Total Estimated Charges: $_____________ Co-Pay: Co-Insurance: Deductible: Total: Total Estimated Patient Amount: Patient Name: _______________________ Service Date: _____________________ Account #: _______________________ Policy #: __________________________ Insurance Company: ______________________________________ Deductible: $xxxx.xx / $xxxx.xx Deductible Met: $xxxx.xx / $xxxx.xx Out of Pocket Max: $xxxx.xx / $xxxx.xx Co-Pay: $xxx.xx Co-Insurance: xxx.xx% Total Estimated Charges: $_____________ Co-Pay: Co-Insurance: Deductible: Total: Total Estimated Patient Amount:

Patient Collections – Final Thoughts  “Take it personal”  Don’t underestimate the difficulty!  Hire for the right strengths  Don’t hang on to small balances  Don’t take too long to send to an agency  Make It Easy to Pay  Web Site Button  Patient Portal  Telephone  Integrated “Swiper”  CCOF  “Take it personal”  Don’t underestimate the difficulty!  Hire for the right strengths  Don’t hang on to small balances  Don’t take too long to send to an agency  Make It Easy to Pay  Web Site Button  Patient Portal  Telephone  Integrated “Swiper”  CCOF

Insurance Collections  Always Work your Task List by Highest $ First  Remember Strengths Based Skills Sets  Complete the tasks and discontinue until (Future follow up needed)  SBOM 2.0  Cleaner Reports and View of Open Tasks  Set a “QA Safety Net Task” for the supervisor – Over 120 Days  Monitor Productivity  Task Values Reports (Value = # of Minutes Required on Average)  Group Problems together by Payer and work en masse  DENIAL MANAGEMENT  Always Work your Task List by Highest $ First  Remember Strengths Based Skills Sets  Complete the tasks and discontinue until (Future follow up needed)  SBOM 2.0  Cleaner Reports and View of Open Tasks  Set a “QA Safety Net Task” for the supervisor – Over 120 Days  Monitor Productivity  Task Values Reports (Value = # of Minutes Required on Average)  Group Problems together by Payer and work en masse  DENIAL MANAGEMENT

Denial Management  TOP 3 Report each month (within your control)  Problem Solving Procedures  Brainstorming  Ask the 5 Why’s  Lean Six Sigma  Implement Procedure Improvements  Increase Claim Edits  Perform Quality Assurance!!!  TOP 3 Report each month (within your control)  Problem Solving Procedures  Brainstorming  Ask the 5 Why’s  Lean Six Sigma  Implement Procedure Improvements  Increase Claim Edits  Perform Quality Assurance!!!

Government Collections  Bill it Right the first time.

Staff Efficiencies  Prepare as much in advance of the appointment as possible!  Simplify  Demographics / Registration Forms (1 signature)  Strengths Based  Track it! (Accountability)  Significant Events Reports (Excel Pivot Tables and Countifs)  Automate, Automate, Automate  Prepare as much in advance of the appointment as possible!  Simplify  Demographics / Registration Forms (1 signature)  Strengths Based  Track it! (Accountability)  Significant Events Reports (Excel Pivot Tables and Countifs)  Automate, Automate, Automate