2. © 2015 TriZetto Corporation 2 Managing Patient Debt: Minimizing the Cost of Collections Pete Bekas TriZetto Provider Solutions ®

3. © 2015 TriZetto Corporation Agenda 3 Shift in healthcare landscape What is causing the rise in bad debt Steps to manage patient debt Patient Demographics Eligibility Patient Estimation Statements Payment Options

4. © 2015 TriZetto Corporation High Deductible Benefit Plans on the Rise Source: PwC Health Research Institute, Medical cost trend: Behind the numbers 2015, June 2014, based on PwC 2014 Touchstone Survey 4

5. © 2015 TriZetto Corporation Out of Pocket Max 5 Family $10,000+ HDHP Single $3,000-$4,000 HDHP

6. © 2015 TriZetto Corporation The Process Setting Expectations POS Collections Demographics Address and contact information Insurance Verification Updated Insurance Information Patient Estimation How Accurate do you need to be Post Service Items Print and Mail or e-Statements Follow Up Visits 6 Patient Estimation Tips & Tricks Demographics Expectations Insurance Verification Follow-ups Overview Post Service

7. © 2015 TriZetto Corporation Setting Expectations The best way to lower patient debt, is to collect at point of service (POS) Define policies about POS Collections and communicate with patients Confirm that patients know they will be expected to pay at time of service If unable to pay in full, setup a flexible payment arrangement. 7 Patient Estimation Tips & Tricks Demographics Expectations Insurance Verification Follow-ups Overview Post Service

8. © 2015 TriZetto Corporation Demographics Incorrect patient demographics can lead to a denial Verify Address and Insurance New Year, could be a new insurance plan Confirm correct address to reduce mailing statements to the wrong address Collect email for e-statement if it is an option 8 Patient Estimation Tips & Tricks Demographics Expectations Insurance Verification Follow-ups Overview Post Service

9. © 2015 TriZetto Corporation Insurance Verification 22% of denials are related to Eligibility & COB Run an eligibility request (270/271) to verify the patient has active coverage Correct order when there is a secondary insurance Obtain deductible & Out of Pocket Max Service type code can impact benefit level details 9 Patient Estimation Tips & Tricks Demographics Expectations Insurance Verification Follow-ups Overview Post Service

10. © 2015 TriZetto Corporation Patient Estimation 10 Patient Estimation Tips & Tricks Demographics Expectations Insurance Verification Follow-ups Overview Post Service Use Insurance eligibility details Covered or not Deductible, family deductible, stop loss Service type Fee Schedule Type of Payer Commercial: PPO, HMO, POS Location: Facility or Non-facility Pricing Rules Mid Levels Modifiers and multi reductions

11. © 2015 TriZetto Corporation Patient Estimation 11 Patient Estimation Tips & Tricks Demographics Expectations Insurance Verification Follow-ups Overview Post Service Create an Invoice/Estimate of Responsible Patient information Charges by code Payer expected allowed amount Deductible & co-pay amount Balance Due Estimate disclaimer

12. © 2015 TriZetto Corporation Patient Estimation – Collections Collect estimate of balance Cash, Check or Card Health Savings Account (HSA) Flexible Spending Account (FSA) 12 Patient Estimation Tips & Tricks Demographics Expectations Insurance Verification Follow-ups Overview Post Service

13. © 2015 TriZetto Corporation Post Service Mail Statements within seven days of receiving Remit (835), if available enroll patients for e-statements to save on postage Average 3.3 statements before paid in full ~ $0.75 per statement Enable e-pay options for cash acceleration Accept credit and debit cards along with ACH Card on File Notify patients of outstanding balances and charge the card after seven days 13 Patient Estimation Tips & Tricks Demographics Expectations Insurance Verification Follow-ups Overview Post Service

14. © 2015 TriZetto Corporation Follow-up Visits Remind the patient of any outstanding balance at check in Ask for balance on any past visits Collect any payment you can $15.77 of every $100 of balance once balance moves to bad debt High balance accounts Setup payment arrangement for six months Greater than six months, refer to outside financing companies 14 Patient Estimation Tips & Tricks Demographics Expectations Insurance Verification Follow-ups Overview Post Service

15. © 2015 TriZetto Corporation Tips & Tricks What Works for Other Practices Give patients a wide variety of options for paying their bills. Be sure to accept cash, checks, credit cards and debit cards. Give patients the opportunity to pay any portion of their balance at any time. Encourage patients to pay past account balances and current charges at time of service Educate patients their on financial responsibility Train all staff ask how to pay. Create a fair patient financial responsibility policy. Let patients in financial difficulty design the terms of a payment plan Communicate, communicate, communicate Consider special programs for communicating with long- established patients who are not accustomed to the new financial policies Say “please.” 15

16. © 2015 TriZetto Corporation 16 Pete Bekas TriZetto Provider Solutions Peter.Bekas@trizetto.com www.TriZettoProvider.com

17. © 2015 TriZetto Corporation 17 Thank You