1. POS Collections: Be a Winner!
May 8, 2015
Getting your wallet-share
Katherine Murphy, CHAM – Vice President, Sales Consulting Experian/Passport Health

2. Healthcare Collection Statistics
Average Recovery Rates
Hospitals – 15.3 percent. (Source: ACA International’s Top Collection Markets Survey*, Jan. 1 – Dec. 31, 2013.)
Non-hospitals – 21.8 percent. (Source: ACA International’s Top Collection Markets Survey, Jan. 1 – Dec. 31, 2013.)

3. Uncollectible write-offs swelled in Midwest hospitals past the benchmark in second quarter 2014.
U.S. hospitals reported that 5.93 percent of their total second quarter 2014 gross revenue was written off as charity care or bad debt, compared to 5.09 percent in the first quarter of 2014.
Of the 5.93 percent written off as uncollectible, 3.03 percent was for bad debt and 2.90 percent was for charity care expenses.
Midwest hospitals reported the highest level of uncollectible write-offs by region, at percent of total gross revenue, or more than double the 4.73 percent of total gross revenue written off as uncollectible in the first quarter.
(Source: The Hospital Accounts Report Analysis on Second Quarter 2014.)

4. Concepts for Optimization Technology - Automation Skills / Be a Winner
Points of Discussion
40 yr History – Collection
Today’s Reality
Concepts for Optimization
Technology - Automation
Skills / Be a Winner

5. 40 years of Collecting

6. Healthcare 1974

7. Collecting Money - not offensive
(unless you’ve trained your patients & staff to think so)
Grocery stores collect before you consume the items
Painter – 50% down before work is started
Physician – copay at check-in
Down Payments
Layaway - Time Payments
Catalogue orders/online orders
Restaurants: Pay preservice, discharge, tips….gratuities

8. 1974 – 276 beds, 350 opt visits daily – advance pay
Bill Medicare & Medicaid
Bill Commercial Insurance if > $250.00
Collect from all Commercial & Self Pay Pts
Lab CBC $10.50
Chest X-Ray $25.00
Semi-private Rm $59.50
Sent home for check book
Sent back to car for wallet in glove compartment
Average daily outpt collections $1200 ($36,000 mo)

9. Point of service Bill used to enter charges/orders Transparency & to Collect 1983-1999
9/20/2018

10. 9/20/2018

11. Today’s Reality

12. Sounds like It will be a good thing
I Understand HIX patients will have Affordable care
It seems like it will make things easier?
I think there is a misunderstanding about what covered services means
Sounds like It will be a good thing
Access
9/20/2018

13. ACA impact on out of pocket expenses “How about a little fire, Scarecrow?” -Wicked Witch of the West, Wizard of Oz
Average individual deductible for exchange plans (2014)
$4,800
Average family deductible for exchange plans (2014)
$7,770

14. Time to Tackle the growing challenge: Balance After Insurance (BAI)
Newly insured will have large deductibles that require collections
Patients pay twice as slowly as commercial payers
The shift requires new, cost-effective collection methodologies
Healthcare providers will see an increase in the cost to collect as collecting from patients is significantly more expensive than commercial collections or charity management programs

15. If only casino Transparency Innovation Could have Engaged me last night…
How much will this engaging night cost me?
Do I qualify for Wisconsin AAHAM Financial Assistance?

16. Wanted 2015: The Perfect world of patient payments
Electronic order created
Physician/office schedules a procedure on behalf of patient
Verify eligibility immediately, med nec, precert completed
Determine price of the procedure & patient liability
Financial Assistance Screening completed
Receive payment or create payment plan / across enterprise
Patient receives service
Children across the world are fed

17. There is peace in the valley

18. Healthcare 2012, 13, 14, 15, 16, 17…

19. Importance of Patient Payments – Nothing’s Changed!?
POS collections opportunity is approx 1.5% of total gross revenue (HFMA/BridgeFront Healthcare Learning, 2008)
2015 – ideal 2-3% of Net Rev (Access Keys realistic: 1-2%)
Bad debt and charity care costs hospitals more than $45.9B or 6.1 % of expenses in (AHA, 2014)
AHA -
Hospitals and physicians can expect to retrieve only half a patient’s balance after discharge, and only 10 to 20% from uninsured patients (McKinsey & Company, 2005)
2015 – Not much changed except Provider more likely to collect in full up front Physicians providing less charity options and hospitals providing more
The Patient Protection and Accountable Care Act – does not fix everything
High deductible vs. Catastrophic benefit / 501r Requirements

20. The real, Real World
Patient Schedules visit, walks in, or arrives unexpectedly
Patient gives insurance information or has no insurance or is deliquent on premium
Calculate estimated payment due by hand/mind/calculator or cheatsheet
Guesstimate given to patient (or worse, NO estimate)
Treatment received
Bill patient
Receive phone call or visit from irate patient because of unexpected size of the bill
Agree to smaller fee because you are losing money by being on the phone or dealing with this patient or your guesstimate was off
Receive payment of lesser amount or send to collection in 12 wks, mos, yrs. 

21. How do we increase POS Collection?
Provide Transparency Ask for the money!
Pre Service or
Point of Service,
Discharge, or
in between.
They told me to avoid stress so I’m not opening my bill

22. But is that all? No. Providers need Financial Assistance screening and application tools, BAD DEBT & Denial PREVENTION TOOLS What is the problem?

23. Price Guesstimation
Customer Service Desk

24. More… Charity Mission / Tax-exempt Status IRS Form 990H
ACA Section 9007 / IRC 501 (r)
Identify charity at POS, match insurance charges, community needs assessment
Aggressive Collections = No no…
Compassion, Respect, Effectiveness
Rising Bad Debt
Survey: 23% of hospitals reported bad debt of 5.1 – 10% in 2010

25. Collections
is a dirty word - Every time I hear it, I wash my mouth out with chocolate
Over the years We have trained our patients well by waffling between – collect, don’t collect, collect. Worrying about market share, customer satisfaction in regard to upfront collection and lack of automation. Now we have patients and staff who are trained to behave one way and now have to do a complete reverse! The good news is that the automation needed for the solution is available. But there are a host of other things that play into the initiative too!

26. Collection Optimization Collection Optimization It’s More Than Just Asking….
Collecting the maximum amount…
while minimizing operational costs…
and maximizing revenue & patient satisfaction.
At Pre, Point and Post Service opportunities

27. Size Doesn’t Matter, Process Does
600 Bed Acute Care
1 Clinic 0r 100 Clinics
Rehab Facility
Critical Access Hospital
PROCESS:
Establish Goals and policies
Create standards for consistent staff expectations
Communicate your practices – internally/externally
Ask for MONEY! Yes, ASK!
As the Manager, show you can take a payment
Make it easy for staff to perform the job
Provide feedback and reward performance

28. Issues with asking for the money
When do we ask?
Staff not adequately trained
Staff uncomfortable due to lack of information
Even if the staff asks, is it the right amount?
How easy is it to take a payment or set up a payment plan?
Patient unwilling/able to pay at that moment
Can we consistently provide accurate consumer friendly pricing transparency information?
Does patient have the financial means to pay (& how much?)
Procedure Cost vs Charge (amt. of effort to collect)
You must have a plan!!!!

29. Strategy Challenges Lack of information - uncomfortable asking for it.
Pre/Point of Service is also the Point of Stress or Point of Crisis for the patient. Is there a better time to ask for the money in some cases?
Request full payment: Online Payment, Mobile, Kiosk
Engagement
Knowing when to Negotiate! ($100, 50 ok I’ll take $20)
“ I gave the doctor my money.”
“I always wait for my bill after my insurance pays”
Decentralized processes: Inconsistent or no collection practices

30. Make The Best Payment Promise
Providers must…
Staff knows who is in front of them.
Have the correct insurance and benefit information.
Consistently and quickly provide pricing transparency
Determine/Enroll Pt. for Fin. Asst. or HIX before rendering service.
Extend hospital charity to those who qualify.
Securely accept payment upfront
Extend payment terms & fundraising options earlier in process
Every patient leaves knowing what they owe and how their services will be paid for! Excellence in Patient Financial Triage.
9/20/2018

31. Kiosk and Mobile Applications
Patient bill presentment and payment
• Surveys
• Patient wait times
• ADA Compliant
Indoor Wayfinding - Triangulate Location
Find Doctors, Labs & Clinics
In App Messaging & Surveys
Track Parking Location
Patient
Allows the patient to navigate from their home or car to the closest parking lot and then to the closest entrance and then to the room or area of their choice. The mobile app also enables the patient to receive turn by turn directions inside of the building while triangulating the position of their mobile device. Overall this will enhance the user experience with the Health Care Facility.
Additionally the patient could find a doctor lab or clinic and if offsite could receive turn by turn directions. If the user is at the Kiosk they then could print out directions to the lab or imaging area and use those as a way to help them navigate throughout the Health Care Facility. The financial benefit to the Health Care Facility could be substantial

32. STATEMENTS

33. Challenging – Under the Gun to meet additional expectations
Hospital and doctors are separate entities with their own bank accounts
Hospital and doctor billing files are separate
Billing limitations to combine families accounts
Patient statements only sent 1x per month
Meet regulatory requirements for charity care

34. Patient Friendly Statements
Hospital and physician accounts can be consolidated into a single statement

35. Smart Statement with Custom Note & Hospital Services

36. Financial Assistance Applications

37. Optimizing Collection Begins at the very Beginning!
Key Components: (A-U-T-O-M-A-T-I-O-N)
1. Screen: who should not be targeted for collections. Screen for bankruptcy, deceased, Medicaid & Commercial eligibility and charity eligibility.
2. Segment: to prioritize inventory and produce optimal collection and treatment strategies.
3. Route: assign accounts to the most appropriate role pre/point/post

38. Optimization
4. Performance Management: Use real-time dashboards and reports to target key performance indicators and benchmarks to support and drive business decisions.
*5. Monitor: Perpetually monitor unpaid accounts for changes in a patient's ability to pay and timely updates to contact information.
6. Collaboration , Consultation and Analytics: identify best practice collection strategies on going, evaluate reports for opportunities and anoint someone to oversee & champion process.

39. POS Collections Benchmarks*
Collection of elective services deposits prior to service (or estimated liability)
100%
Collection of inpatient balances prior to discharge
65%
Collection of outpatient balance prior to service
75%
Collection of ED patient-pay balances prior to departure
50%
Screening of uninsured inpatients and high-balance outpatients for financial assistance
98%
Payment arrangements for non-charity eligible inpatients/high-balance outpatients
Prompt-payment discount
5-20%/65%
*HFMA “The Next Generation of Revenue Cycle Management” 2007

40. Technology: Financial Triage Process
Leverages hospital’s financial assistance policy
Real-time verification/coverage discovery, calculations, & estimates
Identify charity and Medicaid eligibility at POS
Clear, concise, compassionate

41. Data: Propensity-to-Pay
Use available, verifiable information
Determine propensity-to-pay using guarantor’s own information
Discuss payment options at POS

42. THE HOW TO

43. THE PROCESS MUST BE EASY!
Automation
Remove the decision from the staff. Transactions should automatically trigger from a predetermined point in physician office, scheduling or registration
Define the action protocol
Integration
Must fit within your scheduling, hospital registration system and/or Physician/Clinic systems
Must seamlessly feed systems downstream in the strategy
Rules Based Touchless processing
Transactions should trigger based on key criteria pre-determined by management.

44. How rich is the benefit data?
Automation MUST Haves
Give you the information you need
Content – does it contain the information you need?
If you have to login to a web-site for additional information, what have you gained?
Do you learn of secondary or tertiary payers?
Are you provided COB information?
Do you obtain Address Information (patient or payer)
Identify and alert you to incorrect registration/financial data coming from your system
Can you auto-script the corrections real time ?
Share with the other components of your strategy
KEY BENEFIT TO THE STRATEGY!
Data
How rich is the benefit data?

45. So why are we scared giving estimates?
No Name, No Date,
No DOB, Dx?
ST AT WHAT ?
No DX !

46. What’s Really Important is Really Hard!
Estimates! Estimators! Estimatrons!
Identifying the procedure
Updated pricing
Grouped & bundled procedures
Applying the right benefit category
Applying the contractual
Applying provider discounts
Keeping everything updated
Compare prices, liabilities
Be Patient & Access focused
Ability to reconcile and report on estimate discrepancies

47. Cashiering/Portals – What? When? How?
You must make it easy for Customers to pay you!
How easy is it for the registrar/Staff/Customer to make/take a payment or to create a payment plan!
Cashiering program should accept
Cash
Check
eCheck
Piggy Bank
Credit Card
Money orders
On-line payments / mobile app
AND OFFER PAYMENT PLANS

48. Have Payment Options That Span Expectations/ Generations
More patients want to pay their bills online.
Save staff hours and increase patient satisfaction levels with an easy to use Online Bill Pay process.
Enroll patients in your Portal as part of your process
Direct patient to your website for payments
Be certain the Home Page of your website boldly identifies where to Pay Your Patient Balance
Minimized the steps to make online payments easier
Offer more payment options besides cash, check or charge to patients including customized payment plans.
Be sure your process in Patient Access is quick and user friendly.

49. HIX Enrollment

50. Skills / Be A Winner!

51. Success Depends on People
Avoid confrontation
Good communicators
Empathetic
Consciousness/awareness of others
(the gift of emotional intelligence!)
Reward$
I didn’t sign on for this!

52. Role Play Those Common Themes…
Patient does not have any form of payment at POS.
Patient cannot afford to pay, has HDHP – up to 12k
Patient argues that the doctor, ED, said he/she would not have to pay.
Patient does not understand his/her financial responsibilities
Patient states they left their wallet in the car.
Patient - just paid the doctor and can’t pay you.
I never had to pay before

53. Negotiation Skills! Be Confident!
Be sensitive to the situation (emotional intelligence)
Be aware of cultural differences
Be humane, respectful and honest
Determine what leverage you have
Be realistic – understand the strategy and policy

54. Negotiate, Negotiate, NEGOTIATE!!!
($100, 50 ok I’ll take $20)
Listen - Don’t rush to agree
Let the patient talk and give information
Listen - Remember its not You vs the Patient/Family right?
Pay close Attention- Listen
Save your questions until last
If it fails don’t take it personally

55. Why patient Balance Transparency is is topical for Providers!1%
182%
$195B
Patient Collections is
under-invested
Increase in out of pocket
expenditures
Federal spending cuts in
healthcare over next 10 years
In spite of the growing patient collections challenges only 1% of CIO’s indicated that revenue activities were an area of investment in the HIMSS CIO Survey

56. how do you make Success possible?
Rich Benefit data
Contract Data
Financial Triage & PIV
Accurate Data & Denial Prevention
Skills & Patient Satisfaction +
CHANGE
Automated Payment Estimation
Cashiering Tools
Portals
When you have this: Technology!
9/20/2018

57. You Get This….

58. $ It’$ now later than we think $

59. Bronze Medal – you’ve jumped in, committed
Collection of copays – Emergency Room Patients
>50% scheduled patients are preregistered
Collection of deductible or deposit – surgeries (Pre or POS)
JDs revised to include collection
Collection Scripts for staff
Just getting started,1-2 yrs or less
Beginner

60. Silver Medal – you’re humming along, picking the low lying fruit
Collection of copays and deposits – Inpt, Opt, Emerg Rm
>75% scheduled patients are preregistered
Automated Q.A.
Real time integrated automated eligibility
Automated Estimates
Automated performance measures
Staff scripts
Collection of copays, deductibles, deposits – inpt & outpt
Collection by phone for scheduled procedures
Discounts
Updated JD, Collection training
Feedback, incentives/rewards for staff
Have a roadmap to reach a “Gold” standard
July 17, 2014
MSAHAM
COLLECTION

61. Gold Medal – you’re S-L-I-C-K , meeting/exceeding goals
Gold Medal – you’re S-L-I-C-K , meeting/exceeding goals. Patients expect to pay you!
Updated JD - Formal collection / negoitation training
Collection of copays/deposits/ deductibles / F.A. (also in Emerg Rm)
>90% scheduled patients are preregistered
Staff – certified counselor / navigator
Automated Estimates
Provider Discounts / discretionary discounts
Automated integrated eligibility
Automated, Address, Financial Asst. Screening
Established collection goals – incrementally rising
Automated cash collection POS
Automated measures of performance
Pre/POS/ during LOS, Discharge payment plans
Patient Portal – pmts
Ongoing Rev Cycle improvement committee
Staff incentives, feedback & recognition
Collection process runs 24/7

62. Affordable Care?

63. Population Health Management Extreme: Belize Style
“We can buy insurance but it is expensive so I have a personal savings account for that which is important since I have an 8 & 10 year old. But still, I own my house and keep a copy of my papers to prove it. That way I can bring it with me to the hospital to show I have something to offer as payment. You pay for your own pain med so you better be sure you can cover that.”
9/20/2018

64. Population Health Management Belize Style
Q. What if you need heart surgery?
You have to go to Mexico. Belize just did its first heart surgery a few months ago.
Q. What if you break your leg? Do you go to an Emergency Rm?
A broken leg is not an emergency.
Q. OK, What about appendicitis. If you need an appendectomy due to pending rupture how does this work if you have no money?
You have to pay or your family has to come with you and pay.
Q. Well then, if no can pay then what happens? You die?
A. Yeah, something like that.
9/20/2018

65. Health Management Belize Style
Ya, the bottom line is that you must plan and save or borrow from your family. Or you must demonstrate you own a home and can get a 2nd mortgage at 12% interest.
Buying health insurance in too expensive. I have insurance on my car because I drive and I have to have that.
Plan, Save, Live Healthy Lifestyle, Eat Right, Do not allow yourself to be Stressed, be responsible. We expect to do this.
Readmission? We don’t expect to come back. We do what we are told or we will pay or go without.
9/20/2018

66. Are there other answers out there?
My last 2 children were born in England – 1995 & 1997
I was in a ward with many other patients
I didn’t have to pay
A midwife delivered my children
I had a cot-type mattress on a bed with metal slats
I had food if my family brought it to me
I went home the next day but could have stayed as long as I wanted
I survived so I guess it really wasn’t so bad…

67. March 2015 Taxi driver from Egypt:
I can’t believe this country!
Everyone can be well!
When you need medical care you can get it!
“I mean, everyone can. Everyone!
“It is wonderful, don’t you think?”

68. You can do it! Enjoy your collection SUCCESS!

69. Tugs in Use?
IMG_ Shortcut.lnk

70. New Ways of Doing Everything
Meet the RP7!
Using my imagination….
Financial Counseling
Intake Assessment
Discharge
Q & A
Amazing opportunities!

71. Be A
WINNER! .
Questions…