1. Best Practices: POS Collections
Presented by: Reid Mellott and Brandon Childs

2. Overview
Industry Statistics and Trends
Upfront Collection Facts
Compliance Issues
POS Collection Technology
Opportunity Areas
Success Factors
Scripting

3. Current Trends
The 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 practices
Maximizing point of service collections rank in top 10 CFO priorities
– Advisory Board Company 2011
Result: 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)

4. Growth of HSA / HDHP Enrollment
Source: AHIP Center for Policy Research, June, 2011

5. Population Trends Self Pay is the fastest growing payer class
50+ million Adult Americans are uninsured (18.7% )
25 million Adult Americans are underinsured
75 million working-age adults uninsured or underinsured
Fastest growing group of uninsured aged 25 – 34 with income > $70K
Figures increase significantly when including children or undocumented individuals
Employer-based health coverage continues to decrease
2008
2009
2010
2011
49.2%
46.8%
45.8%
45.0%

6. Unemployment and the Uninsured impact* *
*1% increase results in 1M new Medicaid/CHIP enrollees and 1.1M uninsured
Bureau of Labor and Statistics and the Kaiser Family Foundation

7. Increasing patient out-of-pocket
Percentage of Covered Workers Enrolled in a Plan with a General Annual Deductible of $1,000 or More for Single Coverage
Note: These estimates include workers enrolled in HDHP/SO and other plan types. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits,

8. Increasing PO$ Collections: Why the Focus?
Significantly improve the bottom line of your organization through:
Reduce cost to collect
Reduce uncompensated care
Reduce self-pay receivables
Increase overall cash flow
Improve patient satisfaction
Reduce call volumes
Reduce patient confusion about their bills

9. PO$ Collection Facts
Cost to collect is typically reported between 2-3% of revenue
Front-end processes are important … due to increase in patient out-of-pocket
Post discharge, cost to collect increases, likelihood of collection decreases
Educating the patient of their financial obligation in advance improves patient satisfaction

10. Example Medium size hospital Radiology department with 5,000 visits
Average liability $389
Potential to collect $1,945,000
Result: Without collecting at POS,
the hospital can typically lose up to 60%
of the potential amount, or $1,167,000

11. PO$ Collections – Best Practices, is this possible?
Outpatient
Inpatient
Surgery ED
(not admitted)
Total
Annual
Monthly
Total Annual Visits
52,200
4,500
13,800
27,000
97,500
% Commercial Visits
31%
Annual Commercial Visits
16,182
1,395
4,278
8,370
30,225
Average Patient Responsibility
$169.00
$1,225.00
$798.00
$122.00
Total Collection Opportunity at POS
$2,734,758
$1,708,875
3,413,844
$1,021,140
$8,878,617
$739,885
Annual Net Patient Revenue
$57,015,738
Current Annual Collections at POS
$480,000
Current Monthly Collections at POS
$40,000
Current Collections as % of Net Patient Revenue
0.84%
Current Collections as % of Total Collection Opportunity 5%
HFMA Best Practice 2-3% of Net Patient Revenue
Best Practice Monthly Collections at POS
Current Monthly Collections
Monthly Increase from Current
Annual Increase from Current
% Total Opportunity
POS Collections at 1%
47,513
7,513
$90,156
POS Collections at 2%
$95,026
55,026
$660,312
11%
POS Collections at 3%
$142,539
102,539
$1,230,468
16%

12. Compliance
EMTALA
Medical Necessity
ABN
HIPAA
Compliance Hurdles

13. Potential compliance risks while engaging in financial activity
HIPAA
Health Insurance Portability and Accountability Act
Disclosure of information must be limited to the minimum necessary for the purpose of the disclosure
PO$ IMPACT
Potential compliance risks while engaging in financial activity

14. EMTALA 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$ Impact
Collection activity ONLY AFTER medical screening
examination and stabilization

15. Potential patient liability if not medically necessary
Medical Necessity
Social 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 supplier
Within generally accepted professional medical standards (not exploratory or investigational)
PO$ Impact
Potential patient liability if not medically necessary

16. ABN / Notice of Non-Coverage
Advance Beneficiary Notices or Notice of Non-Coverage
Before services are provided
Medicare/select commercial payers will not pay for some or all of the services because they may not be reasonable and medically necessary
Patient/representative must be informed of non-coverage and liability in the event Medicare does not pay
PO$ Impact
Potential patient liability

17. Collection Technology
Detailed eligibility – 271 data is not enough
Medical necessity verification
ABN notification
Financial responsibility estimator
On-line payments
Integrated credit card authorization system
ATM accessibility
Propensity to pay score
Scripting

18. Collection Readiness Training Scripting Policies and procedures
Set expectations and accountability
Communicate goals and expectations
Measure potential vs. actual cash
Develop incentive plan

19. PO$ Collections Opportunity Areas
Registration/ED
Pre-registration
Scheduling
In-house/
Discharge
Other ancillary departments

20. Scheduling / Pre – Registration / Registration
Potentially the first point of contact with the patient!
Verify eligibility
Consistent pre-registration process
Obtain benefits (coverage, co-pay, co-insurance and/or deductible, YTD accumulators)
Inform patient of liability in advance
Offer debit/credit card payment option

21. Financial Counseling
Plays key role in protecting the hospital’s cash flow and exposure to bad debt and collection expense
Medical assistance screening
Alternative state funding application process
Charity care screening
Credit scoring (propensity to pay)
Establish financial arrangements

22. In House / Discharge
Make in-house visits to patient rooms for third party coverage, collect patient financial responsibility, and/or payment arrangements
Implement financially focused discharge control process for all point-of-service areas
Ensure every account is financially evaluated prior to discharge

23. Success Factors Hospital PO$ collections policy
Financially focused Patient Access Department
Financial Counseling best practices
Medicaid eligibility vendor
Physician and physician office manager education
Staff education and incentive program
Consistency in front end process

24. Key Contributors to Success
Senior Management buy in; CEO, CFO, CNO
CIO supporting integration of technology
Physician communication
Clearly defined policies and expectations
Training program
Consumer education and satisfaction
Establish goals and measure performance

25. Best Performers – Hospital wide
CFO/CEO communicates organizational efforts to hospital directors
CNO adopts organizational efforts and level set clinical depts
CIO provides access to currently technology and provides resources to implement
HR incorporates cash collection responsibilities in job description
Patient Access documents Policies and Procedures
Scripting and role playing
Discuss and publish goals and expectations
Track and publish actual vs goals

26. Best Performers – Non ER
Relationship with physician community
Provides specific information at scheduling
Provides insurance information at scheduling
Provides maternity list
Strong Preadmission dept
Insurance eligibility
Medical necessity evaluation
Generates patient liability
Access to propensity to pay data
Access to prior balances
Communicates and collects patient liabilities

27. Best Performers – Non ER cont.
Strong Financial Counselor dept
Evaluates ER admits, direct admits and transfers
Established relationship with case management
Generates and communicates patient estimates
Access to prior balances
Access to propensity to pay information
Access to financial assistance resources
Established prompt payment guidelines
Established uninsured discounting
Decentralized dept adopt and implement existing polices and procedures

28. Best Performers - ER ER:
Clear and timely communication of MSE completed
Clinical team assisting with acuity level
Financial Counselors and Discharge Process
Calculate and collect patient liabilities
Insurance letters with self addressed envelopes
Established prompt payment and uninsured programs

29. Tips to Motivate Payment
Use
Here are some options for you…
Did you know you could
May I suggest…
We have always encouraged
Avoid
I want you to…
I need…
We require…
Our policy states

30. Overcoming 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?

31. Overcoming 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?

32. Overcoming 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.

33. Overcoming 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.

34. Overcoming 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 Response
We’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?

35. Overcoming 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.

36. Overcoming 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.”

37. Overcoming 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 _____.

38. For additional information regarding
Who to Contact:
For additional information regarding
today’s presentation please contact
Terry Truman