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

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

3. What is the primary responsibility of a medical practice?

4. 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

5. 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

6. 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

7. 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…

8. 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.

9. 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.

10. 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 99213 – 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 99213 – collect at least this amount)  Script your Staff and Role Play  Train your Staff

11. 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

12. Likelihood of collection diminishes rapidly…

13. 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, 2013 - $199 https://store.decisionhealth.com/Product.aspx?ProductCode=TA2445CD  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, 2013 - $199 https://store.decisionhealth.com/Product.aspx?ProductCode=TA2445CD

14. CCOF Sample Agreement “I, ____________________________, AUTHORIZE (Practice Name) TO CHARGE MY CRE3DIT/DEBIT CARD LATER FOR UP TO $250.00 FOR ANY UNPAID PORTIONS OF TODAY’S BILL THAT IS NOT COVERED BY MY INSURANCE. $250.00 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 $250.00. This authorization expires in 90 days.”

15. 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:

16. 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

17. 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

18. 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!!!

19. Government Collections  Bill it Right the first time.

20. 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