optimizing pre-service collections presented by michelle tremé
TRANSCRIPT
Optimizing Pre-Service Collections
Presented by Michelle Tremé
Pre-service Collections Improve Patient Satisfaction and Overall Financial Health
• Patients appreciate knowing their estimated cost of services in advance so they can focus on their health.
• Reduces bad debt, because patients are more likely to make better financial decisions when they can plan for the expense before they actually incur it.
• Cuts down on the billing resources hospitals use to collect after services are rendered.
• Patients who are unable to pay can be identified early in the account cycle, allowing time to meet with a financial counselor.
• No surprises about the cost of services enables patients to make more informed choices; like possibly defer non-urgent services, or decide a non-urgent service is cost prohibitive and explore alternatives with their physician.
“More than 8 in 10 Americans report that upfront cost estimates would have a positive impact on their decision to
continue using a provider.”
0306090 62%
25%
71%
8%
United StatesWest Virginia
Source: TransUnion Healthcare “New findings on consumers’ views of billing experiences and what they mean for you”
Outside Forces Affecting Hospital Revenue Cycles in the Near Future
Affordable Care Act
• Higher patient out-of-pocket costs
ICD-10
• Off-set effect of denials and longer A/R cycles by collecting more cash up front
Source: USA Today “Dilemma over Deductibles: Costs Crippling Middle Class”
•A flat dollar amount paid for a medical service by an insured.
Co-Pay
•The amount owed for covered health care services before the health plan begins to pay.
Deductible
•The insured’s percentage share of the allowed amount, after the insurance policy’s deductible is met, and up to the policy’s stop loss.
Co-Insurance
Common Excuses for Not Collecting…
• “Staff doesn’t have time”• “Staff has trouble reading benefits from the 271”• “Not sure what portion of the benefits may have
been met already”• “Cannot collect co-insurance because we don’t
know our contract rates with payers”• “The staff is not comfortable asking for money”• “Our patients wouldn’t pay anyways”
Financial Clearance Policy Collection Tools
Training Reports and Monitoring
Tips for Success
Financial Clearance Policy
Discounts, Deposits, and Payment Plans
Scheduling
Pre-Registration / Registration
Financial Counseling
Implementation
Discounts, Deposits, and Payment Plans
• Do you offer Self-pay discounts?
• Do you offer Prompt pay discounts?
• What is an acceptable deposit amount for a high dollar estimate?
• What are your Payment Plan guidelines?
Scheduling
• How far in advance do you want to schedule non-urgent services? – Pre-Authorizations
• High Dollar• Time Consuming
– Add-On Volumes• Add-ons under 48 hours prior to service cause…
- Less time to determine benefits- Less time to contact the patient to collect
Scheduling
• How should a Scheduler handle non-urgent underinsured and self-pay patients? – Require clearance from financial counselor– Check propensity to pay
Scheduling• Will a non-urgent service be scheduled if the
patient cannot meet their financial responsibilities?
53%47%
Hospitals that Re-Schedule Non-Urgent Services Without Payment
Arrangements
NOYES
Source: The Academy of Healthcare Review “Patient Access Benchmarks”
Scheduling
• What information is required to be collected at the point of scheduling?– Demographics– Insurance and coordination of benefits– Procedure codes and diagnosis codes– Pre-authorization information
Pre-Registration / RegistrationDays Out• How far in advance of the date of service should
pre-registration occur? – Average = 5.3 days– Monitor and control daily add-ons to increase pre-
registration days out
Pre-Registration / RegistrationInsurance Verification• Expectations for verifying insurance eligibility and
benefits?– Verify benefits for ALL payers? Or, just eligibility in
certain instances?• Medicare• Medicaid
– What tools are used to verify benefits?• Integrated Verification Tool• Payer Websites• Phone
Pre-Registration / RegistrationEstimates• How are estimates calculated?
– Methods– Tools– Discounts
• Will you collect estimates over the phone during pre-registration? Or, prompt the patient to bring the payment at the time of service? – 73% of surveyed hospitals attempt to collect estimates
during pre-registration (Healthcare Business Insights: “Best Practices in Patient Collections”)
– Conveying estimates prior to the date of service informs the patient and allows multiple opportunities to collect.
Pre-Registration / RegistrationPayments
• Will partial payments be accepted?
• Will staff attempt to collect outstanding balances on prior services?
• Can registrars set up payment plans?
“Yes” to all of the above allows opportunities to increase collections, reduce A/R, and prevent bad debt.
Pre-Registration / Registration
Medicare• Medicare Secondary Payer and other dual eligibles?
– Not beneficial to collect up front from patients with more than one active coverage.
• What is the process for when Medical Necessity fails and an Advanced Beneficiary Notice is issued? – Prompt the patient for payment– Refer to financial counselor
Financial Counseling
• Under what circumstances should a financial counselor be contacted? Who should contact them? And when? – Financial Counselors should be contacted by staff as soon as the
need is identified.– Patients that are given instructions to call the financial counselor
often times never call.
• Should the Financial Counselor collect payments due from non-urgent financially capable uninsured and underinsured prior to clearing the patient to be scheduled?– Yes. Follow organization’s outlined procedures regarding
discounts, deposits, and payment arrangements.
Financial Counseling
• Financial Counselor Assistance– Healthcare Exchanges / Affordable Care Act – Medicaid Eligibility / Presumptive Medicaid
screening– Charity Care– Patient Friendly Loan Programs – Payment Plans
Financial Clearance Policy Implementation
• Administration Approval– Critical that pre-service collections is part of a
formal hospital policy– Support of the policy from the board, CFO, and
other leadership impresses the importance of the process to staff across all departments in the organization.
– Policy enforcement is important, even if a patient complains.
Financial Clearance Policy Implementation
Communication! Remember that a pre-service collection policy may be a culture change for the hospital staff, as well as patients. It may take a little time, but the culture will start to shift. Patients will expect to pay in advance, and many will actually embrace it.
Financial Clearance Policy Implementation
• Communicate the Policy– Patient Access Staff
• E-mail updates• Regular staff meetings• Periodic Training• Performance expectations and goals• Request Feedback
Financial Clearance Policy Implementation
• Communicate the Policy– Hospital Departments and Physician’s Offices
• Gain support by explaining how up front collections effects the entire revenue cycle and benefits the whole organization.
• Both areas can be very helpful with setting expectations for patients to be asked for payments before services are rendered.
• Coordination between supervisors and departments can quickly identify process breakdowns.
Financial Clearance Policy Implementation
• Communicate the Policy– Public
• Newspapers, hospital website, signage, and brochures
• Include acceptable forms of payment• Consider sending letters or e-mails to pre-
registered patients informing them of their estimate and payment options
Tools for Collecting
Benefit Verification
Price Estimation
Payment Processing
Kiosks
Tools for Collecting
Integrated Eligibility Tools
Accurate benefit verification of most common payers
Response time under 30 seconds
Easy process flow when integrated in registration pathways
Allows for a seamless flow of information into a price estimator
Payer Websites
Good for payers that cannot be accessed by the integrated verification tool
Serves as a back up if integrated system is experiencing problems
Supervisors should maintain logins for everyone that verifies insurance. Be sure to terminate the login when employment ends.
Phone Not the ideal method to verify benefits, but serves as a good back up
Keep a list of payer’s current phone numbers stored in a shared document that can be easily accessed
Benefit Verification
Tools for CollectingPrice Estimation Software
Easily calculate estimates for co-pays, deductibles, and co-insurance
Loaded with data files of organization’s CDM and payer contracts.
Data feeds from your registration software enables the automatic flow of information into the estimate, like demographics and insurance information; as well as benefit information like co-pays, co-insurance, and any remaining deductible and Out of Pocket amounts.
Provides a summary letter of the estimate that can be printed or e-mailed to the patient.
Tools for CollectingWeb-based Payment Processing / E-cashiering
Easy for Pre-registration staff to take payments by phone
Possible for patients can make payments online
Receipts can be e-mailed or printed at the time of payment
Integrated payment platforms allow patient payments to be linked to registration and accounting mechanisms; therefore payments can be posted immediately.
Tools for CollectingKiosks
Increases collections by requesting and accepting payments
Offers the option for patients to pay outstanding balances
Reduces wait times and speeds up the check-in process
Patient forms are signed electronically
Training• Educate staff about the importance of pre-service and point of
service collections as it relates to the financial health of the organization.
• Financial Clearance Policy training.
• Test staff knowledge on how to read and interpret eligibility responses.
• Customer service skills.
• Note everything! “If it’s not documented, it didn’t happen!”
Training• Make sure collectors have a thorough understanding
of key terms, including: contract rate, in-network, out-of-network, co-pay, deductible, co-insurance, and out-of-pocket.– Increases confidence, thereby making it easier to
collect.– Test staff by calculating estimates manually.
Sample Estimate
Sample SolutionAllowable Amount $2000 – Deductible $500 = $1500
$1500 x Co-Insurance Rate 20% = $300
Remaining Deductible $500 + Co-Insurance $300 = $800
Prompt Pay Discount = $800 x 10% = $80
$800 - $80 = $720
Patient Responsibility = $720.00
TrainingScripts
• Create a flow chart for staff to follow when attempting to collect that includes different scenarios.
• Be sure to over-emphasize the word “ESTIMATE” during training. Never use words like “quote.”
• Teach staff to use a disclaimer, “Your Estimate is based on hospital charges for the scheduled procedure. You may be billed for any other charges that apply.”
• Provide scripting to all staff that interacts with patients on how to respond to questions or complaints about pre-service collections.
TrainingScripts• Use phrases that encourage the patient to make a payment.
– “Based on your insurance coverage and the scheduled procedure, your estimated amount due is $200.00. We accept Visa, MasterCard, Discover, and electronic check payments. How would you like to take care of that today?” Opposed to, “Would you like to pay today?”
– “Since you will not be paying over the phone today, how will you be paying at the time of service?”
– “Since you cannot pay your estimated amount due, how much can you pay today?”
– “It is now our hospital’s policy to collect estimated amounts due prior to the time of service. It helps us better serve our patients by informing them of their estimated responsibility, and it cuts down on our billing costs.”
– Do not communicate a minimum amount due until you have exhausted other options.
TrainingScripts• Role Play
– Role Play with different scenarios until staff feels comfortable with scripting. Let staff members challenge each other.
– Meet with staff regularly, and openly engage them to share scripting ideas based on their interactions with patients.
– Include scripting in new-hire training.
Reporting and Monitoring
• Continuous reporting and monitoring on a monthly, weekly, and even daily basis is key to success.
• Share reports with your staff regularly to show them you are paying attention, and convey the significance of what you’re monitoring.
Reporting and Monitoring
• Set performance goals that are measurable and attainable. Base goals on industry and organizational benchmarks.– Amount Collected vs. Amount Available to Collect for each
registrar– Number of accounts with available collections vs. number of
accounts collected– Pre-Service Collections vs. Point of Service Collections– Pre-Registration Days Out, track and trend over time.– Add-ons per day– Insurance Verification Rate = Registrations with Insurance
Verified / Total Registrations– Pre-Registration Rate = Total Pre-Registrations / Total Scheduled – POS Collections as a Percentage of Net Revenue
Pre-Service Collections Vs. Point of Service Collections
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
Time of Service Col-lections
Advanced Collec-tions
Scheduling Trends / Add-On Volume Tracking
39853
39881
39912
39942
39973
40003
40034
40065
40095
40126
40156
40188
0
200
400
600
800
1000
1200
1400
1600
1800
Stat Add-Ons(24 to 48 hours)
Add-ons
Transactions on Initial Schedule
Reporting and Monitoring• Incentives
– Recognition, gift cards, free lunch– Consider incentives for meeting goals, and higher
incentives for surpassing goals– Apply a team incentive approach which encourages
individual participation– Share performance scores to create friendly competition– Realize that goals must be adapted for each area or shift– Ask for feedback about which incentives are most
encouraging
Tips for Success
• Accountability - Hold supervisors accountable for their staff’s performance, as well as the individual staff members. It helps create a culture of high performance standards.
• Standardize collection efforts across all of your organization’s sites to ensure patients are provided with a consistent experience.
• Handling staff members that are resistant to performing pre-service collections because they feel uncomfortable:– Let them know collecting is a requirement of their job. Update the
job description if collecting is not already included.– Staff should sign off that they have been made aware of any new
policies, processes, or procedures.– Offer more training and practice sessions.
Tips for Success
• Don’t get caught up exceptions!
– Pre-service collections should not be an “all or nothing” strategy.
– If your organization is not able to call to pre-register and collect estimates from all scheduled patients due to staffing issues, consider prioritizing patients scheduled for high dollar services.