upfront collection presentation understanding the reasons for collecting upfront and how to collect...

Upfront Collection Presentation

Understanding the reasons for collecting

upfront and how to collect with confidence.

IntroductionI am here to help each on of you become more comfortable with upfront collections and maximizing your potential.

The Need to ChangeHistorically hospitals have provided

services and asked for payment laterThis has caused the healthcare crisis our

society is facing today

By focusing on upfront collection and accurate account information, we can increase the effectiveness of the hospital’s services and also provide financial stability to the

company. Ensuring that a patient pays their portion for services

rendered at time of service is vital to the financial success of the

organization.

The reason for the changeThe rise in the number of uninsured people, coupled with higher co-payments and deductibles from traditional insurance plans and new health savings accounts, has led to an increase in bad debt for the hospital.

This problem is further complicated by the difficulty many hospitals have in collecting patient fees at time of service. Hospitals often don’t collect payment at time of service for several reasons: Difficulty estimating the bill. The feeling that upfront collection is bad customer

service. Registration Reps are uncomfortable with asking for

money.

Definitions:Co-pay/Co-payment: The amount a subscriber must pay towards the cost of a

particular benefit. Ex. A plan might require a $20 co-payment for each Dr. visit and $100 for each X-ray.

Deductible: The amount of covered medical bills that must be paid by

the insured before the insurance company starts sharing the expenses.

Co-Insurance: The percentage of covered expenses an insured person

shares with the carrier. (i.e. for an 80/20 plan, the health plan members co-insurance is 20%).

Out of Pocket Maximum: The amount of expenses paid by an individual after

which the plan pays 100% for the balance of the calendar year.

Show me the MONEY

It is not as easy as “show me the money” Understanding how to have conversations about money and how to handle patient responses will assist in increasing your collections.

Understanding what payment options to offer the patient

1. Payment in full at time of service. We accept all methods of payment, cash, check, credit, debit.

2. If patient cannot pay in full at time of service, negotiate the payment with the patient. Example if the patient portion is $1000, Obtain a minimum of $500 at time of service and make an arrangement with the patient on when they will pay the balance. Be sure to follow up on this account.

3. The patient states they cannot pay anything today, explain to the patient that payment is expected at time of service, review options 1 and 2 with the patient, if still unable to secure a payment, provide the patient an automatic payment plan arrangement or CSI application.

Make sure to review different payment options offered to help

our patients and help you maximize your collections.

In order for us to successfully obtain payments, we must know what options can we offer.

It’s Math TimePt has United Healthcare insurance. They

have a $1500 ded/$600 has been met, 90/10 coinsurance with and OOP max of $6000. The estimated bill is $12,000, how much do you collect?

1st deduct the $900 remaining deductible from the $12,000. Place this $900 on the side, as the patient will have to meet this portion before the insurance will begin paying, that will leave a balance of $11,100.

2nd calculate 10% of $11,100. When calculating Co-Insurance, please remember to use the contracted rate. If that is not available, it’s appropriate to use ½ the co-insurance amount as an estimate. The answer is $555. This is the patient “coinsurance portion”. The insurance will cover $10,545, the patient is responsible for the balance.

We are not done yet!!!

3rd add the remaining $900 ded to the $555 coinsurance since these two numbers are both patient portions.

The final total is

$1,455 patient portion responsibility

Remember, the insurance and the patient have a contract and the benefits we are quoting is something that they have chosen. It is not the hospital or you that is stating this is what they have to pay, it is their insurance and themselves who have assumed this responsibility.

The calculation

$12000 est bill- $900 rem ded

$11,100 hosp est.

$11,100 hosp estx 5% co

insurance(90/10)$555.00 Pt portion

Patient Portion

$900.00 Rem Ded+$555.00 10% co-

in$1455.00 Total due

Here goes another one…Pt has Blue Cross insurance. They have a $2500 ded/$1300 has been

met,80/20 coinsurance with an OOP max of $6000. The estimated bill is$9,500, how much do you collect?


2nd calculate 20% of $8,300. The answer is $830. This is the patient “coinsurance portion”. The insurance will cover $7,470 the patient is responsible for the balance.


3rd add the remaining $1200 ded to the $830 coinsurance since these two numbers are both patient portions.

The final total is

$2,030 patient portion responsibility

The calculation

$9500 est bill- $1200 rem ded

$8,300 hosp est.

$8,300 hosp estx 10% co

insurance(80/20)$830 Pt portion

Patient Portion

$1200.00 Rem Ded

+$830.00 20% co-in

$2,030.00 Total due

One more for good luck Pt has Beechstreet insurance, they have a $3000 ind ded/$2200 met with a coinsurance 25% and a OOP of $6,000. Patient is an inpatient who also has a $500 copay for inpatient services. The total bill estimate is $21,000, how much do you collect?


2rd deduct the $500 copay as this is a per visit payment for the service type indicated, place this portion on the patient portion side. This leaves a balance of $19,700.

3rd calculate 25% (remember contracted rate) of $19,7000. The answer is $2462.50. This is the patient “coinsurance portion”. The insurance will cover $17,237.50, the patient is responsible for the balance.


4th add the remaining $800 ded to the $2462.50 coinsurance and the $500 copay since these three numbers are patient portions.

The final total is

$3,762.50 patient portion responsibility

The calculation

$21,000 est bill- $800 rem ded- $500 copay

$19,700 hosp est.

$19,700 hosp estx 12.5% co

insurance(75/25)$2,462.50 Pt portion

Patient Portion $800.00 Rem Ded+$500 Copay+$2462.50 25% co-

in$3,762.50 Total due

Four Keys to Unlock Upfront Collections

1. Educating your patient through initial conversation. Many people do not understand their insurance coverage, explaining their benefits will open a trust factor between your patient and yourself. Speaking with confidence will assist the patient to have confidence in you.

2. Cutting through the clutter and immediately providing payment methods will eliminate unnecessary questions and delays. Options have been laid out and the patient will be able to choose the best one for them.

3. Identifying and Managing high risk accounts. Reviewing previous outstanding balances. Having this conversation with the patient will alert them that we are aware of their balances and payment is expected at time of service.

4. Providing the patient with the same collection scripting consistently each time they present themselves for treatment regardless of who registers them will assist the organization in maximizing their collection potential and build confidence with the patient that they are receiving accurate information.

How to overcome the obstacles:

Begin the collection effort with confidence this will impact the end result

Mrs. Smith, I have verified your insurance benefits and you have a $100 copay for today’s visit. Will you be paying by cash, check, Credit or Debit today?

Do not ask yes or no questions, (example: do you want to pay for that today? Can you pay for that today?)

Mrs. Smith was told that the insurance was verified already and given her payment options.

The patient is not with you for very long, but the way you confidently speak to him/her and the way you ask for payment can make the difference in how they will feel about the entire visit.

I have never had to pay before!!!

These situations can be handled with an upbeat and caring attitude. It all depends on your ability to remain calm and confident. This is your chance to educate the patient on the mindset of paying their responsibility at the time of service and not wait. Be compassionate but firm because you still do need to collect payment:

Mr. Fuller, I am sorry that in the past you were led to believe that you did not have to pay. I do know that now we are requiring payment at the time of service. We are able to accept payment in a number of ways and I am sure that one of these methods will be convenient for you. I can also check the balance on your previous account so we can get that outstanding balance taken care of as well. Which method will you like to use to cover your services today, cash, check, Credit or debit card.

Mr. Brown I understand your concern, changes in hospital procedures were needed to contend with rising costs of health care. Paying at time of service is the hospitals policy and will keep you from having an additional bill in the mail later. Which method will you like to use to cover your services today, cash, check, Credit or debit card

I don’t have my purse/wallet, checkbook, credit card, etc

You have the power to solve this problem. The patient has other things on their mind, so if you in a kind and helpful manner, offer a solution, you will probably be met with a favorable response. Remember to treat this patient and every patient with the respect, care and dignity you would give to the most important person in your life. Without our patients, we have NO JOB!!! I would be happy to give you the phone so that you could call

home for the information. I can take credit or debit cards or checks over the phone. Would you like to use my phone, I can step away from my desk if you would like some privacy.

Ms. Phillips how were you going to pay if you did have your purse/wallet? If check: For your convenience, we can now take checks over

the phone. I would be happy to give you the phone so you can call home for the information.

You are more concerned about payment than my care.

You seem more worried about the bill than my care. Ms. Jones, you care is our primary focus. Payment for

the care you are receiving ensures that we can continue to provide the quality treatment you and other patients expect. Would you like to pay by cash, check or credit card?

Send me a Bill Ms. Bhanote it is the hospital’s policy to collect

payment in full at the time of service. How would you like to pay, cash, check or credit card?

Ways to Reduce Bad Debt at Registration Time

Verify address, phone number and employer information on every registration.

Always ask for money up front when payment is due and collect money on every self pay account. If unable to obtain payment in full, attempt to collect a portion of the payment due and discuss other payment options available.

Add any pertinent comment on the account that may help in its collection efforts.

Key Elements to Boost up Front Collections

Start with you:Registration Reps often feel it is wrong to ask the patient for money.

When you feel this way, keep this in mind:Healthcare carries a price and most patients are responsible for a portion of that price.You are not out of line in asking patients to pay their portion due.Your attitude and commitment will determine your success in your collection efforts.Customer Service will directly impact upfront collections. Providing prompt, courteous, efficient and accurate customer care will increase your patients trust and willingness to pay at time of service.

Questions/Comments