Point of Service Collections

Transcription

1 The Front-End Revenue Cycle Specialists Point of Service Collections Paul Shorrosh, MSW, MBA, CHAM CEO & Founder, AccuReg

2 POS Collections What are we trying to do? Customers want three things: Product or Service that is Free of Defects Timely Response to their issues Feel Valued at the End of Every Interaction Direct Quote from a Patient Access Director: Fix the Errors Collect the Money Horst Schulze - Former COO of Ritz Carlton

3 POS Collections What are we trying to do? How do we do both? How do we change an industry? How do we change a culture? Why do we need to do this? Can we get agreement on what POS Collections actually are?

4 What are POS Collections? Point of Service Collections POS, TOS, Pre-service, Up-front, Front-end Various definitions: Prior to Arrival Point of Service Point of Service up to DC date Point of Service up to X days after discharge May include outstanding balances and bad debt recoveries 4

5 NAHAM Definition NAHAM Definition of POS Collections: Any and all collections posted by Patient Access prior to and including discharge date. This might include: Collections from self-pays Collections from insured patients (copay/deductible/co-ins) Initial payments collected for approved payment plans Prior balances and bad debt accounts Is that your final answer? Business School Answer 5

6 HFMA Definition HFMA Definition of POS Collections: Point-of service payments are defined as patient cash (self pay cash) collected prior to or at time of service and up to seven days after discharge and/or patient cash collected on prior service(s) at the time of a new service. This includes: All posted POS payments, including undistributed payments (debit transactions only) Cash collected on prior encounters, including cash collected on bad debt accounts, at the current pre-service or time-of-service visit Pre-admit dollars captured in the month payment is posted rather than received Combined hospital/physician payments, if included in denominator 2 6

7 Liability Shift from Payer to Patient Revenue Mix Before ACA After ACA 10% Patient 90% Payer 30% Patient 70% Payer Patient Payer 20 Patient *Why More than Half of Hospital Bills Don t Get Paid USA Today Network - Holly Fletcher, The Tennessean March 8,

8 Why are POS Collections Important? 70% chance of collecting at point of service (30% after discharge) Academy for Healthcare Revenue, 2014 Many patients may actually be willing to pay when they need the service Reduce the cost of billing Reduce bad debt Correctly identify charity Accelerate cash flow for financial viability Point of Service Collection Chance After Discharge Collection Chance 8

9 Why Estimate and Collect at POS? For Patients 30% of revenue now comes from patients Patients want price transparency and comparison Patients want to know their cost after insurance Patients don t like surprise bills Estimates enable financial assistance discussions Estimates reduce patient financial stress Easier to collect up front than after service Likelihood of collecting is greatest at POS Cost to collect is lowest at POS For Hospitals 30% of your revenue now comes from a new source Patient estimates are required Price transparency laws Ohio, Connecticut, etc. NY State No Surprise Bill Act Patient Rescheduling Policies Arrives without payment for service Financial Assistance Policies Patient isn t able to pay deductible 9

10 So what is your hospital doing? Audience Poll What does your hospital do if a patient arrives and isn t prepared to pay the deductible? 1. Does your hospital reschedule the patient? 2. Does your hospital refuse service? 3. Do you screen for other forms of payment? (Medicare, Charity, Financial Payment Plans?) 10

11 Patients Arriving without Paying Financial Responsibility One hospital s policy: If the test is considered medically urgent, the patient is allowed to proceed without payment. In instances that the patient expresses they cannot pay, they are screened for charity. If they do not qualify for charity and the test is not considered medically urgent, then the patient is required to meet the minimum down payment amount of 30%. The patient is rescheduled if they are unable to meet the financial obligation. 11

12 NAHAM Pre-Registration Process Tiers 12

13 POS Collections Potential Best Practices ID# DOMAIN AccessKey (KPI) EQUATION POS-1 Collections POS Collections to Revenue POS-2 POS-3 Collections Collections POS Collections to Total Patient Collections POS Collection Opportunity Rate POS-4 Collections Total POS Dollars Collected POS-5 Collections POS Collected Accounts Rate POS-6 Collections Estimate to Registration Rate POS-7 Collections Estimation Accuracy Rate POS Collections Net Patient Service Revenue POS Collections Total Patient Collections POS Collections POS Estimations Total Dollars Collected (<= Discharge Date) Accounts Collected Total Registrations GOOD Benchmark Early Implementation Phase or Manual Process BETTER Benchmark Middle Implementation Phase or Semi-Auto BEST Benchmark Mature Implementation Phase or Auto Process 1.0% 1.5% 2.0% 30% 40% 50% 30% 45% 60% 20% 40% 60% Estimates Generated Total Registrations 1 30% 40% 50% Accurate Estimates Qualified Estimates National standard benchmarks represent progressive phases to achieving a high performing Patient Access team and are largely dependent on the level of executive support, community and board adoption, available technology, staffing, processes and use of best practices. Total POS Cash Collected compare to prior periods (no ratio or benchmark for peer comparison) 85% 90% 95% 13

14 NAHAM POSC Best Practices Good 1. Establish a Baseline What are your average POS collections per month? By Location? 2. Identify Gaps - Assess the current POS collection policies, practices, training needs and technology at each Patient Access location (ED, Surgery, Outpatient, Pre-Reg, etc.) 3. Provide staff with - Estimation and payment tools, training on insurance terminology, calculation of copay, deductible and coinsurance. 14

15 Not all Collection Systems are Equal Estimates Automated from scheduled procedures CPT Codes Accurate POS-7 Estimation Accuracy Rate = 85% ± 10% Workflow Alerts Scripts Employee and/or patient facing Kiosk/portal/mobile Payments Integrated estimates/payment processing Patient payment portals and mobile apps Payment options personalized to each patient Credit/debit/ACH/cash Retail and EMV / Chip Reader Discounts (Prompt Pay / Amnesty) Flexible Payment Plans Loans (bank vs hospital) Auto-posting for real time status POS collections/reconciliation reporting 15

16 NAHAM POSC Best Practices Better 4. Train Staff - How to collect effectively (soft-skills customer training) with scripting, objection handling, and financial assistance options they can offer patients which are pre-approved by the hospital s financial assistance policies (FAPs). 5. Develop Collection Policies - Empower registrars to offer discounts, payment plans, loans and charity for those who qualify, and provide them with clear parameters to reschedule non-urgent services for patients that decline financial assistance. 6. Foster a Collections Culture - With support from the Board, Executives, Management and Physicians, where every registrar asks at every opportunity, of every patient with an estimated liability, at every location and every time. 16

17 Changing Patient Payment Expectations Co-Pays, Co-insurance, Deductibles and Deposits are expected prior to or at time of Service Please be aware, depending on your insurance coverage, your insurance carrier may hold you responsible for multiple co-pays (technical and professional) for this visit. You should contact your insurance carrier for further clarification. $800! BOO! Help Us Help You Keep Healthcare Costs from Rising! We Accept Cash, Check and Credit Cards (Mastercard, Visa, Discover and American Express Includes flex spending accounts). We do NOT accept Care Credit. 17

18 Payment Expectations Where else do we see this? Fast Food Cell Phone Plan Car Purchase House Purchase Buying a Yacht Buying a Small Island Child s College Education It should not come as a shock patients expect this $ $ $ $ Lowest Price Highest Price 18

19 NAHAM POSC Best Practices Best 7. Continually Raise the Bar - As goals are met, raise the bar but keep goals attainable. 8. Implement Incentives - These can be non-financial (recognition, parties, etc.) or financial (depending on facility). 9. Engage Physicians and Office Managers - To set expectations at ordering and scheduling levels. 10. Monitor POS Collections Performance - On a monthly, weekly and daily at four levels; health system, facility, location and employee, using all 7 POS Collections AccessKeys. 19

20 POS Collections Real-time Visibility Performance Transparency Constant Monitoring Department Dashboards 20

21 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Amount Collected What is the Impact of Best Practices? $400,000 Payment Processor $350,000 $300,000 $250,000 $200,000 Estimates Training 3x 2x 1. System: Patient estimation implemented 2. Training: Classroom and elbow-to-elbow training $150,000 $100,000 $50, Optimization: Integrated payment processing Pay Now button $0 Monthly Timeline 21

22 Consistency is the Key to Changing Culture Consistency propagates future success Let patients know ahead of time so they can prepare and make proper arrangements. An incentive or discount increases the likelihood that a patient will comply with a facility s request for upfront payment. Financial scripting is used to define terms as the Patient Access specialist walks the patient through the math. It cannot be overstated that next week s and next month s upfront collections are reliant upon what was asked last week and last month. - Jeffery B. Dallas, Jr., MBA, CHAA 22

23 Affordability Tipping Point How Much Can They Pay? FPL Account Patient Balance Due 23

24 Credit Scoring Who Will Pay? FPL Credit Score 24

25 Patient Conversion Propensity to Pay Little ability to pay No available credit, low credit score Potential charity care or Medicaid Identity issues Incorrect data Potential fraud Strong ability to pay Credit available Collect payment at time of service Borderline ability to pay High credit score Consider for financing solutions 25

26 Financial Impact POS Collections Revenue Generation Earlier cash Prior balance resolution Divert bad debt Expense Reduction Cost to collect Time value of money Early out and collections fees Aged Payments 26

27 Paul Shorrosh CEO and Founder