10 Ways to Speed Up Patient Revenue

Transcription

1 10 Ways to Speed Up Patient Revenue Deborah Walker Keegan, PhD Medical Practice Dimensions, Inc. 1

2 Speaker Biography Deborah Walker Keegan, PhD, FACMPE Consultant, Keynote Speaker, Author National healthcare consultant and keynote speaker Industry leader in physician-hospital integration, physician compensation, revenue cycle, and practice operations Over 25 years of experience as a healthcare consultant and medical practice executive Author/co-author of six textbooks including The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid PhD, The Peter F. Drucker Graduate School of Management Founder and President, Medical Practice Dimensions, Inc. 2

3 Speed Up Patient Revenue 3

4 High Deductible Health Plans 49% of Non-Government Plans are HDHP HDHP / HSA Million Million 15% Average Annual Growth Rate Bronze Exchange Plan - $5,000+ Source: AHIP Center for Policy & Research, July Annual census of America s Health Insurance Plans. Data as of January

5 High Deductible Health Plans 30% Revenue from patient vs insurers 80% Workers with annual deductibles > $1,000 41% of workers with deductible > $2,000 20% of workers with deductible Plus copay, coinsurance, drugs Source: Kaiser Family Foundation Employer Health Benefits 2014, Annual Survey Employee Cost Sharing 5

6 High Deductible Health Plans Deborah has a $5,000 deductible plan Deborah Paid? Allowable Payer Paid? Deductibl e Copayment Coinsurance 6

7 1 Collect at Time-of-Service Copayment, Balance, Prepayment, Co-insurance, Unmet Deductible Copayment, Balance, Prepayment Copayment Level 3 Best Practice Level 2 Typical Practice Level 1 Basic Practice 7

8 1 Collect at Time-of-Service 1. Research insurance benefits and eligibility 2. Research patient responsibility copay, co-ins, deductible 3. Know precise services CPT codes/modifiers 4. Determine payer allowable level 5. Script staff to collect money from the patient 6. Post the payment 7. Issue receipt Amid the chaos of the front desk! Often involving hundreds of staff that must be trained! Difficult to get the numbers precisely correct! Refunds Small balance statements Telephone calls 8

9 1 Collect at Time-of-Service Who? What? When? At check-in At check-out Both check-in & check-out In exam room Central registration area Patient accounting office Prepayment/deposit Copayments 100% Other payments at TOS 75% Collect prior to elective > 50% 9

10 1 Collect at Time-of-Service Of the money we should collect, how much did we collect? If not, why not? report Patient Amount Due Status 7:45 a.m. Janet Jones $10.00 Yes No Why not? 8:15 a.m. Ellie Smith $ Yes No Why not? 8:30 a.m. Cade Thomas $0.00 Yes No Why not? 8:45 a.m. Nick O Hara $ Yes No Why not? 10

11 1 Collect at Time-of-Service Determine what to do if patient does not pay - Reschedule patient - Assess rebilling fees (documented in financial policy) - Direct to online payment; verify money received in 2 days - Give patient self-addressed, stamped envelope; call patient in 4 days if not received - Involve patient s carrier - Offer lending options 11

12 2 Improve Statements Make it easy for patients to understand their statements and ensure statements do not encourage delayed payments - Ask a non-billing colleague to read and interpret a statement - Remove 30, 60, 90 age buckets - Remove blank line for patient paid amount - Include primary and secondary insurance - Use dunning messages - Send a statement to yourself 12

13 3 Analyze Inbound Calls Track the reason for patient inbound calls and take action to reduce call demand Name/Account Description Resolution 1 Mary Smith Did my secondary pay? Informed patient secondary has paid and requested payment. Processed credit card for $250 balance. 2 Tom Davis I was told my out of pocket cost would be $250. Now I am being charged $325. Why? Authorization for procedure differs from procedure billed. Submitted task to coding unit to investigate. 13

14 4 Shrink your Cycle Statement 1 Statement 2 Statement 3 Letter 1 Letter 2 Phone Call 1 9 Months! Letter 75 Days! Statement 2 1 Statement 1 14

15 Predictive Dialers 4 Shrink Your Cycle Risk Segmentation Low 2 Statements 1 Letter 0 Phone Calls Moderate 2 Statements 1 Letter 1 Phone Call High 2 Statements 1 Letter 1-3 Phone Calls Advanced Practice: Differentiate by $$ 15

16 4 Shrink Your Cycle Use a Predictive Dialer - Predictive dialer telephones the patient account - If the call is not answered, leaves a message - If the call is answered, the patient is connected to a biller/agent Advantages: Improves productivity and efficiency Aligned with changes in technology and use of that technology 16

17 5 Transition to On-line Make it easy for patients to pay you! - On-line statements - On-line bill pay Patient Statement Notification Dear Mrs. Smith, You have received a secure and confidential billing statement from your healthcare provider at ABC Medical Group. Please Click here to retrieve your message via our secure Patient Portal. If you have previously registered for our Patient Portal, simply sign in to retrieve your message. If you are a first time visitor to our Patient Portal, please click the REGISTER button to create a Patient Portal account and retrieve your message. 17

18 5 Transition to On-line On-line Payment Instructions Patient Please Click Here to make your secure payment via credit or debit card. You may also visit the Billing section found on this portal to review specific charges and any explanation of benefits provided to us by your insurance carrier. If you feel like this notice is inaccurate please reply to us with a message. Thank you again for your business and for your prompt attention to this matter. 18

19 6 Charge Billing Fees Make it hard for patients NOT to pay you by charging billing fees to patients who fail to pay in a timely manner - Failure to pay at time-of-service fees - Rebilling fees - Finance charges for late payment - Statement fees - Collection agency fees Notify patients in advance via financial policy Comply with state and federal laws/regulation 19

20 7 Request Payment Request payment via telephone - At scheduling - At appointment reminder - At nurse triage call - As part of patient collection cycle - At practice sites (including small balance) Request payment via Request payment via text message Request payment via patient portal 20

21 7 Request Payment Voice Mail/Text Example This is a reminder from ABC Medical Group. The following is an important message for Mary Smith. You have received a message from ABC Medical Group regarding your recent bill. Please view this message on line by accessing your patient portal account on our website at If you have not yet registered for our online patient portal please go to our website to register. If you have questions please call the following number during regular business hours:

22 7 Request Payment Notification Example Dear Mrs. Smith, You have received a secure and confidential message regarding a billing matter from your healthcare provider at ABC Medical Group. Please Click here to retrieve your message via our secure Patient Portal. If you have previously registered for our Patient Portal, simply sign in to retrieve your message. If you are a first time visitor to our Patient Portal, please click the REGISTER button to create a Patient Portal account and retrieve your message. Thank you for your attention to this message. Due to the secure nature of healthcare information, replies to this are not allowed. Please use the Patient Portal to reply to the message that you have received. If you experience any difficulties, you may contact us by phone during regular office hours at Sincerely, ABC Medical Group. 22

23 7 Request Payment Patient Portal Example Dear Mrs. Smith, We appreciate your business and the opportunity to be your partner in health. Our records indicate that you have a current balance of $ that is over 30 days past due. This balance represents charges that are not covered by your insurance carrier for which they indicate you are responsible. Please Click Here to make your secure payment via credit or debit card. You may also visit the Billing section found on this portal to review specific charges and any explanation of benefits provided to us by your insurance carrier. If you believe this notice is inaccurate please reply to us with a message. Thank you again for your business and for your prompt attention to this matter. 23

24 8 Align with a Partner Collection Agency - Early out partner; full scope of self pay collections - Transfer all self-pay accounts fully self-pay and patient due balance after insurance - Transfer only true self-pay accounts - Transfer work after 3 statements/letters - To send collection letters Attorney: To manage high dollar accounts Small Claims Court Credit partners/health credit cards/loans 24

25 9 Implement Credit Card-on-File 3 Options for Patient Payment Option 1 Provide Service Submit Claim Wait for Payment/Denial Initiate Patient Collections Cycle Statements Letters Phone Calls Collection Agency 25

26 9 Implement Credit Card-on-File 3 Options for Patient Payment Option 2 Estimate Patient Responsibility Prior to Service Collect Estimate Prior to Service Reconcile Account When Receive Payer Payment/Denial Initiate Patient Collections Cycle If Contracts Permit! Statements Letters Phone Calls Collection Agency 26

27 9 Implement Credit Card-on-File 3 Options for Patient Payment Option 3 Estimate Patient Responsibility Prior to Service Collect Credit Card/Banking Information Prior to Service Wait for Claims Adjudication Charge Credit Card Actual Amount & Patient Receipt 27

28 9 Credit Card on File (CCOF) Estimate patient financial responsibility for the service to be performed Obtain written patient consent to charge credit card/ bank account (often up to a financial limit) Use payment gateway to authorize and securely store payment information Payment Card Industry (PCI) compliant (Tier 1 is highest) Charge credit card within 48 hours (or other timeframe) of claims adjudication (payment or denial posted) Call/ /text to notify patient card has been charged Use recurring process for budget plans Issue refunds to credit card on file 28

29 9 Credit Card on File (CCOF) Sample Financial Estimate Tool Description of surgery/procedure - CPT code and modifier Estimated total cost of surgery Contract allowable rate Total expected patient payment - Patient outstanding deductible - Patient copayment - Patient coinsurance Payment Plan (Yes/No); Terms Patient signature 29

30 9 Credit Card on File (CCOF) Sample Consent to Use Credit Card for Billing Note: Prior to implementation evaluate State law and payer contracts As part of our effort to control the cost of health care for our patients and streamline our administrative processes, we have established an automated credit/debit card system. Our system will securely hold your card information until your health insurance processes your claim and mails you their Explanation of Benefits that outlines your financial obligation. At that time your credit card will be charged for the amount determined by your insurer as your out-of-pocket payment responsibility. This authorizes ABC Medical Group to charge your card for the balance due on your account after insurance has paid. You will be notified via when your card is charged with a link to our Patient Portal for you to review your account status. Patient Signature: Date: 30

31 9 Benefits of CCOF No patient surprises Reduce patient statements Minimal patient collections follow-up Reduce collection agency/fees Reduce bad debt Streamlined check-in/check-out Streamlined financial reconciliation Speed up revenue!!! 31

32 10 Be Price Transparent 98% Plans Offer/support cost calculator 77% Hospital & Physician Choice Tools Offer integrated cost calculators Need a Plan -Who and How to quote prices to patients -Who to monitor how your group is treated Source: Catalyst for Payment Reform Copyright 2014 Walker Keegan 32

33 10 Be Price Transparent Health Care Cost Institute Joint Project United, Aetna, Humana Provide consumers with reference pricing

34 10 Be Price Transparent How do you compare in your market? 34

35 10 Be Price Transparent Online Marketplace Colonoscopy Prices Posted Online Bundled price: Facility, physician, anesthesia Purchase the procedure online If book through the website, a 66% savings Providers pay a monthly subscription fee 4 Providers paid within 6 days of procedure 35

36 10 Ways to Speed Patient Revenue Not Mutually Exclusive 1. Collect at Time-of-Service 2. Improve Statements 3. Analyze Inbound Calls 4. Shrink Your Cycle 5. Transition to Online 6. Charge Billing Fees 7. Request Payment 8. Align with Partner 9. Adopt Credit Card on File 10.Be Price Transparent 36

37 Speaker Deborah Walker Keegan, PhD, FACMPE Consultant, Keynote Speaker, Author President, Medical Practice Dimensions, Inc None of this material may be reproduced without the written consent of Medical Practice Dimensions, Inc. Contact Dr. Keegan at or 37

38 Questions & Answers Reminder: Attendees of the live webinar will receive a follow-up by February 20 th with: Webinar recording & handouts Webinar CEU certificate To ensure delivery of this , please add marketing@navicure.com to your safe-sender list.