MINING FOR GOLD: UNEARTH COVERAGE IN SELF-PAY ACCOUNTS

Transcription

1 MINING FOR GOLD: UNEARTH COVERAGE IN SELF-PAY ACCOUNTS November 15, Navicure, Inc. All Rights Reserved.

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3 Today s Speaker LISA WATERFIELD Enterprise Revenue Cycle Consultant ZirMed

4 Agenda Self Pay Market Pressures Unknown Coverage and its Impacts Ways to Uncover Self Pay Coverage ZirMed s Coverage Detection Solution

5 Self-Pay Market Pressures Rise in Insured Patients Increased Financial Risk Growing Self Pay More Americans have insurance coverage than ever before Patients may be unsure about coverage they have Self-pay - #1 Contributor to Bad Debt

6 Self-Pay No Small Problem Uncompensated care risks are real 81% $538 Billion in Uncompensated Care 1 Self pay revenues go unrecovered 2 CMS expected to cut DSH funds by $43B 3 80% of newly insured patients are deemed high risk to not pay 2 1 American Hospital Association Uncompensated Hospital Care Cost Fact Sheet, December Commonwealth Fund Biennial Health Insurance Survey 3 Billions in federal uncompensated-care funds to be cut starting in October, by Virgil Dickson, Modern Healthcare, July 28, 2017

7 New Underinsured Population More Insured Patients Doesn t Equate to Less Bad Debt $ Higher Deductibles Higher Co-Pays Tight Budgets

8 Why We Don t Know about Patients Insurance Coverage A Surprising Number of Self Pay and Charity Care Patients Have Full or Partial Coverage Why don t we know about it? Payers have no proactive way to share coverage details Patients don t understand their coverage Plans and contracts are complicated Difficult to capture insurance information for a host of reasons

9 Reasons for Missing or Unknown Insurance Information Emergency Room Visits The Charity Problem Confusion Over Status Transported by Ambulance Retroactive Medicaid Disability Patients Dual Coverage Worker s Compensation

10 Impact of Missing or Hidden Coverage Tracking down patients missing or unknown coverage: Is time consuming and costly Can involve multiple functions in the revcycle Patient Access AR staff/collections Outsourced to third party Negatively impacts cash flow, profit Can impact patient relationships 49% of patient responsibility is written off as bad debt* *Becker s Health IT

11 True Self-Pay vs Self-Pay After Insurance $ $ True Self-Pay Patients pay about 6% of what they are billed Self-Pay After Insurance Patients pay 15.5% of what they are billed * 5 tips for identifying whether self-pay patients have hidden health coverage, by Kelly Gooch, Becker s Hospital CFO Report, April

12 Ways to Uncover Insurance of Self-Pay Patients METHOD #1 PROCESS Call each payer or visit each payer website to check for coverage. If patient not covered, start again with next payer. Manual Payer Contact PROS & CONS Phone calls average 30 minutes; website visits average five minutes Some payers limit the number of patients discussed per call Labor-intensive to contact numerous payers Increased AR days Can jeopardize timely filings

13 Ways to Uncover Insurance of Self-Pay Patients METHOD #2 PROCESS Send 270 transaction to each payer to check for coverage. Based on 271 responses, if coverage is inactive, start again with next payer. 270/271 Transactions PROS & CONS Less time-consuming than manual process Labor-intensive to contact numerous payers Risk of sending to wrong payers Can jeopardize timely filings

14 Ways to Uncover Insurance of Self-Pay Patients METHOD #3 PROCESS After specified days in accounts receivable (AR), outsource to third-party call center. Outsourcing PROS & CONS Staff time and energy already invested Adds to cost to collect Loss of control

15 Ways to Uncover Insurance of Self-Pay Patients METHOD #4 PROCESS Use automated processes to identify coverage, eligibility and recoverable opportunities. Coverage Detection Tools PROS & CONS Finds more coverage than manual processes Reduces AR days Lowers costs and labor requirements Improves patient satisfaction

16 The Solution 2017 Navicure, Inc. All Rights Reserved.

17 ZirMed s Coverage Detection Solution Coverage Detection: Proprietary financial intelligence 15 years of data Identifies active and inactive coverage Routinely finds 5-15% billable insurance Without proper tools, searching for active coverage can be like mining for gold

18 ZirMed s Coverage Detection Solution Find hidden coverage for self-pay patients to collect the revenue owed to you IDENTIFY hidden coverage CONFIRM coverage is active DELIVER results to collect revenue Business Intelligence Engine processes requests against Best in KLAS technology platform to identify hidden coverage. Robust repository contains data across the continuum of healthcare equating to billions of transactions that are leveraged for identifying hidden coverage. Proprietary algorithms identify coverage on all patient accounts with pre-identified payers confirming active coverage exists. The advanced payer logic leverages over 1,200 payer connections resulting in a superior hit rate. Actionable results delivered to client, clearly articulating active and inactive coverage for all patients provided. Efficiently collect owed revenue by taking action with information delivered in flexible formats.

19 Benefits to Your Organization INCREASED STAFF PRODUCTIVITY LOWER COSTS MORE CONTROL HIGHER PATIENT SATISFACTION HIGHER REVENUE AND PROFIT MARGINS LOWER AR DAYS AND BETTER CASH FLOW EASY, COST- EFFECTIVE IMPLEMENTATION

20 Key Differentiators Robust Data Intelligence Leverages proprietary data on 1 in 8 US patients ZirMed owns the data through the clearinghouse & the repository is growing daily Maximize Reimbursement Advanced Payer Logic Delivers 1,200+ payer connections Gathers & aggregates insight through data-mining & machine-learning on a continuous basis Provides one of the nation s largest eligibility platforms Superior Hit Rate Confirms 2.8x more coverage than the competition Finds 5-15% billable insurance routinely

21 At the End of the Day It s All About the Patient Remember Patients may not understand: if they have benefits if coverage is active what they will owe whether they qualify for financial assistance Doing all you can to assist patients in understanding their financial situation improves overall satisfaction

22 Key Takeaways 2017 Navicure, Inc. All Rights Reserved.

23 What Becomes Possible Decrease self-pay receivables by identifying active, billable coverage Maximize the opportunity to capture revenue from newly insured population created by ACA Optimize staff productivity by reducing labor-intensive patient follow-up processes Reduce the need for outsourced collections on self-pay accounts, reducing sunken costs Accelerate cash by identifying active coverage faster and collected owed revenue

24 Strong Customer Results CUSTOMER #1 Type: Hospital Revenue Recoupment Opportunity: $21M Hit Rate: 35% Payments Recouped: $2.2M CUSTOMER #2 Type: Medical billing and coding services for EMS agencies Coverage found for 36,050 patients Hit Rate: 28.24% CUSTOMER #3 Type: Hospital Revenue Recoupment Opportunity: $10M Coverage found for 1,925 Patients Hit Rate: 20% CUSTOMER #4 Type: EMS Services Coverage Found for 4,769 patients Hit Rate: 38%

25 The ZirMed Difference Multiple solutions designed to maximize patient collection while improving the patient payment experience Estimation Estimate patient responsibility before rendering service Credit Card Processing Staff & patient self-generated payment plans, EMV, & End-to-End Encryption Statements & Lockbox Print & Electronic Statements customized for providers - securely accept checks that automatically deposit to bank account Patient Center One-stop shop for all patient interactions, collect payments with virtual terminal, and create payment plans Maximize Collections Check/ACH Processing Securely accept personal checks in the mail, in person or over the phone Online Patient Notebook Pay anywhere with mobile-responsive site, create payment plans & get real-time balance or view statements Dynamic Reporting Create any custom report, on any schedule, and drop to a customer s FTP Coverage Detection Identify and verify active insurance coverage that wasn t known at the time of service so you can bill payers for the care provided.

26 Q&A and Resources For more Information Visit: Call: (888)