Cash Collection Strategies in a High Deductible Environment

Cash Collection Strategies in a High Deductible Environment

The Shift Insurance Patient Higher Insurance Premiums Average premium has risen 19% over the past 5 years $7,000 for single coverage $19,000 for family coverage Employers typically cover 75% of their employees premiums Increase in out-of-pocket costs Co-pays, co-insurance, and deductibles Experienced a 66% increase between 2005 and 2015 Higher deductibles for Surgery and Imaging Significant co-pay increases for Therapy services Projected to grow faster than the economy in the years ahead Source: Kaiser Family Foundation

A/R Review Patient Balances Increased by $500,000 from 2014 to 2017 Processes needed updated Front Desk Challenges System Automation

Accounts Receivable Patient Responsibility $2,500,000.00 $2,000,000.00 $1,500,000.00 $1,000,000.00 2015 2016 2017 $500,000.00 $0.00 Accounts to Collection Agencies

Appointment Scheduling Patient is informed that co-pay is due at time of service Patients receive two statements, a letter and on-line payments are available Collections Demographic and Insurance Information Front desk staff are expected to collect co-pay or other balances due Patient Statements Current Patient Experience Pre-cert Coordinators contact patients for surgery payment A/R Follow Up Coding Payment Posting Charge Entry and Claim Submission

Retrospective Collections vs Prospective Collections Retrospective Request payment upfront Patients seen regardless of payment or non-payment Billing Office sends statements and letters Collectors set up and monitor monthly payment plans Accounts sent to Collection Agency for non-payment Prospective Notify Patient of Cost of Service before Treatment Provide Patient Payment Solutions

Appointment Scheduling Collections Demographic and Insurance Information Patient Statements Transforming the Patient Experience Transcription A/R Follow Up Precert and Coding Payment Posting Charge Entry and Claim Submission

Optimizing Patient Collections Appointment Scheduling New Implementation February 1st Radix Health Cloud Based System Maximizes Scheduling Process Real time eligibility Clearinghouse Availity On-line Payments Website Portal

Providing Patient Payment Solutions

Patient Payment Solutions BHG More MasterCard No provider fee or discounted services 0% APR for 6 months on each healthcare transaction over $499 Must have a credit score of 680 or higher for approval Patient can apply in minutes at physicians office or at home Approval is instant Can use card anywhere MasterCard is accepted Cash Back Rewards Can use for existing or older balances CareCredit Provider fee or discounted services may apply Some promotional financing options for patients Must have a credit score of 680 or higher for approval Patient can apply in minutes at physicians office or at home Approval is instant Can use for most Orthopedic Services except SPINE

Patient Payment Solutions MyLoans Providers Enables Providers to offer low-interest loans to patients Provider receives payment in full within 48 hours Offloads statements and payment processing Practice guarantees the loan Bank requires reserve (Withhold) Loans that default after 60 or 90 days are paid back to bank Balances $200 or higher qualify Patients No Credit Check Fair and unchanging interest rate No fees or prepayment penalties

Implementation of Payment Solutions Financial Counselor Clinic Setting All Surgeries, MRI s and Current Balances over $200 Works with Pre-cert and Coding team to determine CPT Codes Cost Estimator accessed to determine allowed amounts Experian Contacts Patient regarding payment options Scripted Call Provides price transparency Front Desk is notified to collect promised payments Internal Payment Plans are no longer offered

Results Patient Payments as a percent of revenue 13.6 to 18.8 percent in the last five years. MyLoans program $140k in patient loans Recourse rate of 28%. Upfront Collections increased $670k in 2017

Results $100,000.00 CareCredit Payments $90,000.00 $87,478.14 $80,000.00 $70,000.00 $60,000.00 $50,000.00 $40,000.00 $30,000.00 $33,219.41 $20,000.00 $10,000.00 $14,977.75 $- 2015 2016 2017

Monitoring and Analyzing Examine All Collection Strategies Upfront Office Collections Back End Collections Collection Agencies Review all Payment Solutions

Future Considerations Card on File Solution Patient approval on file for designated amount Price transparency provided at time of service Less Administrative costs for practice Propensity to Pay E-statements Text reminders Other Solutions

Contact Information: Tennessee Orthopaedic Clinics, P.C. Earl Anderson, CEO AndersonE@tocdocs.com Tina Snodderly, COO SnodderlyTR@tocdocs.com