METHOD TO THE MADNESS METHOD TO THE MADNESS 10 payment collection strategies that work 10 payment collection strategies that work Visit availity.com to download the full e-book TODAY S PRESENTER Colleen Wood, MBA Vice President Revenue Cycle Solutions, Eastern U.S. Availity LEARNING OUTCOMES After you have completed this session, you should be able to: Describe the healthcare landscape and why point-of-service patient collections is imperative Identify methods to leverage best practices to optimize yield Identify how effective patient collections practices improves net income 1
PAYMENT COLLECTIONS ARE A PAIN Bad debt rates in some hospitals Patient responsibility of total provider revenue Providers who don t know what to collect from a patient Patient bad debt in the U.S. Growth in patient out-of-pocket payments Patients who know their cost, but don t volunteer it HOSPITAL LANDSCAPE Hospitals across the nation are facing a myriad of financial challenges Underpayments for both Medicare and Medicaid More than $121 billion of new cuts since 2010 Hospital closings Over 64 rural hospitals, past five years 10 bankruptcies in 2015 POLLING QUESTION Approximately how many US consumers report problems paying their medical bills? 10 million 20 million 50 million 75 million 2
STRATEGY ONE Optimize your preappointment workflow Best practice: run 98% of E&Bs before the patient visit The revenue cycle starts at pre-service. Verify insurance eligibility, educate patients about financial responsibility, and invest in a good payment estimation tool. STRATEGY 1: OPTIMIZE YOUR PRE-APPOINTMENT WORKFLOW Clearly convey patient financial responsibility up-front. Educating patients on assistance programs, qualifying patients for coverage, and assisting with account resolution will improve billing and payment collections. STRATEGY TWO The importance of patient statement design Patients who don t understand their bill are unlikely to pay. Bills should be clear, concise, correct and patient-friendly. 3
POLLING QUESTION Physician practices and hospitals struggle with patient collections, with hospitals collecting less than 20% of at the point of service. Co-pays All patient-owed fees Deductibles Insurance information STRATEGY THREE Set expectations early and often The best opportunity to collect from patients is when they are standing in front of you. Take time to train your staff how to approach a variety of payment scenarios. Chances of collecting payment are reduced by 62% once I leave your office.* *Resource: National Association of Healthcare Access Management STRATEGY 3: SET EXPECTATIONS EARLY AND OFTEN Top-performing Make sure office staff is comfortable asking for payment. organizations don t just ask if a customer would like to pay today, they ask how. 4
STRATEGY 3: SET EXPECTATIONS EARLY AND OFTEN Establish and document payment agreements that include maximum times, minimum payments and consequences for defaulting. Give a copy to your patient and keep one for your files. PATIENT ACCESS HFMA MAP KEYS Measure Point-of-Service (POS) Cash Collections Purpose: Trending indicator of point-of-service collection efforts Value: Indicates potential exposure to bad debt, accelerates cash collections, and can reduce collection costs Equation: N: POS payments D: Total patient cash collected STRATEGY FOUR Convenience makes it easier to pay Reduce reliance on paper statements and bill collectors. Determine what payment options make sense for your business, based on your unique patient demographics. 5
STRATEGY 4: CONVENIENCE MAKES IT EASIER TO PAY Credit card Online payment Phone Text message STRATEGY FIVE Invest in training Educate and evaluate. Your commitment to continuous improvement through webinars, user group meetings and conferences will pay off. STRATEGY SIX Scrub claims clean Improve the accuracy of your claims with customized automation. Clean claims can reduce coding errors, improve reimbursement and ensure compliance. 6
PATIENT ACCESS HFMA MAP KEYS Measure Pre-Registration Rate Purpose: Trending indicator that patient access processes are timely, accurate, and efficient Value: Indicates revenue cycle efficiency and effectiveness Equation: N: Number of patient encounters pre-registered D: Number of scheduled patient encounters PATIENT ACCESS HFMA MAP KEYS Measure Insurance Verification Rate Purpose: Trending indicator that patient access functions are timely, accurate, and efficient Value: Indicates revenue cycle process efficiency and effectiveness Equation: N: Total number of verified encounters D: Total number of registered encounters STRATEGY SEVEN Measure and monitor Analytics tools can provide greater transparency into the payment cycle, and pinpoint areas to focus improvement efforts to maximize performance. 21 Availity, LLC. All rights reserved. 7
STRATEGY 7: MEASURE AND MONITOR What should your organization measure? Staff productivity Measure speed and accuracy Bad debt <2% is ideal Accounts receivable 20% should be 90 days old Denial rates Aim for <7% Customer satisfaction Solicit feedback STRATEGY EIGHT Be aggressive with claim denials and rejections Less than 50% of denied claims are reworked and resubmitted.* Help your billing staff identify and prioritize denied claims according to the following criteria: Does it need to be written off? Does it need to be corrected? Does it need to be appealed? *Medical Billers and Coders. Evaluating the Procedural Constituents of Medical Claims Management Cycle. 2010. STRATEGY 8: BE AGGRESSIVE WITH CLAIM DENIALS AND REJECTIONS Review your claim rejection report often and carefully. Uncover underlying issues like needed training, repeated coding errors, or technological mishaps. Set daily and weekly targets for working claims based on your high performers, and incentivize productive employees. 8
POLLING QUESTION Over the past six years employee out-ofpocket health care costs have increased: About 20% Exactly 40% Nearly 60% More than 80% STRATEGY NINE Offer financial incentives and discounts Reward your patients by offering pre-payment Employ common retail tactics to help collect patient payments discounts, payment plan options, or health care gift cards. 26 Availity, LLC. All rights reserved. STRATEGY TEN Timing is everything Aim for 24 hours to release patient statements Find the sweet spot for post visit collections. The right window of time before initiating collections activity is between 90-120 days. After that, the chances of being paid drop significantly. 27 Availity, LLC. All rights reserved. 9
STRATEGY 10: TIMING IS EVERYTHING Get everyone on the same page. A formal collections policy that can be shared with patients and staff will reinforce your position on payment and collections activities. No surprises. STRATEGY 10: TIMING IS EVERYTHING Optimize your revenue cycle efficiency. Review your aged accounts receivable for trends at 30, 60, 90 and 120 days. Top performers have accelerated billing and collection cycles. HONORCARE PROGRAM 82% of people say price is the most important factor when making a healthcare purchasing decision* The costliest 1% of patients in the US consume 20% of the nations healthcare* 11-20% of Americans think healthcare is affordable* Percentage of covered workers enrolled in a plan with a deductible of $1000 or more is on the rise* 43% of patients in fair or poor health found medical treatment unaffordable** In 2015 25% of employers are only offering high deductible plans** Source: *Price Waterhouse Copper HRI Consumer Survey 2014 Source: **Money Matters Billing and Payment For A New Health Economy 10
WHY HONORCARE? Best solution to health care payments Zero interest flexible payment terms A quick and easy application and approval process Affordable, accessible plans accepted nationwide HONORCARE OVERVIEW Unique, modern approach to managing healthcare costs and collecting payments Low investment financing program Helps patients manage the costs of healthcare treatments and procedures over time with affordable monthly payments Providers are paid 65% of patient responsibility Providers are paid within 15 business days PROVIDER BENEFITS Low investment solution Zero interest flexible payment terms Improved financial performance Enhanced patient satisfaction and loyalty 65% quick payment rate High collection rate Streamlined, efficient financing program Eliminates the need/cost of sending multiple patient statements Focused on providing quality patient care 11
PATIENT BENEFITS Control cost of healthcare treatments and procedures Zero interest flexible payment terms No impact on credit score Will not show up on patient s credit score if default occurs Easy-apply online in less than 10 minutes Patient sets terms: 3, 6, 12 months $3500 current loan amount Online payment option Manageable monthly payments BE A HERO. Take the pain out of collections and optimize your billing cycle. REFERENCES/RESOURCES Sage Growth Partners. Market Overview October, 2011 National Association of Healthcare Access Management HFMA MAP Keys Medical Group Management Association. The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid. First edition. American Medical Association s Health Insurer Report Card Modern Healthcare. Hospitals Offering Patients No- Interest Payment Plans. May 31, 2014. 12
QUESTIONS? Reach us at: Colleen Wood 919-622-4241 Colleen.wood@availity.com Mary Bowles 502-689-5580 Mary.bowles@availity.com (Georgia) Dave Pape 502-435-5021 Dave.pape@availity.com (Florida) 13