1 Automating Estimation of Patient Services Jonathan G. Wiik, MSHA, MBA Imaging Operations Manager...

1

Automating Estimation of Patient Services

Jonathan G. Wiik, MSHA, MBA

Imaging Operations Manager

Boulder Community Hospital

Val Kraus, MBA

Director of Admissions & Case Management


2

The overall cost to collect is typically reported between 2 and 3 percent…

Front-end processes are important … especially in this era of increasingly high co-payments and consumer-directed health plans.

…. the more time that passes following the patient’s discharge, the cost to collect on that account continues to go up while the chance of actually collecting payment goes down.

Therefore, any payment that can be collected early in the patient encounter is more valuable in the long term.

– Understanding your true costs to collect, HFMA, JAN 2006

Estimation of Patient Services – Introduction

3

Why Should the Patients Pay in Advance?

Patients need to be educated and understands their financial obligations for the care they are receiving

Eliminate discharge delays

Eliminate worry about how to cover patient-pay portion

Maintain or establish good credit record

Patients earn piece of mind knowing their obligations have been met

Avoid future collection headaches

Estimation of Patient Services – Introduction

The Advisory Board Company – HWORKS initiative

4

"The immediate goal is to make sure there are more people on private insurance plans.

I mean, people have access to health care in America…..after all, you just go to an emergency room.”

- President George W. Bush

Estimation of Patient Services – Current Trends

AFP PHOTO/Saul LOEB

5

Session Objectives:

1. Discussion of trends in current Health Care market

2. Identify best practices to maximize collection efforts

3. Understand components of Estimating Pre-Service

4. Streamline scheduling and reception workflows5. Outline training for front-line staff

Estimation of Patient Services – Objectives

6

Estimation of Patient Services

Current Trends

7


Percentage of Non-elderly Adult Workers Without Health Insurance, 1987-2005

The problem of the uninsured is continuing to grow. The federal government estimates that nearly 45 million individuals lacked health insurance coverage of any kind during 2005. Other research shows that tens of millions more Americans go without health coverage for shorter periods of time.

Source: Employee Benefit Research Institute estimates from the Current Population Survey,

March 1988-2006 Supplements.

8

Medicaid/ Other Public

12%

Medicare14%

Private Non-Group5%

Uninsured16%

Employer-Sponsored Insurance

53%

NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, SCHIP, other state programs, and military-related coverage. Those enrolled in both Medicare and Medicaid (1.8% of total population) are shown as Medicare beneficiaries. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

2006 Total = 296.1 million

47.4 Million Uninsured!


9


2,245.62,394.3

2,555.1

3,097.8

3,523.6

4,007.8

2,105.5

4,277.1

3,757.0

3,305.0

2,905.12,725.8

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

2006* 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

16.0 16.3 16.6 16.9 17.1 17.4 17.7 18.0 18.4 18.8 19.1 19.5

*2006 are actual data from the 2006 National Health Expenditure Accounts; 2007-2017 are projected data from the 2006 National Health Expenditure Accounts.Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp#TopOfPage (see Projected; NHE Historical and projections, 1965-2017, file nhe65-17.zip) and http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2006; file nhegdp06.zip).

NHE as a % of GDP:

Dolla

rs in

Bill

ions

$4.3T

10

What are a BILLION or TRILLION Dollars?!!

$ 1,000,000,000,000……”12” zeros…..or….. “one-thousand-billion”:

– One Million dollars stacks up 500 feet - as tall as the big pyramid in Egypt– One Billion dollars is 10 times higher than Mt. Everest– One Trillion dollars is 1/4 of the way to the Moon or 60,000 miles.

– It would take someone more than 30 years to “count aloud” to one Billion

– If you had gone into business on the day Jesus was born [~2013+ years ago], and your business lost a million dollars a day, day in and day out, 365 days a year, it would have taken you until October 2737 to lose just ONE Trillion dollars

www.buelahman.wordpress.com/2008/05/06/what-does-a-trillion-look-likewww.jimloy.com/math/trillion.htmwww.scoroncocolo.com/debt.htmlwww.ehd.org/science_technology_largenumbers.php


11

7%

10%

22%

6%

41%

30%

46%

3%Declared bankruptcy

Borrowed money from relatives

Unable to pay for basic necessities like food, heat, or

housing

Used up all or most of savings

Percent who say each of the following happened to them/their family member as a result of the financial cost of dealing with cancer…

Ever uninsured

Always insured

Source: USA Today/Kaiser Family Foundation/Harvard School of Public Health National Survey of Households Affected by Cancer (conducted Aug 1-Sept 14, 2006)


12

Financial Burden of Medical Bills by Insurance Status, 2005

9%

12%

14%

18%

34%

29%

Contacted byCollection

Agency aboutMedical Bills

Spent Less onBasic Needs toPay for Health

Care

Medical BillsHad a Major

FinancialImpact

Uninsured

Insured

NOTE: Insured includes those with public or private insurance coverage. SOURCE: Kaiser Commission on Medicaid and the Uninsured analysis of the Kaiser Low-Income Coverage and Access Survey 2005: National All-Income Sample.

Percent of adults (age 19-64) reporting in past 12 months


13

% OF US DOLLAR SPENT BY CONSUMER 2008

RENT/MORTGAGE16%

OTHER**14%

UTILITY BILLS15%

FOOD14%

CLOTHING4% MEDICAL

CARE*17%

CAR4%

HOUSEHOLD/FURNITURE4%

RECREATION4%

TRANSPORTATION4%CAR FUEL

4%


Bureau of Economic Analyis - Personal Consumption Expenditures by Major Type of Product and Expenditure

www.bea.gov/national/nipaweb/nipa_underlying/TableView.asp?SelectedTable=19&FirstYear=2007&LastYear=2008&Freq=Qtr

•Medical care includes all expenses, including premiums, prescriptions, and out-of-pocket costs

** Other includes food other than groceries, alcohol, tobacco, luxury items, etc.

14


15

Average annual premium for family of four in 20081?….

1. National Coalition on Health Care 2008. www.nchc.org/facts/cost.shtml

2. Medical News Today (Coverted to 2008 using 10% inflation rate)

www.medicalnewstoday.com/articles


$16,000

Average annual health care costs for family of four2?….

$3,300Average out-of-pocket costs for family of

four (incl. Premium above)2?….

$6,075

16

Having a job, even a full-time job, does not guarantee access to health insurance.

Uninsured Non-elderly Population by Work Status of Family Head, 2005

Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2006 Supplement


17

Many workers are paying higher co-payments for physician visits in HMOs.

Percentage of Covered Workers Facing Various HMO Co-payment Amounts for Physician Office Visits, 1996-2006

Source: Kaiser Family Foundation/Health Research and Educational Trust.


18

Distribution of Deductibles for Employee-Only PPO Coverage, 2000-2006

Source: Kaiser Family Foundation/Health Research and Educational Trust.


19

Distribution of Health Plan Enrollment for Covered Workers, by Plan Type, 1988-2007

* Distribution is statistically different from the previous year shown (p<.05). No statistical tests were conducted for years prior to 1999. No statistical tests are conducted between 2005 and 2006 due to the addition of HDHP/SO as a new plan type in 2006.

Note: Information was not obtained for POS plans in 1988. A portion of the change in plan type enrollment for 2005 is likely attributable to incorporating more recent Census Bureau estimates of the number of state and local government workers and removing federal workers from the weights. See the Survey Design and Methods Section from the 2005 Kaiser/HRET Survey of Employer-Sponsored Health Benefits for additional information.

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2007; KPMG Survey of Employer-Sponsored Health Benefits, 1993, 1996; The Health Insurance Association of America (HIAA), 1988.

73%

46%

27%

10%

8%

7%

4%

5%

5%

3%

25%

21%

20%

21%

11%

26%

28%

39%

42%

46%

52%

54%

55%

61%

60%

57%

7%

14%

24%

21%

23%

18%

17%

15%

15%

13%

13%

4%

5%

3%

3%

16%

21%

31%

28%

29%

24%

27%

24%

0% 20% 40% 60% 80% 100%

1988

1993

1996

1999

2000

2001

2002

2003

2004

2005

2006

2007

ConventionalHMOPPOPOSHDHP/SO

*

*

*

*

POS COLLECTIONS – Current Trends

20


Industry Best Practices

21

Estimation of Patient Services – Best Practices

BCH POS COLLECTIONS TIMELINE

3/28/05: BDY SITE POS COLLECTIONS GO LIVE (PILOT)

8/15/05: CMC SITE POS COLLECTIONS GO LIVE

8/22/05: FTH SITE POS COLLECTIONS GO LIVE

8/29/05: BMC SITE POS COLLECTIONS GO LIVE

4/1/06: BCH POS COLLECTIONS INTIATIVE

(CICP/WECARE/HWORKS)

1/25/07: POS COLLECTIONS TASK FORCE INCEPTION

8/28/06: CCI PAY GO LIVE BDY SITE (PILOT)

9/1/07: CCI ACTIVE ALL IMAGING SITES

11/1/07: DEDICATED INSURANCE SPECIALIST HIRED

1/1/08: BCH SITE PILOTS ESTIMATOR

4/1/2008: ELGIBILITY AND BENEFITS FOR SCHEDULED

PATIENTS

1/27/09 PRESENTED RESULTS AT HFMA SYMPOSIUM

Jan-05 Jun-05 Dec-05 Jun-06 Dec-06 Jun-07 Dec-07 Jun-08

OUR JOURNEY…

22


(REV 3/20/06)

DEPT CATEGORY SELF PAY DISCOUNT PRICECT ANGIO / RUNOFF $1,900.00CT NON ANGIO $900.00CT ABDOMEN SCREENING** $965.00CT CT VIRTUAL COLONOSCOPY** $695.00CT CARDIAC SCAN CALCIUM SCORE** $490.00CT LUNG SCREENING** $390.00

** Discount does not apply with these examsDEPT CATEGORY SELF PAY DISCOUNT PRICE

DX SPINAL PROCEDURE (I.E. MYELO) $1,100.00DX ARTHROGRAM $600.00DX FLUORO (GI/GU) $500.00DX LUMBAR PUNCTURE $300.00DX DEXA $200.00DX PLAIN FILMS (ALL OTHER) $200.00DX PLAIN FILMS (< 3 VIEWS) $75.00

DEPT CATEGORY SELF PAY DISCOUNT PRICEMA STEREO BX (Deposit Platform*) 2,000.00$ MA NEEDLE LOC / GALACTOGRAM 800.00$ MA DX MAMMO (BILAT, incl CAD) 160.00$ MA SCREEN MAMMO (BILAT, incl CAD) 130.00$ MA DX MAMMO (UNILAT, incl CAD) 100.00$

DEPT CATEGORY SELF PAY DISCOUNT PRICEMR BREAST MR LOC / BX 2,500.00$ MR W & W/O CONTRAST 2,400.00$ MR BREAST MR 1,700.00$ MR W or W/O CONTRAST 1,100.00$

DEPT CATEGORY SELF PAY DISCOUNT PRICEUS PROCEDURE(INCL DRAIN, BX, VEIN MAPS, ETC) 700.00$ US OB, BREAST SONO, OTHER 400.00$ US LIMITED OR F/U, GEN COUNSELING 200.00$

DEPT CATEGORY SELF PAY DISCOUNT PRICEIS ALL (DEPOSIT PLATFORM)* 750.00$

DEPT CATEGORY SELF PAY DISCOUNT PRICENM ALL (DEPOSIT PLATFORM)* 1,000.00$ PET ALL (DEPOSIT PLATFORM)* 2,500.00$

* Deposit Platform is a partial payment (deposit), patient will be billled for the remainder at a 40% discount.

OVERALL ESTIMATE (USE ONLY IF ABOVE NOT DETERMINED)

DEPT AVG PRICE OVERALL ESTIMATECT $ 1,422.14 $ 750.00 DX $ 358.33 $ 150.00 IS $ 1,216.98 $ 750.00 MA $ 485.26 150.00$ MR $ 2,217.66 1,250.00$ NM $ 1,658.62 1,000.00$ PET 3,504.00$ 2,500.00$ US $ 540.02 250.00$

NOTE: This Pricing Table is for quoting/collecting amounts on SELF PAY PATIENTS ONLY, w ho pay at the time of service

** < 3 VIEWS MNEUMONIC EXAMPLES INCL: "KNEE", "FINGER", "SCAPULA","CLAVICLE","ELBOW","PELVIS","KUB","SACCOC","HUMERUS","HAND", ETC.

IMAGING SELF PAY PRICING TABLE

23


BOULDER COMMUNITY HOSPTITAL POS COLLECTIONS2004 TO CURRENT

$1.4M$1.1M $1.2M

$2.0M$2.3M

$2.9M$3.3M

$5.2M

$5.8M

42474

28735

35757

18747

22342

$-

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

2004 2005 2005 CCI$ 2006 2006 CCI$ 2007 2007 CCI$ 2008* 2008 CCI$*

PERIOD

AM

OU

NT

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

CO

UN

T

AMOUNT COUNT

CURRENTLY: ~25% Collection Rate or 1.2% of Gross A/R

24

DO THE MATH!:

Annual self pay losses versus savings in up-front collection:


- Point of Service Collections, Techniques that Work, HFMA, Sandra Wolfskill

Would you like to lose “$3.5M” OR

“$2.0M”

this year ???

25

Have clear intentions…

Patients First, Collections Second1

Treat ALL patients equitably, with dignity, with respect, and with compassion2

Serve the Urgent and Emergent needs of everyone, regardless of their ability to pay2

Assist patients who cannot pay for their part of the care they receive2

Provide resources, NOT restrictionsMake it an EXPECTATION

Estimation of Patient Services– Best Practices

1. Point of Service Collections, Techniques that Work, HFMA, Sandra Wolfskill

2. Patient Friendly Billing Project, February 2005 Report

26

Best Practices of Top-Performing Facilities:

– Adopt guiding principles and communicate the message

– Set the expectations, and establish accountability

– Update the mission, job descriptions, policies, and procedures

– Couple patients with the best funding mechanism available

– “best” could be charity care

Estimation of Patient Services - Best Practices

Overwhelming The Bad Debt Crisis - HWORKS

Patient Friendly Billing Project, February 2005 Report

27

Identify and address the “barriers”:

We do not know what to collect?!I’m not asking people for money?!This is against our policy?!You have never collected this from me before?! Public Relations and CommunicationsInsignificant Dollars


- Point of Service Collections, Techniques that Work, HFMA, Sandra Wolfskill

28


Components and Tools

29

Components of a Successful POS Collection Program:

1. Metrics (Data)

2. Executive-Level Support

3. Active Participation at All Levels

4. Policy, Procedure, Protocol and Scope

5. Patient Education

Estimation of Patient Services – Components and Tools

30

1. Metrics - DATAHigh Level

– Billed Revenue

– Reimbursement

– Up-front (POS) Collections (if any)

– Bad Debt Write-offs ($)

Detail– Payer Mix including Self-Pay (uninsured)

– Account Aging and Costs (A/R, Collections agency, etc.)

– Patient Mix (Outpatient, Inpatient, ED)

– Number of Scheduled Patients and Walk-ins

– Modality Mix (CT, MRI, XRAY, ULTRASOUND)

– Access Points and Volume at each area (Scheduling/Reception/Intake/Admissions)


31

Why so much data?!

• Get a Baseline (What can we track?)• Identify Priorities (Why is this important?) • Focus efforts (Who will be impacted?)• Establish Goals (When can we do this?)• Determine Needs (How can we do this?)

Estimation of Patient Services - Components and Tools

32

KNOW your numbers….

• How much should an uninsured person pay?• What do we collect if it is not on the card? • What do we do if data is not available?• How do (or can) we estimate allowable?• What can we (or can we not) estimate in advance?


33


$0.00

$50,000.00

$100,000.00

$150,000.00

$200,000.00

$250,000.00

$300,000.00

CLINIC ESTIMATED CHARGES BY PRIMARY PAYOR

BCH IMAGING PROCEDURES 01/01/05 - 12/31/05

Drill down to the core….

34

2. Executive-Level Support

• Bottom-up, top-down, sideways, and up-side-down, the organizational CULTURE must live, breathe, and act consistently

• Every person, from the Radiologist to the Receptionist, from the Office Manger to the patient, must clearly understand the project and its rationale

• Services should not be reduced in a POS Collections Program – they should be ENHANCED

Estimation of Patient Services– Components and Tools

35

2. Executive-Level Support (cont.)

Typical POS Collections Team:

• Executive - VP/CFO, Owner, Office Manager• Director / Site Manager (s)• Billing and Contracting• Admissions / Scheduling / Reception • Others?

– If multi-site/functional areas, leads from each access point should be represented

– Should end up with 6-8 “key” personnel involved in patient and billing flow

* This group should have a philosophical, business-decision discussion concerning “boundaries” PRIOR to any implementation


36

3. Active Participation at All Levels

Administration and ManagementBilling Financial CounselorsClinical PersonnelOther Areas


37

Letters/Communication do not hurt…..

Estimation of Patient Services - Components and Tools

38

3. Policy, Procedure, Protocol and Scope

“Three Doors” for funding their care:

InsuranceNo Insurance (self-pay)Other Funding Mechanism (be specific)

ONE (AND ONLY ONE) OF THE ABOVE MUST BE ELECTED BY THE PATIENT PRIOR TO

RENDERING SERVICES – NO EXCEPTIONS!!!


39

• “DOOR” will determine direction and conversation we take with the patient:– “Collection Advisory” List

• Medicare/Medicaid• Third Party Liability (Work comp, MVA, Litigation)• “Agreements”

– Patient Types• ED, STAT, URGENT, SAME DAY ADD-ONS• Procedure changes• Oncology, Mammography, DEXA• Indigent, Homeless, Out-of-network


40


41


42

3. Policy, Procedure, Protocol and Scope(cont.)

Be VERY clear on the following:

who is asked when the question is posed what is said what happens when people refuse or get upset who is contacted for service recovery


43

When is the question posed?• At Physician’s office? • At Scheduling? • At Reception? • On the Table?

– Earlier and the more frequent, the better – ELIMINATE SURPRISES

What is said?• Tailor the conversation to fit the situation…


44

$


45

What’s Realistic?

– Scripting is difficult and does not afford flexibility, however in some cases you must ensure consistency

– Key Phrases are best where possible– The 4 “C”’s:

• Confident• Competent• Compassionate• Collaborative


46


EXAMPLES:– Key Phrases

• All of our patients are expected to….• Do you know what your payment is today?• We have several options available for payment,

our best is…?• We typically do ______ when patients ______….• Most patients elect this option as it….

47

How much should I ask for??

– Remember the Bull’s Eye

1. Self-Pay

2. Indigent Copay

3. Known Insurance Patient Portion

4. Unknown Insurance Patient Portion


48

Strategies to Determine Amounts:

1. Self-pay• Take average net-deduction-in-revenue (NDR) and add 5-

10% for “administrative savings”• For example, if block of business has an NDR of 25%,

make the self-pay amount 35%• Take charge master and reduce billed amounts by 35% to

establish Prompt Pay Fee Schedule by Category and/or line-item CPT

• “ALL PATIENTS WHO PAY AT TIME OF SERVICE WHO DO NOT HAVE INSURANCE ARE ELGIBLE FOR THE PROMPT PAY DISCOUNT. PAYMENT MUST BE MADE IN FULL AT TIME OF SERVICE TO BE ELIGIBLE”


49

Strategies to Determine Amounts:2. Indigent Amounts

• Program Copay, Coinsurance, Deductibles• Sliding scale to Federal Poverty Level (FPL)


CICP RATING

PEOPLES CLINIC DISCOUNT PLAN

WECARE RATING

INPATIENT COPAYMENT

OUTPATIENT SURGERY

MRI, CAT SCAN, NUC MED ER VISIT

LAB WORK X-RAY

N C-5 N $15.00 $15.00 $15.00 $15.00 $5.00 $7.00A C-10 A $65.00 $65.00 $65.00 $25.00 $10.00 $15.00B C-20 B $105.00 $105.00 $105.00 $25.00 $10.00 $15.00C C-30 C $155.00 $155.00 $155.00 $30.00 $15.00 $20.00D C-40 D $220.00 $220.00 $220.00 $30.00 $15.00 $20.00E C-50 E $300.00 $300.00 $300.00 $35.00 $20.00 $25.00F C-60 F $390.00 $390.00 $390.00 $35.00 $20.00 $25.00G C-70 G $535.00 $535.00 $535.00 $45.00 $30.00 $35.00H C-80 H $600.00 $600.00 $600.00 $45.00 $30.00 $35.00I C-90 I $630.00 $630.00 $630.00 $50.00 $35.00 $40.00N/A N/A J $1,500.00 $1,500.00 $1,500.00 $200.00 $100.00 $125.00Z N/A Z $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

* Peoples Clinic Discount Plan is equivalent to Boulder Community Hospital's WeCare Plan.

*A patient will be charged multiple copays for multiple services done during the same admission or the same visit.same visit.

50


3. KNOWN insurance amounts

– Collect what is on the card:

Copays Coinsurance/Deductible

• Estimate allowable amount(s)• BEWARE of the “floating deductible”

– Have patients bring in Benefits Screen Prints/EOBs– Have patients or staff call insurance in advance– ASK patient and collect that


51


* DATA IS FICTIONAL – NOT ACTUAL CHARGES

52


4. UNKNOWN insurance amounts• Consider benefits of collection versus

downstream costs to refund• Avoid “over collecting”

Customer Service issues Refund Turn Around Time Inflated Results Carrier and Employer “ripple effect”

• Credit Card on File


53


Credit Card on File

• Store Credit Card Numbers for subsequent billing• Line of Credit

• Compare to when you check into Hotel and they take a card for “incidentals”

• Several vendors offer a software solution that integrates/replaces existing credit card terminals

• BCH Imaging alone generates ~600-700 per month, or approximately $100K+ in downstream revenue per month!


54

Other considerations with Amounts:

– Distribution and communication of amounts is critical

– Paper or Plastic? • Do you have hard copy price sheets, or do you

have software• Version Control• Usability/Math• Accuracy


55

Other considerations with Amounts:– Estimators

• Homegrown– Spreadsheet, Database, Calculators, Abacus, Paper

» PROs: Cheap and Easy» CONs: Time investment, Maintenance, Inaccurate

• Proprietary– Real-time estimate and/or eligibility– Configured to managed care contracts

» PROs: Accurate, Fast, Professional» CONs: Initially can be expensive with

hardware/software, interface/integration concerns


56

Other considerations with Amounts:

– Estimators (Continued):

But we “NEED” this fancy new thingy?!!!

– Prove it:

» Pilot/Trial in focused area to demonstrate value» ROI» Proformas» Customer Service

• Huge Opportunities – – several vendors – “buyers market” currently– ROI is typically a matter of months


57

Estimators (Continued):

• Determine Risk at front end from Eligibility, Auth, Benefit/OOP, and propensity to pay

• Couple with Credit Scoring to establish eligibility to other funding mechanisms

• Pre-qualify scheduled appointments• Streamline estimation and eligibility checks


58


59


ELIGIBILITY AND BENEFITS ESTIMATION TOOL JUSTIFICATIONPROJECTED 2008 - BCH IMAGING

$-

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

REVENUE WITH TOOL REVENUE WITHOUT TOOL

NET ADDITIONAL REVENUE 2008: $359,000

`

60


Streamlining Workflows

61

Implementation Suggestions:

Test the workflowRole PlayRoll out in PhasesFocus efforts on simple items first

low-hanging fruit, e.g. uninsured/self-pay

Estimation of Patient Services– Streamling Workflows

62

Keep it simple…..

– “It is an expectation of your job to ask for patient portions”

– Ask the simple question – “Do you know your amount to pay today?”

– Provide Options, NOT ultimatums– Start small, use paper, then expand to

system-wide integration

Estimation of Patient Services – Streamling Workflows

63

Estimation of Patient Services– Streamling Workflows

64

LOOK BEFORE YOUR LEAP…

Know the amounts (even if a estimates) before you ask people, to ask patients, for it

Know how you are going to handle and process the money

Know how to handle customer service issues and complaints

Know how to defend the mission of the POS Collections Effort

Know how to adjust the process quickly

Estimation of Patient Services– Streamlining Workflows

65

Workflow Development:

– Develop POLICY to support the PROCEDURE within the SCOPE of the project

– Determine:• When (Specific Steps)• Who (Collection Advisory)• Why (“Doors” and “Bulls eye”)• What (how much $)• How (Scripting/Key Phrases)

Estimation of Patient Services– Streamlining workflows

66

Enter Tests to bePerformed

Patient Arrives

EXAMPERFORMED

ADMITPATIENT

CURRENT OPTIONS TO DETERMINE/COLLECT PATIENT RESPONSIBILITYPORTION (PRP)1. SSI FEED2. "CHARGE ANTICIPATION" FEE SCHEDULE (IF COINSURANCE EXISTS)3. MINIMUM COLLECTION OF BILLED($ OR %)4. CREDIT CARD/BLANK CHECK

PRE-REG AND REGISTRATION:

Patient Verification Order Verification Insurance Verification Copay Determination

PRPREQUIREDOR SELF

PAY ?

? FINANCIALCOUNSELORROLE HERE

YESNO

SEE SCRIPT

FINANCIALRESOLUTIONACHIEVED? NO

YES

SELF-PAY:PATIENT INSTRUCTEDTHAT EXAM RESCHEDULED

INSURED: ATTEMPT COLLECTION,ALLOW EXAM IF UNABLE TO PAY,REINFORCE POLICY

REQUEST PAYMENT/SIGNATURE

(SEE SCRIPT)

POS COLLECTION

WORKFLOW

DRAFT

Patient scheduled and pre-registered(where possible)

Opportunity tocommunicate

collection effortsto patient

Estimation of Patient Services – Streamling Workflows

67

POS COLLECTIONS

Scheduling / Pre-Registration Workflow

EXAMSCHEDULINGCOMPLETE

Patient/Physician /Faxed

Order ?

Scheduler: "BCH expects payment of the Patient Responsibility Portion (PRP) for exams at thetime of service. If you have insurance, we encourage you to contact your insurance companyprior to your appointment to determine your insurance benefits and any out-of-pocket expensefor your exam. Please bring information from your insurance company (last explanation ofbenefits from insurance (EOB), on-line print screen, etc) that indicates the amount you owe foryour exam. We will be collecting that patient portion of your exam when you arrive for your test,in the form of a credit card, personal check, or cash. If you cannot determine your portion, orare a self-pay patient, we can estimate the amount that we will be collecting. [use pricer orestimated cost of care down payments] If your PRP cannot be easily determined, a credit cardimprint will be obtained to bill for your portion once determined."

SCHED/PRE-REG AWAITSPATIENT TO CALL FORSCHEDULED TIME (IF TIMEPROVIDED BY PHYSICIANOUTBOUND CALL WILL BENECESSARY BYSCHEDULING / PRE REG)

Physician/FaxedOrder

Patient

DNC LIST?

BYPASS ALL

PRP collectionsactive?

YES

NO

NO

YES

Scheduler: "If you do not have a creditcard, we can accept a personal check"

Additional billingquestions?

Pt: "I don't have a credit card."

CREDITCARD?

PersonalCheck?

Scheduler: "Thank you, we willcollect payment in that form. If youhave insurance, make sure youcheck with your insurance beforeyou come in. We will see you foryour [exam] at [time] on [date] at the[facility] Campus. Is there anythingelse I can help you with today?"

Scheduler: "Let me transfer you to ourfinancial counselors at (303) 440-2139 (orother area as appropriate) to address yourquestions. Please call us back once yourquestions have been answered and we willcomplete the scheduling of your exam. Thankyou for your patience."(Call transferred to appropriate area)

Placeappointmentin "Pending"

Y/N?Scheduler:"Have a niceday" (Call ends)

YES

YES

NO

YES

NO

NO

cash?

YES

NO

POS COLLECTIONS

RECEPTIONWORKFLOW

SR: "I can estimate the amount for you based off of someinformation we have from various insurance companies and ourcharges. If you are not comfortable with an estimate, we collect animprint of a credit card to allow the hospital to bill for your portion ofyour exam(s) today. That portion will be determined after the claimis submitted to your insurance company, in approximately 60 days.Ten days prior to that time, the billing office will send you a letter tonotify you of the amount and charge it to your credit card. This willallow you time to review your charges prior to them being billed.

SR: "I would like to go over the insurance information youhave provided so far to make sure we complete andaccurate information to file a claim with your insurancecompany. Let's go over this, and please feel free tointerrupt me if you don't understand something."

PT: "Yes, I havemy Credit Card"

SR: "Thank you. Iwill prepare your

receipt"

SR: "Thank you again, and if you have any questions,please contact our billing department at (303) 544-5744"

CREDITCARD?

(SR REVIEWSINSURANCE INFO WITHPATIENT AND MAKESANY NECESSARYCHANGES)

For unknown amounts with a CCI, SR takes the credit card and imprints it,writing "[AREA] EXAM - PATIENT PORTION" in the description field of theCredit Card Slip. The CUSTOMER copy is given to the patient, and theMERCHANT copy is attached to a face sheet. The Credit Card Slip ishand delivered to the PBA and held until the account is processed. Note:Known amounts are processed through the credit card machine andposted into the Cashier Drawer.

Yes

SEE NEXT PAGENO

SR: "Did your insurance company determinethe patient portion of your exam today?"

AMOUNTKNOWN?

NO

YESSR: "Great. How would you like to pay thisamount today, by Credit Card or Check"?

PTPORTION?

YES

NO

Patient is provided with a "CopayCollection information sheet"

(ISR verifies amount)

SELF-PAY?

YES

SR; "We collect "x"amount for the testyou are receivingtoday(refer to Pricer orEstimated Cost ofCare Downpayment).We can acceptpayment via cash,

credit card or check. "

YESDNC LIST? YES

BYPASS ALL

NO

NO

START

END

YES

ESTIMATE /CCI / NONE ?

ESTIMATE

CCI

IF INSURED, REINFORCE POLICY. BILL WILLBE SENT, PAYMENT WILL BE EXPECTED

NEXT TIME, AND EXAM CAN OCCUR.IF SELF PAY, SEE NEXT PAGE

NONE

SR = SERVICE REPRESENTATIVE (RECEPTION)

COVERAGEAMOUNT

DETERMINED?

Yes

NO

Yes

NO

NONO

Estimation of Patient Services – Streamlining workflows

68

Be prepared to handle the following scenarios with patients:

They may not have their wallet They may not have their ins card Their may not have cash on hand They may not have credit cards Their deductible may be too high


69

Estimation of Patient Services– Streamlining workflows

COPAY COLLECTIONTASK FORCE

RECEPTION WORKFLOW

(continued - NO CREDIT CARD, NOCHECK, NO CASH - RESCHEDULE IF

SELF-PAY)

NO CASH ORPERSONAL CHECK?

YES

No

SEE PRIOR PAGE

PT: "I do not want to pay with acheck at this time." OR "I do notwish to pay a copay at this time".

SR: "I understand. We mustcollect a credit card imprint orcheck for the estimated paymentportion to bill more efficiently.

ISR: "Is their anything else Ican help you with today"

(ISR provides patient with a Copay CollectionForm and addresses any outstanding issues)

[**** IF PATIENT OR PHYSICIAN INDICATES EXAM IS AN EMERGENCY (I.E. STAT EXAM), AND INDICATES THEY ARE UNABLE TO PAY, CONTACT THE SITE MANAGER, DIRECTOR, OR SUPERVISOR TO DETERMINE IF EXAM NEEDS TO BE PERFORMED TODAY. IF A SUPERVISOR, MANAGER, OR DIRECTOR IS NOT AVAILABLE, ALLOW APPOINTMENT TO BE PERFORMED. IN CASES WHERE THE EXAM IS DEEMED AN EXCEPTION THOUGH ABOVE THEN DOCUMENT, “EXAM IS DEEMED MEDICALLY EMERGENT”, IN THE BLUE COMMENTS FIELD OF THE REGISTRATION SCREEN, PRINT IT, AND PROVIDE TO SITE MANAGER OR DIRECTOR. ALSO DOCUMENT EXCEPTION ON EXCEPTION LOG.]

INSURED PATIENTS: Please be aware that a bill will be sent to you outlining the charge(s) for the procedure(s) performed today. Payment in full will be expected at that time. At your next visit, please be prepared to pay for your exam(s) before services are rendered. [REFER TO FINANCIAL COUNSELING/PBA IF FURTHER FINANCIAL ASSISTANCE IS NEEDED

SELF-PAY CICP/ WECARE: Unfortunately, we cannot perform your exam unless you provide us payment. Would you like to speak with Financial Counseling at x2139? (303) 440-2139? You can reschedule your exam after you have made arrangements for payment. [Provide numbers and “commonly asked questions sheet”]

70

Point of Service (POS)Collections Manual

Jonathan Wiik PH: (303) 440-2049 PG: (303) 509-0176 E-mail: [email protected]

To see the binder spines, turn to page 2 of this publication.

Version 1— 6/13/06

POS COLLECTIONS

Scheduling / Pre-Registration Workflow

EXAMSCHEDULINGCOMPLETE

Patient/Physician /Faxed

Order ?

Scheduler: "BCH expects payment of the Patient Responsibility Portion (PRP) for exams at thetime of service. If you have insurance, we encourage you to contact your insurance companyprior to your appointment to determine your insurance benefits and any out-of-pocket expensefor your exam. Please bring information from your insurance company (last explanation ofbenefits from insurance (EOB), on-line print screen, etc) that indicates the amount you owe foryour exam. We will be collecting that patient portion of your exam when you arrive for your test,in the form of a credit card, personal check, or cash. If you cannot determine your portion, orare a self-pay patient, we can estimate the amount that we will be collecting. [use pricer orestimated cost of care down payments] If your PRP cannot be easily determined, a credit cardimprint will be obtained to bill for your portion once determined."

SCHED/PRE-REG AWAITSPATIENT TO CALL FORSCHEDULED TIME (IF TIMEPROVIDED BY PHYSICIANOUTBOUND CALL WILL BENECESSARY BYSCHEDULING / PRE REG)

Physician/FaxedOrder

Patient

DNC LIST?

BYPASS ALL

PRP collectionsactive?

YES

NO

NO

YES

Scheduler: "If you do not have a creditcard, we can accept a personal check"

Additional billingquestions?

Pt: "I don't have a credit card."

CREDITCARD?

PersonalCheck?

Scheduler: "Thank you, we willcollect payment in that form. If youhave insurance, make sure youcheck with your insurance beforeyou come in. We will see you foryour [exam] at [time] on [date] at the[facility] Campus. Is there anythingelse I can help you with today?"

Scheduler: "Let me transfer you to ourfinancial counselors at (303) 440-2139 (orother area as appropriate) to address yourquestions. Please call us back once yourquestions have been answered and we willcomplete the scheduling of your exam. Thankyou for your patience."(Call transferred to appropriate area)

Placeappointmentin "Pending"

Y/N?Scheduler:"Have a niceday" (Call ends)

YES

YES

NO

YES

NO

NO

cash?

YES

NO

POS COLLECTIONS

RECEPTIONWORKFLOW

SR: "I can estimate the amount for you based off of someinformation we have from various insurance companies and ourcharges. If you are not comfortable with an estimate, we collect animprint of a credit card to allow the hospital to bill for your portion ofyour exam(s) today. That portion will be determined after the claimis submitted to your insurance company, in approximately 60 days.Ten days prior to that time, the billing office will send you a letter tonotify you of the amount and charge it to your credit card. This willallow you time to review your charges prior to them being billed.

SR: "I would like to go over the insurance information youhave provided so far to make sure we complete andaccurate information to file a claim with your insurancecompany. Let's go over this, and please feel free tointerrupt me if you don't understand something."

PT: "Yes, I havemy Credit Card"

SR: "Thank you. Iwill prepare your

receipt"

SR: "Thank you again, and if you have any questions,please contact our billing department at (303) 544-5744"

CREDITCARD?

(SR REVIEWSINSURANCE INFO WITHPATIENT AND MAKESANY NECESSARYCHANGES)

For unknown amounts with a CCI, SR takes the credit card and imprints it,writing "[AREA] EXAM - PATIENT PORTION" in the description field of theCredit Card Slip. The CUSTOMER copy is given to the patient, and theMERCHANT copy is attached to a face sheet. The Credit Card Slip ishand delivered to the PBA and held until the account is processed. Note:Known amounts are processed through the credit card machine andposted into the Cashier Drawer.

Yes

SEE NEXT PAGENO

SR: "Did your insurance company determinethe patient portion of your exam today?"

AMOUNTKNOWN?

NO

YESSR: "Great. How would you like to pay thisamount today, by Credit Card or Check"?

PTPORTION?

YES

NO

Patient is provided with a "CopayCollection information sheet"

(ISR verifies amount)

SELF-PAY?

YES

SR; "We collect "x"amount for the testyou are receivingtoday(refer to Pricer orEstimated Cost ofCare Downpayment).We can acceptpayment via cash,

credit card or check. "

YESDNC LIST? YES

BYPASS ALL

NO

NO

START

END

YES

ESTIMATE /CCI / NONE ?

ESTIMATE

CCI

IF INSURED, REINFORCE POLICY. BILL WILLBE SENT, PAYMENT WILL BE EXPECTED

NEXT TIME, AND EXAM CAN OCCUR.IF SELF PAY, SEE NEXT PAGE

NONE

SR = SERVICE REPRESENTATIVE (RECEPTION)

COVERAGEAMOUNT

DETERMINED?

Yes

NO

Yes

NO

NONO

POS COLLECTIONS – QUICK SCRIPT Scheduling/ Pre-reg

1. PHYSICIAN/ OFFICE:

Insured Patient: SR: "BCH expects payment of the Patient Responsibility Portion for exams at the time of service. We encourage patients to contact their insurance company prior to their appointment to determine insurance benefits and any out-of-pocket expense for their exam. We will be collecting that patient portion when they arrive for their test, in the form of a credit card, personal check, or cash. Please inform your patient of this policy. Thank you.”

Self-Pay / CICP / WECARE Patient: SR: " Payment in full is required prior to services being rendered. There is a discount program available, where if paid at time of service, a discount off the price can be applied. If payment in full is not received at the time of service, this discount may be less or after 30 days, not available. We encourage your patient to contact us as soon as possible to discuss payment options regarding their exam(s). Please inform your patient of this policy. Thank you.”

2. PATIENT:

Insured Patient: SR: " Do you happen to know your insurance benefit or patient responsibility portion for the exam(s) that have been ordered for you?” [If “YES” SKIP TO OPTION (1)]"BCH expects payment of the Patient Responsibility Portion for exams at the time of service. We encourage you to contact your insurance company prior to your appointment to determine your insurance benefits and any out-of-pocket expense for your exam. Please bring information from your insurance company (last explanation of benefits from insurance (EOB), on-line print screen, etc) that indicates the amount you owe for your exam. We will be collecting that patient portion of your exam when you arrive for your test, in the form of a credit card, personal check, or cash.

[3 OPTIONS – (1) USE AMOUNT PROVIDED, (2) ESTIMATE AMOUNT, (3) CREDIT CARD IMPRINT]

Self-Pay / CICP / WECARE Patient: SR: ”Payment in full is required prior to services being rendered. There is a discount program available, where if paid at time of service, a discount off the price can be applied. If payment in full is not received at the time of service, this discount is not available. Please wait a moment while I determine the charge for the exam(s) in which you are receiving”

[ESTIMATE CHARGE(S) FOR EXAM AND PROMPT PAY DISCOUNT] SR: “The exam that will be performed is a [PROCEDURE]. The charge for this exam is $xxx. It is discounted to $xxx if paid at the time of service per the discount policy I mentioned earlier. Again, please note that this discounted price only applies if the amount is paid in full prior to services being rendered.

POS COLLECTIONS – QUICK SCRIPT Scheduling/ Pre-reg

1. PHYSICIAN/ OFFICE:

Insured Patient: SR: "BCH expects payment of the Patient Responsibility Portion for exams at the time of service. We encourage patients to contact their insurance company prior to their appointment to determine insurance benefits and any out-of-pocket expense for their exam. We will be collecting that patient portion when they arrive for their test, in the form of a credit card, personal check, or cash. Please inform your patient of this policy. Thank you.”

Self-Pay / CICP / WECARE Patient: SR: " Payment in full is required prior to services being rendered. There is a discount program available, where if paid at time of service, a discount off the price can be applied. If payment in full is not received at the time of service, this discount may be less or after 30 days, not available. We encourage your patient to contact us as soon as possible to discuss payment options regarding their exam(s). Please inform your patient of this policy. Thank you.”

2. PATIENT:

Insured Patient: SR: " Do you happen to know your insurance benefit or patient responsibility portion for the exam(s) that have been ordered for you?” [If “YES” SKIP TO OPTION (1)]"BCH expects payment of the Patient Responsibility Portion for exams at the time of service. We encourage you to contact your insurance company prior to your appointment to determine your insurance benefits and any out-of-pocket expense for your exam. Please bring information from your insurance company (last explanation of benefits from insurance (EOB), on-line print screen, etc) that indicates the amount you owe for your exam. We will be collecting that patient portion of your exam when you arrive for your test, in the form of a credit card, personal check, or cash.

[3 OPTIONS – (1) USE AMOUNT PROVIDED, (2) ESTIMATE AMOUNT, (3) CREDIT CARD IMPRINT]

Self-Pay / CICP / WECARE Patient: SR: ”Payment in full is required prior to services being rendered. There is a discount program available, where if paid at time of service, a discount off the price can be applied. If payment in full is not received at the time of service, this discount is not available. Please wait a moment while I determine the charge for the exam(s) in which you are receiving”

[ESTIMATE CHARGE(S) FOR EXAM AND PROMPT PAY DISCOUNT] SR: “The exam that will be performed is a [PROCEDURE]. The charge for this exam is $xxx. It is discounted to $xxx if paid at the time of service per the discount policy I mentioned earlier. Again, please note that this discounted price only applies if the amount is paid in full prior to services being rendered.


71


TRAINING FRONT LINE STAFF

72

• Be empathetic not sympathetic – understand patient’s situation but pursue reasonable

payment options with the patient

• Put yourself in the patient’s shoes – how would you want the situation explained, presented and

handled?

• We must be sincere when empathizing with the patient

Estimation of Patient Services – Training


73

How Do You Request For Payment In Advance?

• Registrars must choose their words carefully and be respectful, yet be direct with the patient

• Registrars need to be aware of their tone of voice when speaking with the patient

• Be firm about hospital policy and reassure the patient that paying in advance is for their benefit



74

“The goal of the BCH POS Collections Program is not to collect money. Our goal is to educate patients as to the costs of their care, and help them navigate these costs”

‘Boulder Community Hospital strives to help patients understand their health care costs. In that effort, coverage is verified, costs are discussed, and payment arrangements are made - in advance. Through this, bad debt is reduced and the operations of our hospital remain financially viable to continually serve our community”


75

“I never had to pay at time of service before.”

REGISTRAR RESPONSEI understand that you may have not been asked before. Since you were here last, we have made changes to our processes that no longer allow us to delay collecting payments. Also, there are many advantages of paying up-front. Foremost, you know the costs of your health care upfront, and we can process your payment using a variety of options available to you right now. How would you like to pay today? We accept check, cash,

credit cards.

Estimation of Patient Services– Training

76


Incentive Plans

Health Care is moving to retail, business-like atmosphere

Should not pay people to their jobs, it is an expectation

Award successes and good performance

Set awards at roughly 3-6% of salary

Incentives work, but are risky

Ensure Longevity of plan before launching

Large Policy and procedure

77

POS COLLECTIONS – Training

INCENTIVE AS COMPARED TO CCI ADJ COLLECTIONS

$-

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

JAN FEB MAR APR MAY JUN JUL AUG SEP* OCT* NOV* DEC*

PO

S C

OL

LE

CT

ION

S

$-

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

AW

AR

D P

AY

OU

T

CCI ADJ $ AWARD

78


Conclusion

79

In Summary…

– Critically analyze market trends and evaluate best practices– Adopt what would work well in your organization– Identify the components and scale the project to the

resources you have available– Train, retrain, and adapt the workflows– Educate your coworkers, customers, and community

Estimation of Patient Services – Closing Thoughts

80

Develop a Strategy and Collection Mechanism that is:

Easily deployedElegant and simpleFlexible by role and patient typeSupported by managementScalable

Estimation of Patient Services– Closing Thoughts

81

Have clear direction and momentum:

1. Have a meeting At an early stage, ensure to include the people who are

going to ask people for their money

2. Assemble a team

3. Build from existing workflows and add to them

4. Develop the “plan”

5. Test the workflows and track your results

6. Discuss Challenges and Celebrate Successes

7. Lead by example

8. Do not ever give up

Estimation of Patient Services - Closing Thoughts

82

Questions?

Estimation of Patient Services - Closing Thoughts

THANK YOU

Jonathan G. Wiik, MSHA, MBA

Imaging Operations Manager


(303) 440-2049

[email protected]

Val Kraus, MBA

Director of Admissions and Case Management


(303) 440-2124

[email protected]

Date post:	16-Dec-2015
Category:	Documents
Upload:	rosa-gillem
View:	214 times
Download:	1 times

1 Automating Estimation of Patient Services Jonathan G. Wiik, MSHA, MBA Imaging Operations Manager...

Documents