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OWEN DAHL, FACHE, CHBC Patient Collections Get Results
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OW E N DAHL , FACHE , CHBC
Patient Collections Get Results
Call to action Key performance indicators Strategy Pre-visit Time-of-service Post-visit Conclusion
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MGMA research: 10% of practice’s revenue now derived from High-
Deductible Health Plans1
The Rise of Consumer-Directed Health Care
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12011: MGMA Practice Perspectives on Payment – 2009, http://www.mgma.com/patientpayments/, Median data reported. *Estimate is statistically different from estimate for previous year shown (p<.05).
Note: The 2011 estimate includes 0.3% of all firms offering health benefits that offer both an HDHP/HRA and an HSA -qualified HDHP. The comparable percentages for 2005, 2006, 2007, 2008 and 2009 are 0.3%, 0.4%, 0.2%, 0.3% and 0.1%, respectively.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2005-2011. Published 10/10. 3
The Increase in Uninsured
Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2011 ASEC Supplement to the CPS. December 6, 2011.
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Private Non-group 5%
Source: 2007 & 2013: The ‘Retailish’ Future of Patient Collections”, Celent, February 2009, http://reports.celent.com/ 2011: MGMA Practice Perspectives on Payment – 2009, http://www.mgma.com/patientpayments/, Median data reported.
Patient Responsibility as a Percent of Total Revenues
2007 2012
12%
20%
30%
2011
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Collecting from patients costs 2 times what it costs to collect from a payer!!
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Days in receivables outstanding (DRO)
Range: 40 to 45
Total Receivables^, Net of Credits
Average Daily Charge*
*Previous 12 months worth of gross charges, divided by 365 ^Invoices sent to collection agency are excluded.
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Aged Trial Balance (ATB)
Receivables owed by age, net of credits
0-30 (Current)
Over 120
61-90
91-120
31-60
Range: 10 % to 15%
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Adjusted collection rate Dollars collected by dollars owed (not charged)
Net collections
Expected payments (allowables)
Of the dollars that we deserve to get paid, how much do we actually collect?
Range: 95% to 98%
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Time-of-
Service
Post-Service
Pre-Service
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Copays
Copays, Balances, Deposits
Copays, Balances, Deposits; Non-emergent Surgeries:
Coinsurance, Unmet Deductibles
Copays, Balances, Deposits; All: Coinsurance,
Unmet Deductibles
Contract
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Financial policy
In writing
On your website
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Opportunity to establish expectations
Insurance verification + Benefits eligibility + Financial responsibility
When?
In concert with scheduling the appointment
2 to 3 days in advance of appointment
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“Financial Clearance”
Appointment confirmation
Reveal expectations regarding time-of-service payment
Collect on “due” balances
Request pre-payment for scheduled services*
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*Check with your payer contracts regarding ability to collect on a pre-service basis.
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Time-of-
Service
Post-Service
Pre-Service
Time-of-Service •Expectations •Staff
•Directors of TOS Collections •Tools & resources
•Scripts •Scan •Practice management system •Credit/debit card
Check in
Demographic and insurance information
Scan or copy the card and patient identification
Ask for the referral source
▪ Protocol to thank him/her
Financial policy
Billing-related authorizations (more…)
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Assignment of Benefits I hereby assign to XYZ Practice any insurance or other third-party benefits available for health care services provided to me. I understand that XYZ Practice has the right to refuse or accept assignment of such benefits. If these benefits are not assigned to XYZ Practice, I agree to forward to XYZ Practice all health insurance and other third-party payments that I receive for services rendered to me immediately upon receipt. _________________________________________________________ Signature of Patient/Legal Guardian Date Sample only
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Non-Covered Services Your insurance company will only pay for services that it determines to be medically necessary. If your insurance company determines that a particular service, although it would otherwise be covered, is not medically necessary, your insurance company will deny payment for that service. I believe that, in your case, your insurance company is likely to deny payment for one or more of the following reasons: [Statement regarding the service being provided and why the insurance company is likely to deny payment.] I have been notified by my physician that he/she believes that, in my case, my insurance company is likely to deny payment for the service identified above, for the reasons stated. If my insurance company denies payment, I agree to be personally and fully responsible for payment. ______________________________________________________________ Signature of Patient/Legal Guardian Date Sample only Medicare: ABN
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https://www.cms.gov/BNI/02_ABN.asp
Don’t forget to greet the patient!
Do ask for payment:
“How would you like to take care of your payment today, Ms. Jones?”
“Ms. Jones, will it be cash, check or credit card?”
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Say “thank you”!
Collect a “minimum” deposit for full-pay patients
Example:
A. $100 for new patients; $50 for established
B. $250 for all patients
C. $10 for all patients
At minimum, for scheduled procedures and surgeries – dollars or percent
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Do ask for all payments:
“Due” account balance
Copayment
Coinsurance and unmet deductibles
▪ At check-out
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Cash Credit cards Debit cards HSA Cards Personal checks (more…)
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Personal Checks Make sure all fields – practice’s name, dollar
amount, signature – are complete Contract with a check verification service Request photo identification Require patients who have submitted bad
checks in the past to use an alternative form of payment
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Offer lending options
External vendor
Internal payment plan
▪ Parameters: example: $25; 6 months
Secure collection of credit card information
▪ “Swipe, hold,a and charge”
“How much more time do
you need?”
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• Use the patient’s name • Look the patient in the eye • Demonstrate that you expect payment
• Write out the receipt • Accept all forms of payment • Once you take possession of the card…
“You have a small balance of $XX. Can we go ahead and run your card for that, too?
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Refer to the patient’s “discount” versus “contractual adjustment”)
Choose a Partner!
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•Change your signage
•Instead of …
“Copayments are Expected at the Time of Service”…
*Check with your payer
contracts; may need to negotiate ability to assess fee.
•Charge a “non-collection” fee* •Use the benefits summary and the EOB •“If not, why not?” report
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Third-Party Payer
Claim*
Patient
Statement •Submit daily •Transmit electronically •Work “errors” immediately
•Submit 3x per week; better: online •Drop when due, not by alpha •Don’t send “FYI” notices
*CMS 1500: www.cms.hhs.gov/CMSForms/CMSForms/
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Collections
•Tighten your cycle
Statement at Check-
out
30 days Statement
Two
60 days Statement
Three
75 days Final
Notice
90 days Collections
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Patients who are willing to pay, will
Source: AthenaHealth, 2006, based on 6,000 physicians.
< 4%
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Collections •Use U.S. Postal Service’s “Address Service Requested” •Go online •Accept credit cards •Send compelling collection letters •Don’t threaten what you do not intend to do •Supplement with phone calls •Get your front office intimately involved
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•Include a due date •Blame someone else… “Our accountant will not allow us to carry the account on our books.” •Be specific regarding amount due •Outline options •Use colored paper •Handwrite the address; stamp the envelope •Use an “invitation-sized” envelope
Collection letters
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Inside of the card
“…and it would be appreciated if you
paid your outstanding amount
of $xxx.” www.rentons.com
Congratulations! Your account just had a birthday. It is 30 days old. Please pay it!
Give choices with a box beside each that the guarantor checks off: o I am sending a check on _______. o Here is part of your bill to show that my heart is in the right place. o Here’s the whole amount; so leave me alone!
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•Adjust it off to “Agency” code (you can always reverse it…)
•Pre-collect /Early out
•Collections (15% to 35%)
•Other services?
•Bad addresses
•Payment plans
•Negotiate Rate
•Evaluate process of sending – and receiving
•Key is to automate it!
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Collection Agency
•Confirm (court v. patient)
•Stop all collection efforts
•Adjust all balances to “bankruptcy”
•File proof of claim
•Wait (and hope)
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Bankruptcies
Opportunity to address administrative fees*
•Copayment collection fee
•Statement rebilling fee/interest
•Claim re-filing fee
•Pass-through of collection agency fee
•Reinstatement fee after dismissal
*NOTE: May be disallowed by payer. Please consult with an attorney regarding applicable state and federal laws.
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Other Collections Considerations
•Dismiss patients for non-payment •Consult with your malpractice carrier
•Use small claims court •You will get the judgment, but the court won’t collect for you
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•Develop financial hardship policy •Put it in writing •Decide what you want to collect from patients to substantiate it •Apply it consistently •Can extend to Medicare beneficiaries
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Appendix
Professional courtesy is defined in Stark II as “the provision of free or discounted healthcare items or services to a physician or his or her immediate family members or office staff.” In addition to the prohibition to Medicare patients, professional courtesy rules include:
•Must be offered to all physicians on the practice’s staff or in the local community without regard to volume or value of referrals; •May include only those services regularly offered by the practice; •Must be a policy written and approved by top practice management; •Cannot be offered for copay waivers unless the insurance company paying the bill is informed in writing; and •Does not violate anti-kickback laws or claims submission rules and regulations.
•Evaluate professional courtesy protocols
Source: March 26, 2004, Federal Register at http://www.cms.hhs.gov/PhysicianSelfReferral/Downloads/69FR16054.pdf
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Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals October 2009. Available at: www.cms.gov/MLNProducts/downloads/physicianguide.pdf The Physician Billing Process: Potholes in the Road to Getting Paid 2nd Edition, 2009. Available at www.mgma.com Maximizing Billing and Collections in the Medical Practice Available at www.amapress.com
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Owen J. Dahl, FACHE, CHBC Principal, Owen Dahl Consulting The Woodlands, TX 281.367.3364 www.owendahlconsulting.com [email protected]
© 2014
None of this material may be reproduced without the written consent of Woodcock & Associates. Contact Ms. Woodcock at 404-373-6195 or [email protected]
