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Don't fail to collect on challenging accounts
Collection of high-dollar accounts is important to patient access for more reasons than the obvious. In addition to having a direct impact on the hospital's bottom line, it boosts staff morale and gives everyone a reason to celebrate. It's a golden opportunity to broadcast success to other areas of the hospital.
At Affinity Health System in Menasha, WI, patient access staff try "their best to get their copays up front, or even collect cash up front," says Jackie Mitchler, revenue cycle analyst in the patient business services department. "Having an experienced cashier up front is very helpful in your collection process. Let's face it, in order to survive, we need to collect the cash up front as much as we possibly can."
Some of the most challenging high-dollar collection accounts seen recently involve patients who do not have any insurance. "With economic times as they are, this is becoming more prevalent with time," says Mitchler.
Rex Healthcare's frontline intake specialists use formatted scripting "when having that crucial conversation with patients," says Joe Palumbo, CAM, CHAA, manager of patient access site administration for Rex Healthcare in Raleigh, NC.
"Upfront collections is one of our key performance indicators," says Palumbo. "I meet with the staff quarterly to review their monthly averages and remind them of this important part of their job. If they meet the criteria of our pay-for-performance process, they are rewarded with a bonus based on the previous month's outcomes."
Helen Contreraz, manager of patient access services at University of California-Los Angeles Medical Center, says that with clinically complex, high-dollar accounts such as an obstetrics or transplant patient, early identification of payer information and any potential "non-covered" amounts are key.
Armed with this information, staff can then research other possible payer sources. This may mean applying for state or federal programs, or there may be some flexibility within the payer itself. "For instance, for a catastrophic case, a care manager may be able to get them to make an exception. If it's a self-funded group, there may be some flexibility to manipulate some funding to take from this and give to that," says Contreraz. "We are also very aware of when the open enrollment period happens. With a transplant patient, for example, the patient might be able to switch to an HMO that has transplant benefits. You just need to get to that open enrollment period."
UCLA's access staff have had a great deal of success collecting on high-dollar trauma accounts by ensuring that the payer is concurrently notified. "This reduces our exposure for the notification not being timely and allows for the patient to be transferred when he or she is stable," says Contreraz. "We also work closely with the clinicians, so that a clinical discussion can occur with the appropriate clinician on the payer side."
Palumbo says there are various bariatric and surgical procedures that tend to result in patient liability "in the thousands," especially since they're considered non-covered services by most health plans. Here are some strategies to collect on these and other challenging, high-dollar accounts:
Give accurate estimates to patients.
Rex Healthcare's insurance processing team uses price estimator software, along with information from the payer's web sites, to determine out-of-pocket costs. "Our goal in the near future is to call all patients with an amount over $999, to forewarn them of what will be due at time of service," says Palumbo. "We hope to offer online services as a method of collecting those high amounts from our patients later this year."
Give staff monthly updates.
Palumbo says that this information helps his staff to see the immediate impact their collections have on the health system as a whole. "They also receive timely education on any related changes to insurance contracts or plan codes that will affect the price estimator software," he says.
Offer additional payment options.
Mitchler recommends looking at ways to expand your discount programs. "This will allow a greater volume of patients to pay their obligations," she says. "Provide a cash discount by giving 10% off the bill if the patient pays the full amount. Or, augment your point-of-service collections at patient access points." Here are some of the changes Affinity's patient access services department has made to improve its collections:
A Quality Assurance Policy & Procedure with a template specific to the hospital's registration health care information system was developed, as a way to hold staff accountable for their errors.
"Currently, this is being piloted in sample areas within the hospital and clinic setting," Mitchler says.
The patient business services department's system trainer and revenue cycle analyst installed a web-based product for credit card payments.
"The patient business services department plays a huge part in the patient access department's success," says Mitchler. "Hook up a $50 USB swiper on your current PCs, and set up your merchant ID numbers with the company you selected, and you are well on your way. There is no software to purchase." Monthly standard fees and transactional fees are incurred, which vary depending on the vendor you choose. With this in place, Affinity's department collected more than $7 million from July 2008 to December 2009.
The hospital's business office tracks denials through a software product and downloads the denials specific to registration every month.
These data indicated that terminated coverage and wrong payers were two of the most common reasons for denials. "We are paying closer attention to insurance eligibility patient information and trying to be more conscientious of selecting the right insurance," says Mitchler. "We are providing ongoing training on insurance information for our registrars."
Insurance eligibility software is used to validate the patient and subscriber's insurance benefits.
"This is a useful tool to provide the necessary copay, and validation of the patient's insurance plans," Mitchler says. "We can also build rules to pop up for additional information to 'push' out to staff regarding a certain insurance."
The department is currently looking at investing in software that identifies errors to the registration staff immediately. "Registrars would have to correct the errors on their workflow sheet prior to leaving at the end of the day," says Mitchler. "We have taken the first step in creating our ROI, should we want to purchase this software at a later date."
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