Enhancing the Patient Collection Process to Decrease A/R ... · Patient is billed once for pending balances Collection process is started Patient is sent to collection agency Characteristics:

Enhancing the Patient Collection Process

to Decrease A/R Days and Bad Debt

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 2

Session’s Objectives• Discuss the importance of proactively collecting self pay balances.

• Review different options for successfully collecting self-pay balances throughout the revenue cycle

process.

• Learn how Allscripts tools and solutions can help you support these efforts.


Agenda• The importance of streamlining self pay collections

• The patient collection process

• Self pay collection policies

• Strategies for reducing bad debt

• How to implement sustainable changes

• Measuring success

The Importance of Streamlining

Self Pay Collections


Patients are the NEW Payer

(i) PWC 2013 / (ii) Kaiser Foundation 2014/ (iii) American Medical News 2011



(i) The commonwealth fund 2012 / (ii) MGMA 2010 / (iii) McKinsey 2010



90%

70%

40%

Before they seetheir physician

At checkout After leavingmedical practice

% Likely to Pay

21%

79%

Collected After TOS

Collected Not Collected

SuccessEHS Study – Increasing Patient Collections: A Study on Patient A/R – Oct 2013 McKinsey & Company 2013

The Patient Collection Process


Typical Collection Process

Day 1 30 to 45 days 45 to 165 days

Patient is seen and copay is collected

Claim is created

and billed

Claim is paid by

the insurance

Patient is billed once

Patient is billed twice

Patient is billed three times

collection process

is started

Patient is sent to

collection agency

Characteristics:

• Limited efforts to collect prior to the patient being seen

• Basic patient collections at the time of service

• Extraneous efforts to collect after the patient has been seen


Desired Collection Process

Day 1 30 to 45 days 45 to 90 days

Eligibility & Benefits

Patient is contacted

Patient is seen and payments

are collected

Claim is created

and billed

Claim is paid by

the insurance

Patient balance is charged to their credit card

Patient is billed

once for pending balances

Collection process is started

Patient is sent to

collection agency

Characteristics:

• Extraneous efforts to collect prior to the patient being seen

• Comprehensive patient collections at the time of service

• Limited efforts to collect after the patient has been seen

7 Days Before


Leveraging Allscripts Tools

Scheduling

Pre-Visit

Check – InCheck –

Out

Post - Visit

* Use the Appointment Scheduling Screen to

identify outstanding balances

* Use Payerpath

Appointment Calls to remind

patients of your financial

policies

* Use scripts and Payerpath

Patient Payment Assurance to

collect credit card information

* Use Office Manager to manage

delinquent accounts

* Use scripts and Payerpath Patient

Payment Assurance to estimate future

balances and collect credit card

information

* Automate patient payments

using Payerpath Receipt

* Use Payerpath eStatements to

capture online payments

* Use Phreesia to establish payment

plans with automatic deductions

* Use Payerpath Eligibility to

review the patient’s coverage

Revenue Cycle Management (RCM) Services


What are MGMA Members Implementing?

Source: MGMA Member Community Research

40%

62%

16%

40%

12%

24%

18%

13%

21%

19%

36%

31%

15%

7%

11%

9%

15%

21%

27%

18%

52%

32%

37%

24%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Credit Card on File

ACH Payment Plans (Auto Withdrawal from CheckingAccount)

Credit Card Payment Plans

Virtual Credit Card Terminal

Patient Portal

Patient Liability Estimator

Not Planning Planning Implementing Implemented

1

2

3

4

5

Self Pay Collection Policies


Top 5 Self Pay Collection Policies• Payment Plans (Budget Plans)

• Collection Agency

• Patient Correspondence

• Financial Hardship

• Bad Address


Payment Plans

Policy: An account representative can create a payment plan and

payment schedule for a patient with a qualified outstanding

balance.

* The Physician Billing Office - MGMA

• Tips: • Document a payment schedule based on the patient’s balance that

includes the amount due per month and the minimum payment

requirements that do not require supervisor approval

• Implement a credit card on file program


Collection Agency

Policy: If a patient balance remains after patient balance follow-

up, a minimum of 95 days has passed from the date of posting,

and it is determined that the patient balance will not be written off,

the account will be turned over to a collection agency.

• Tips:• Automate the process and eliminate paper

• Track recovery rates and time elapsed from transfer of account

• Keep constant communication with the agencies to improve processes

• Utilize two collection agencies so they can compete for your business



Patient Correspondence

Policy: Written, telephone, or electronic correspondence from

patients will be directed to the billing office for expedient follow-

up and resolution.

• Tips:• Document all correspondence in the Practice Management system

• Automate follow-up using Office Manager

• Work your correspondence within 48 hours

• Scan all your correspondence using the PM batch numbers



Financial Hardship

Policy: Patients are expected to pay for services rendered. The

practice will assist patients who indicate they are unable to meet

their financial obligations by resulting from care provided by our

practice. Patients may be determined as eligible for partial-to-full

discounts using the current poverty guidelines issued by the state.

• Tips:• Use different transaction codes to track these adjustments

• Consider using sliding fee scales to automate the auto adjustments

• Consider using account types to easily identify these accounts



Bad Address

Policy: The billing staff will determine the reason for bad address

information resulting in returned mail, and will obtain correct

information for rebilling.

• Tips:• Consider using account and/or note types to easily identify these

accounts

• Consider sending these accounts to a collection agency within 60 days


Strategies for Reducing Bad Debt


Recommendations

• Set protocols for patient follow up following the Fair Debt

Collections Practices Act (FDCPA) recommendations

• Establish protocols for payment plans

• Develop a relationship with a financier of medical services

• Collect when the patient is in the office

• Use a credit card on file program and an estimator

• Follow up on all patient correspondence

• Process returned mail within 48 hours


Recommendations (Cont’)

• Show patients how to read the statement

• Offer e-statements and online patient bill paying

• Research coverage for self pay patients

• Develop and use a charity care policy

• Consider reporting bad debt to the credit bureau(s)

• Identify focused staff for patient inquiry management

• Apply best technology configuration for optimal collections

How to Implement Sustainable

Changes


Successfully Implementing Change

Step 1: Get Leadership

Support

Step 2: Conduct a

Gap Analysis

Step 3: Investigate

Options

Step 4: Prepare for

Implementation

Step 5: Train Staff Members


Get Leadership Support


Conduct a Gap Analysis

• Evaluate current policies and procedures

• Identify macro-economic changes that directly affects the

organization’s financial performance

• Review underutilized reimbursement programs


Investigate Options

American Association of Orthopedic Surgeons

Industry Associations:

Specialty Associations:

Business Partners:


Prepare for Implementation

• Identify the project’s scope and priorities for change

• Map end-to-end processes and discover redundancies

• Document opportunities for improvement

• Determine measurable goals and improvement targets

• Establish ownership and accountability

• Develop a timeline


Train Support Staff

• Share the BIG picture

• Develop incentives for desired outcomes

• Provide sample responses to communicate with the patient

• Provide easy-to-use job aids

• Provide ongoing support

Measuring Success


Tracking Productivity• Based on 7 hours of productive time per day

Measure Daily Benchmark Hourly Benchmark

Self pay follow-up 70 – 90 / day 10 – 13 / hour

Correspondence

processed

90 – 105 / day 13 – 15 / hour

Patient billing inquiries 125 – 140 / day 15 – 18 / hour

Responding to patient

billing inquiries

Within 24 hours



Tracking Financials

Measure

Self pay A/R

Average self pay balance

Self pay aging

Self pay collections

Bad debt vs Charity Care

Days revenue outstanding

Don’t Forget Patient Satisfaction

What if I need help with my

revenue cycle?


Allscripts RCM Services

Allscripts Practice

Management™

Allscripts

Payerpath®

Allscripts Practice

Performance™

Education

& Training

RCM Services

Client


How do we do it?

A unique and proven

combination of people,

process and technology

created to deliver

exceptional customer outcomes

CURVE

ANALYTICS

CLIENT

EXECUTIVE

CODING &

COMPLIANCE

EDI

SERVICES

WORKFLOW

OPTIMIZATION

DOCUMENT

MANAGEMENT

RECONCILIATION

& AUDITING

DATA

APPLICATIONS

SUPPORT

CENTER

OPTIMIZATION

& TRAINING

ACCOUNT MANAGER

CHARGE ENTRY | PAYMENT POSTING

PATIENT CALLS | FOLLOW-UP

APPEALS


Two Options To Fit the Client’s Needs

• Full service, comprehensive outsource – allows practice to virtually eliminate billing office and reduce/repurpose FTEs

• Includes services from master files maintenance to self-pay follow-up

• Provides piece of mind and easy scalability with end-to-end services bundle

• Transparency for all stakeholders

• Limited scope co-source services – allows practice to retain more control over revenue cycle

• Minimal change to practice staff count – focus on practice initiatives and patient care

• Clients can handle their own denial management and self-pay follow-up functions

• Transparency for all stakeholders

Full Services RCM Shared Services RCM


Shifting the Responsibilities: Full Services


Shifting the Responsibilities: Shared Services


Top 3 FAQ• How often should our organization review self pay processes?

– Review self pay processes at least once a year to make sure they support the current and

future needs of the organization.

• Should I include staff members during the implementation planning?

– Yes: Staff members’ buy-in is important to encourage adoption.

• Does Allscripts provide revenue cycle outsourcing?

– Yes: Allscripts provides different solutions to support your revenue cycle needs.

Documents

Enhancing the Patient Collection Process to Decrease A/R ... · Patient is billed once for pending balances Collection process is started Patient is sent to collection agency Characteristics: