TOS Collections Initiative: Union General Hospital

Industry WebinarDecember 13, 2016

● Webinar Recording and Presentation Slides

● Handouts

● Questions for Panelists

Housekeeping

Handouts:

● Presentation Slides● CSH-3550-4 UGH Daily Deposit Form● CSH-1300-3 ED Point of Service Collections● CSH-3515-3 Daily Cash Drawer P&P● CSH-3517-3 Web Pay Reconciliation Sheet● CSH-3516-3 Web Pay Posting Job Aide● REV-1102-3 POS Scrpting● CSH-3520-4 Daily Collection Log● CSH-3515-4 Cash Drawer Log● CSH-3516-2 Paragon Payment Posting Job Aide

Housekeeping

Panelist

Jay MerryDirector of Revenue Cycle

Union General Hospital

jaymerry@uniongeneral.org

TOS Collections Initiative

Jay MerryDirector of Revenue Cycle

▶ Collections at Union General

◦ Culture

⚫ Keep patient happy – limit refunds

◦ Limited tool set

⚫ Eligibility

⚫ KPI management

⚫ Tracking of Collections

◦ Historically retrospective

◦ Shifting payment models

Context

▶ Emergency Department (UGH and CRH)

▶ Rationale

◦ Starting Point - Virtual zero collections

◦ Controlled Environment – Easier to evaluate changes

◦ Limited service offering- Copayments and deposits only

◦ High Patient Volume – More opportunity for engagement

◦ Registration Staff – Limited training requirements at onset

▶ Once Perfected – adjust and implement for all levels of care

Initiative Setting

▶ TOS Collections as a % of net revenue (ED)

◦ UGH – .0432%

◦ CRH – .0866%

◦ Industry benchmarks*

⚫ Top Quartile – 1.1%

⚫ National Average - .8%

⚫ Best – 2.4%

◦ *Based on HFMA and Revenue Cycle Academy national data

▶ Avg collection per ED registration (Based on FY volumes)

◦ UGH - $.21

◦ CRH- $.35

Historical Performance FY 2016

Average TOS Collections in ED

• Under 200 beds• Average - $11,750 per month• Best - $20,833 or more• UGH - $4,269.04 total FY2016

▶ Policy and Procedure Development

▶ Cash Control

▶ EMTALA regulation compliance

▶ Clinical Staff Cooperation

▶ HIPAA (Patient Privacy)

▶ Incentives

Challenges

Best Practice for ED Collections

▶ Focus Group◦ Policies and Procedures – Cash Control, etc.◦ Scripting◦ Job Aides◦ Best Practice Standards◦ Incentive Plan

▶ Workflow◦ COWs – do not use currently◦ EMTALA compliance◦ Incorporated with full registration◦ Creation of “check out” area⚫ Early discharges, fast track, and semi private rooms

Development

▶ Relay Health ◦ Web Pay - All payment methods◦ Eligibility – Integrated Rev Runner Toolbar◦ Estimator - (pending implementation)

▶ Polices and Procedures◦ CSH-1300-3 ED POS Collections◦ CSH-3515-3 Daily Cash Drawer P&P◦ CSH-3517-3 Web Pay Reconciliation Sheet◦ REV-1102-3 POS Scripting

▶ Sisense◦ Collection performance – Key KPIs◦ Incentive management

Tools

Sisense

Sisense

Sisense

Sisense

▶ Self Pay◦ $0.01-$100.00 - .10%◦ $101-$9999.99 - .15

▶ Insurance◦ $0.01-$999.99 - .10%◦ $1000.00 - $9999.99 - .15$

▶ 10 day window (posting date based)▶ Credited to creator of registration event▶ Paid Monthly, in following pay period

Incentive Plan

Incentive payout – Oct 2016

▶ FY 2016◦ TOS Col % NR⚫ UGH - .0432%⚫ CRH - .0866%⚫ Top Quartile – 1.1%⚫ Best – 2.4%

◦ Avg Col Per ED Reg⚫ UGH - $.21⚫ CRH - $.35

Performance Comparison▶ FY 2017 To Date◦ TOS Col % NR⚫ UGH – .6598%⚫ CRH - .5465%⚫ Top Quartile – 1.1%⚫ Best – 2.4%⚫ GOAL – 2.4%

◦ Avg Col Per ED Reg⚫ UGH - $3.30⚫ CRH - $2.15⚫ GOAL - $5.00

▶ FY 2016

◦ Copay collection⚫ 2.5%

◦ Self Pay collection⚫ 3.7%

Performance Comparison▶ FY 2017 To Date

◦ Copay collection⚫ 27.3%⚫ Best – 42%⚫ GOAL – 40%

◦ Self Pay collection⚫ 12.4%⚫ Best – 32%⚫ GOAL – 30%

◦ Tools⚫ Eligibility – batch and real time⚫ Policies and Procedures (cash control, collections, etc.)⚫ Scripting⚫ Reporting⚫ Estimator ⚫ KPI Management – Benchmarking⚫ Industry resources – MGMA, HFMA, Revenue Cycle Academy

◦ Strategies⚫ Incentive structure – make it a competition⚫ Pre-visit estimation (where applicable)⚫ Batch AND real-time eligibility use⚫ Combination of account AND encounter specific balances⚫ Azalea uses “Patient Time of Service Collections Report”

Outpatient Application

◦ Strategies⚫ Goal setting⚫ Educate, explain, and give the patient⚫ Options⚫ Reasons

⚫ Documentation in the record⚫ Train, Educate, Measure, Manage, Repeat⚫ Culture

Outpatient Application

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