“Surviving the Changing World of Patient Collections”

Page 1February 1, 2014

Prepared for WellStar Business of Medicine Program

Surviving the Changing World of Patient Collections

Presented to: WellStar Business of Medicine Program

February 1, 2014

Presented by:

Lori A. Foley, CMA, PHR, CMM

www.pyapc.com



Objectives

Understand how recent changes in healthcare reimbursement affect the practice bottom line.

Describe how you can best equip yourself in the current environment to maintain high collection percentages

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Recent Changes that Affect Patient Collections

• New health exchange plans– Platinum, Gold, Silver, Bronze – Greater liability regarding patient

responsibility if plan is subsidized

• Newly insured individuals– Patients that have been previously un-

insured may not understand the provisions of their plan or how insurance works in general




• More high-deductible plans- Many patients have plans with $5,000-

$7,500 deductibles

• Increased patient co-insurance responsibilities- Patient co-insurance responsibility (after

deductible) ranges from 20%-30% in most cases.

• Higher co-pays- Average copays range from $40 to $75.



Overall Impact in Georgia• As of December 28th, approximately 58,000 people had

enrolled in a plan through the exchange. However, others may have selected to apply directly with payers if they were not eligible for a subsidy.



Overall Impact in Georgia• As of December 28th, approximately 58,000 people had

enrolled in a plan through the exchange.

• The enrollment deadline was extended to March 31, 2014.

• Existing insurance benefits are changing overall to absorb the cost of expanding coverage.



Overall Impact on Practices• Practices must be more diligent in patient collections to

maintain a healthy bottom line.

• Insurance verification is more important now than ever. Practices risk a significant portion of revenue by not doing so.

• Patients and staff must be educated on the variety and complexity of plans.



Overall Impact on Staff• Front-line employees must be comfortable requesting money

from patients while maintaining a professional demeanor. Having the right people in these positions will be critical to the bottom line.

• Depending on the practice specialty and resources, insurance verification may require more staff time.

• More staff time may be required on the back-end to follow up and collect patient balances.



First Point of Contact

POINT OF CONTACT

Front office employees are typically the first point of contact for patients. This role is very important as this sets the tone for the patient/practice relationship and is the starting point for the billing cycle.

If patient demographics are not correctly entered, this delays the entire collections cycle.

If practice financial policies are not enforced, patients will take notice and may become more “relaxed” in their payments to the practice.

It is important to be welcoming and pleasant while also being firm on policies.



Best Practice – Verify Insurance• Verify insurance – no more than 2 days prior to appointment

per new ACA guidelines. Maintain evidence of verification.

• Obtain pre-authorizations prior to appointment date. Know what procedures/services need authorizations.




• New health exchange plans– Platinum, Gold, Silver, Bronze – Greater liability regarding patient responsibility if plan is

subsidized

• Newly insured individuals– Patients that have been previously un-insured may not

understand the provisions of their plan or how insurance works in general



Establish Practice Policies • Obtain demographics and medical insurance information at

time of appointment scheduling to include phone number for verification.

• Nature of visit is also important for insurance verification• Detailed verification of insurance and benefits will be

required. The practice should investigate potential resources such as PMS add-ins; 3rd party vendors (Availity, Freesia, etc.); registration at payer sites.

• Patient should be contacted if anticipated services will not be covered or subject to co-insurance. All expected amounts should be communicated to patient PRIOR to appointment.



Establish Practice Policies • All notes in the patients’ profile must be reviewed and

addressed by the front office. Individuals responsible for appointment reminders and check-in/out must review patients’ information prior to contact and be prepared to address any issues.

• Comments should be cleared from patient profile once issues are resolved to eliminate “noise” in the profile.



Best Practice – Time of Service Collections

• Collect cash and co-payments and any portion of patient balances at time of service.

• Estimate patient responsibility for self-pay patients and require payment prior to being seen.

• Understand what is considered Preventative Care (covered at 100%).



Maximize Collections

Co-pay $40

% Insured

Total Visits/Month (30 pts/day x 22 days)

Insured Visits/Month

Monthly Copay $

Quarterly Copay $

Annual Copay $

5% 660 33 $1,320 $3,960 $15,840

10% 660 66 $2,640 $7,920 $31,680

15% 660 99 $3,960 $11,880 $47,520

20% 660 132 $5,280 $15,840 $63,360

25% 660 165 $6,600 $19,800 $79,200

30% 660 198 $7,920 $23,760 $95,040

35% 660 231 $9,240 $27,720 $110,880

40% 660 264 $10,560 $31,680 $126,720

45% 660 297 $11,880 $35,640 $142,560

50% 660 330 $13,200 $39,600 $158,400



Maximize Collections

Average Patient Responsibility $1,500

% Insured

Total Visits/month eligible for deductible (5 pts/day x 22 days)

Insured Visits/Month

Monthly Deductible $

Quarterly Deductible $

Annual Deductible $

5% 110 6 $8,250 $24,750 $99,000 10% 110 11 $16,500 $49,500 $198,000 15% 110 17 $24,750 $74,250 $297,000 20% 110 22 $33,000 $99,000 $396,000 25% 110 28 $41,250 $123,750 $495,000 30% 110 33 $49,500 $148,500 $594,000 35% 110 39 $57,750 $173,250 $693,000 40% 110 44 $66,000 $198,000 $792,000 45% 110 50 $74,250 $222,750 $891,000 50% 110 55 $82,500 $247,500 $990,000



Odds of Collecting After Date of Service



Establish Practice Policies • Collect all balances at check-in• Collect deposit or estimated amounts for patients with

coinsurance/deductibles. Settle-up may be completed at check-out

• Unless emergent, patients should not be seen if balance is not paid

• Fees for no show appointments, forms, etc.• Self-pay discount



Establish Practice Policies • *Require deposit or balance in full prior to procedures

whenever possible. Patient responsible amounts may be separated in 2-3 installments:

- 1st installment at time of scheduling

- 2nd (final) installment at pre-op

- 3rd installment (for high amounts) due within 2 weeks following procedure

*Recent research has shown that some carriers are now advising patients not to pay prior to insurance claim processing (BCBS, CIGNA).



Establish Practice Policies • If patients object to payment in advance due to carrier policy, advise them

of the estimated amount due and obtain their signature on a promissory note. Employees should attempt to obtain a credit card number for future billing at this time as well.

• Employees will need to review EOB’s once payment is received and contact the patient regarding actual amount due. They should inform the patient that their card will be billed at this time and a receipt will be mailed to them.

• If no card is on file, the patient should be notified that payment is due immediately.



Offer Convenient Payment Solutions• Accept all forms of payment

• Convert checks to debit

• External financing

• Online payments

• Automatic payments

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Best Practice – Patient Billing• The patient collections cycle should be defined.

• Generally, patients should receive no more than 4 statements prior to being sent to collections.

• Patient statements should not show the collections timeline (i.e., 0-30 day, 31-60 days buckets). This falsely indicates that the patient has several more cycles before they must pay. Alternatively, statements should have a payment due date.

• Patients with accounts in collections should not be scheduled for an appointment prior to balances being paid in full.



Best Practice – Patient Billing• The practice should set parameters within

the billing system to generate patient statements at the time a patient responsible balance is created after insurance payment posting. Not doing so could significantly delay payment.

• Once statements are generated, they should follow the normal statement cycle of the practice (i.e., statement every 30 days).



Establish Practice Policies • Set parameters of payment plans:

- No more than three installments for balances under x dollars

- No more than four installments for balances under y dollars

- Only allow payment plans for emergent or costly procedures. Otherwise, patients should be instructed to pay prior to procedure/visit.

- Practice should generally not allow more than six installments.



Establish Practice Policies

Staff must consistently monitor payment plans. Establishing them and not enforcing is not effective. Patients should be contacted within 1-2 days of missing a scheduled payment. This will reinforce to the patient that the practice is monitoring and will hold them to the terms of the established plan.



Set Patient Expectations• Post policies in office and communicate directly with patients.

• Remind patients of past due balances prior to appointments (utilize notes within system).

• Consistently enforce policies.

• Limit physician involvement.



Educate Staff• Prepare a listing of all plan products and practice status to

better inform staff. Advise patients at the time of registration of practice’s status with plan--participating, not participating, in process.

• Employees must understand how to identify plans, especially with the addition of exchange plans. Most have an X in the identification number or have the metallic name as a part of plan name.



Educate Staff• Ensure all employees are aware of policies.

• Advise them of tools available to them (manuals, websites, cheat sheets, etc.).

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Monitor Data Entry• Garbage in = Garbage out:

Ensure staff are trained on important patient data fields.

Monitor data entry errors.

Use a claim scrubber.



Monitor and Communicate• Communicate problems with management.• Staff should share complex cases with each

other so that experience is gained.• Monitor compliance with established policies

and effectiveness.



Lori A. Foley, CMA, PHR, CMM

Principal

[email protected]

Contact Information

Pershing Yoakley & Associates, P.C.

(404) 266-9876

www.pyapc.com

Health & Medicine

“Surviving the Changing World of Patient Collections”