Showing posts with label medical billing and collections. Show all posts
Showing posts with label medical billing and collections. Show all posts

Thursday, September 21, 2023

How to put your medical collections department out of business

Finding a solution to the problem of patient collections may not be as challenging as we think — if we thinkdifferently about it. Instead of viewing collections as a one-off event, we can instead reframe it as a continual process that starts even before care is administered.

Considering a recent survey revealed that 40% of patients would either cancel or postpone care without upfront cost information, the urgency for providers to make transformative changes on the front-end is higher than ever. Fortunately, providers may find they already have the tools and technology they need to minimize bad debt later on.


Strategies to minimize collection issues


The first step to minimizing future collections issues is making the patient experience more convenient. A recent Experian Health survey revealed 72% of respondents emphasized the importance of online or mobile payment options. In light of this, a streamlined self-service payment process—including IVR, mobile, kiosk, and patient portals—is essential to encourage timely payments.


Secondly, a system needs to be in place to identify which patients are at risk of non-payment and then recommend additional or alternative financial pathways. An efficient system will determine which patients qualify for financial assistance and which ones have the propensity and likelihood to pay—at or before the point of care. This will enable providers to offer personalized payment plans and recommend relevant financial assistance programs.

Finally, it's essential to identify any potential gaps in coverage that could later impact collections. Automated solutions currently exist to screen patients for Medicaid, charity, or other assistance programs prior to service. They also allow providers to evaluate payment risk, ensuring a more effective collections policy and less bad debt. Considering that, according to reports, more than one million people have lost their Medicaid coverage since continuous enrollment ended earlier this year, it’s vital that providers have a tool in place to catch any gaps in coverage—and a plan for helping those who no longer qualify.


Easing the burden of collections


When collections become problematic, a few timely actions can make the process more efficient.

One effective strategy is to screen out patient accounts that are unlikely or unable to pay, focusing your energy and resources instead on more viable ones. High-performing collections teams implement automated processes and AI to pinpoint these types of accounts. Once identified, teams can take quick action—either by removing these accounts from the AR file entirely or assigning them to a specialty vendor. This streamlines the process, ensuring that the focus of the collections team remains on accounts with a realistic likelihood of payment, maximizing both efficiency and revenue.

To improve patient communication, consider implementing automated messaging. Provide bill reminders via secure, cloud-based dialing software, offering queue callback options to keep hold times to a minimum. You might also consider touchless text messaging. This can maximize in-house collections while ensuring compliance standards are met. Automated campaigns can further increase efficiency and revenue.


Redefining collections


The conversation surrounding collections needs a paradigm shift. It’s time to move away from the notion of collections as a one-off, manual, and labor-intensive process. Instead, let's view it as a part of an ecosystem that begins before patients receive treatment, starting with upfront, self-service payment options and early screening of patients for potential coverage. In this way, we can transform collections from a destination into a process—and perhaps, by doing so, we can even put our traditional collections departments out of business.


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Monday, January 23, 2023

Handling patient collections

Collecting from patients is not an easy job, but there are ways to handle it in an efficient and compassionate manner. We talk to experts on how to prevent payment delinquencies and how to handle them when they occur.


Ways to prevent delinquencies


Before physicians worry about collecting delinquent payments, there are several strategies to ensure collections take place up front. “Patients are consumers and they need to be treated like consumers,” according to Noel Felipe, senior vice president and revenue cycle practice leader at Firstsource, a company based in Columbus, Ohio, that offers digital solutions in the health care space. “Consumers make decisions about where they shop and what they pay. They make value judgments based on their perceived value of a product or ease of consuming that product. The health care industry has to migrate to that type of mentality.”

This means making payment as simple and efficient as purchasing a product on Amazon, utilizing technology so patients can pay by phone or iPad, steering clear of too much technical jargon and having a comprehensive patient portal. “Your patient portal should allow them to make payments, to establish payment plans,” he adds.

Additionally, he urges physicians to take some payment up front. “You should collect 100% of your copays at the time of service. Your chances of collecting money go down post-service by 54%.”

The only exception to taking payment up front may be in a practice that includes services such as labs or X-rays, according to Lillian Phelps, senior director for product management at Availity, a health information network in Jacksonville, Florida. “Maybe collecting payment is better on the back end in that case, because you don’t know if they have to get a lab drawn or an X-ray,” she says.


Payment plans


Payment plans and options are an effective way of getting patients to pay, Phelps says. “You should come up with a financial clearance policy that sets dollar thresholds and time frames. You might even look at the relationship you have with the patient — if this has been your patient for 10 or 15 years, and he’s never had a financial collection, there should be some sort of consideration for their history.”

Any form of collections is improved by including digital means of paying, says Phelps. “Are you sending your statements digitally? Do the statements have a link to pay the bill? Folks don’t go to the post office (much) anymore,” she says. “Being able to offer digital or mobile payment options is a great place to ensure the bill is paid.”

Having a digital means of paying also increases the likelihood of patients making some payment rather than none, Felipe points out. “If I owe my physician 500 bucks and I go onto the portal and I have no choice but to pay 500 bucks or leave, and I can’t afford it, I’m going to exit out. But if I have payment terms, I’m going to pay what I can pay.”


Propensity-to-pay analytics


Beyond simply making easy payment options available, Felipe encourages physicians to utilize propensity-to-pay analytics to drill down and figure out the demographic of a practice. “It’s easy to collect from people with high ability and high desire — those are automatic,” he says. “The people with low desire and high ability, you’re going to have to work at a bit. Propensity-to-pay modeling to help you understand where to place your expectations is critical in a successful physician practice.”


This sort of analysis can circumvent delinquencies by allowing the physician to preemptively offer financial resources and support to those patients most likely to have trouble paying, according to Srulik Dvorsky, cofounder and CEO of TailorMed, a health care IT company for health care providers and pharmacies in New York City.

“Instead of waiting for patients to experience financial distress or have a bill be written off, if you have the technology that can screen for patients based on their out-of-pocket responsibility, you can come to those patients as early as their diagnosis or registration and offer assistance programs,” Dvorsky says.

Additionally, remember that not every patient will engage in the same way, so pick the right strategy for the right demographic, Felipe says. “Baby boomers will not respond to text messages, but millennials will. Millennials will not talk to you on the phone and they don’t really care to look at email. So, if you want to collect more money, you have to pick the right engagement strategies for your patients.” He recommends having software that uses algorithms to predict engagement behaviors.

Physicians who utilize software and technology of this sort have an advantage in collections. “I think physician practices are in a very unique and enviable position where they can predict pretty closely what the patient should owe, and I think that conversation should happen either at the time of service or before service,” Felipe says.


Having the conversation


When a balance is outstanding, Felipe advises that physicians should not be the ones to raise this issue directly with patients. “This is a relationship that doesn’t need to be strained over financial dialogue,” he says. He gives the example of how most dental practices work. After your oral examination, the dentist comes in to tell you what services you will need, and the billing staff member talks to you about the money.

He recommends having a financial counselor of some form on staff — this could be your billing person, a care coordinator, or another front office employee. This person can direct the patient to philanthropic organizations and resource documents such as those already prepared by the Centers for Medicare and Medicaid Services.

“You don’t have to recreate the wheel with resources,” says Gloriann Sordo, J.D., a principal at AdviCare, a company in Lakeland, Florida, that handles clinical denials for hospitals. She also encourages physicians, or their billing staff, to ask insurers what resources they have for patients. “I believe the payers should be doing more in trying to help patients understand what their responsibility is.”

Additionally, this person can help patients review and understand their insurer’s explanation of benefits, says Sordo. “Patients assume it’s their physician’s office that is responsible for their balance, rather than the insurer,” she says.

Sordo emphasizes the importance of helping patients understand the role the insurer plays in their care, since they may deem something not medically necessary. “It’s important to help patients understand it is not an arbitrary decision your physician’s office is making on what to charge you.”


Other strategies


Sometimes the simplest steps can ensure the most efficient collections. Phelps urges physicians to make sure their front desk and billing staffs are collecting basic but crucial information. “Make sure you have a copy of their card. Get the ABCs down and run patient eligibility,” Phelps says. “Ask for the money up front.”

Phelps also recommends preparing ahead for each day by running all patients’ eligibility and benefits the night before. “Doing that work the night before makes your check-in process go more smoothly and gives you the opportunity to accurately calculate what their cost share would be once they’ve done their visit.”

Phelps says, “At the end of the day I tend to believe that people want to pay their part and they want to have the opportunity to do so. But sometimes they need education.”


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Thursday, November 17, 2022

3 Revenue management KPIs people don’t talk about

In 30 years of running revenue management the usual suspects come up in a Key Performance Indicator (KPI) Dashboard such as Charges, Payments, Adjustments, Net Collection, Gross Collection, Days in AR, AR over 90 Days and Bad Debt. Then you have the breakouts for each category by payer, CPT Code, Location, or ICD Code.

There are 3 other KPIs that I track that may not be traditional KPIs, but they have a significant impact on collections and cash flow.


Denials


You probably notice the C codes related to denials such as CO 11 – Diagnosis Inconsistent with Procedure, CO 22 – Coordination of Benefits, CO 167 – Diagnosis is Not Covered, etc.

I take the time to program a listing of denial codes that make sense to the practice. The C Codes are very generic and can only go so far to alert you of denial patterns and potential issues. I always ensure I have a listing of denial codes that correlate with the C codes and provide more pertinent information. For example, if I receive a denial of CO11 I would have several categories such as Need additional medical information from physician, diagnosis not covered with procedure, need additional modifier.

Getting the denial and correcting the issue for that claim is not enough. Many times, I notice repeated instances of correcting the same issue on multiple claims. Once you identify the denial, seek to place a rule in your billing system that would correct this denial before the claim is sent out. The goal is to prevent the denial from ever happening.

I seek to quickly capture trends in the denials before they result in a bulge of denials that become difficult to manage and get paid due to volume. Payers may have different denials for specific procedures and diagnosis in accordance with their policies or your contract. Weekly I review any denials to ascertain if there is a trend or an accumulation of denials before it becomes an acute issue.

Always remember, the goal is not to correct the denial quickly but to prevent it from ever happening.



Number of touches


The Number of Touches indicates the number of times a specific claim has been worked. The claim may have been resubmitted, identified as still in process, in appeals, additional information being submitted, etc.... I will look for claims that have been touched multiple times, usually more than 3 and then I drill down. It is not infrequent to see claims that have been touched 15-20 times. The objective when working the Accounts Receivable is to get the outstanding claims resolved, not to solely perform an action that may perpetuate the unpaid claim. Sometimes incentives are misaligned and incentive the number of accounts worked as opposed to number of accounts paid. I am always looking for a claim to get paid within 3 touches.

When it gets beyond the 3 touches, I tell my team not to hesitate about ringing it up the ladder. Sometimes if claims are denied by a payer, it could indicate there is an underlying issue such as the status of the provider, a failure to update a new policy, a contract not being uploaded or a glitch in the system. Creating a culture of rewarding the right outcomes and encouraging communication when there is an issue is imperative in running an effective revenue management department.


Forecasts


I have weekly meetings with my revenue management team. Usually these take about 30 minutes. To the outsider it may seem simple and common sense. However, I find this practice vital. Establishing the amount each month you are expected to bill out and collect and comparing to actual charges and collections is a quick gauge of how collections and charges are doing throughout the month. You will be able to quickly identify any issues with this simple review. My teams found trend in denials, issues with the payment cycle of a payer or missing charges from this simple review. It is not uncommon to find organizations where their Accounts Receivable and financials are in disarray because they have not implemented a forecast even in its simplest form.


Waterfall analysis


I utilize a Waterfall analysis in estimating the amount of collections in any month. A Waterfall analysis is a report that indicates the percentage of collections contributed by each month. For example, if you are running a Waterfall analysis in June you may find 20% of the collections come from charges in that month, 35% come from charges entered in May, 20% come from charges entered in April, etc.... I find this along with modifications made for specific events such as seasonal differences or temporary closure of a location provides a decent estimation of collections.

Incorporating these 3 KPIs into your analysis will help you identify issues in a timely manner and improve collections and cash flow.


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