Patient Access Impact on the Patient s Journey. By: Michele Sutherland

Transcription

1 Patient Access Impact on the Patient s Journey By: Michele Sutherland

2 Today s Financial Objectives Vs. Today s Inefficiencies Today s Financial Objectives Today s Inefficiencies Improve Operating Margin Increase Net Revenues Increase Services & Growth Improve Quality Measures Improve Outcomes for Population Health Increase POS Collections Improve Self Pay Conversions Improve Payment Options Improve Physician & Patient Loyalty plus Satisfaction Scores Reduce Barriers for Patients Reduce Bad Debt Reduce Operating Costs Reduce Denials & Write Offs Multiple Systems with limited or no integration High Staffing Levels Ease of Access Issues Under-Utilization of Resource Tools Expensive Training & Re-Training Physician & Patient Loyalty and Satisfaction Issues Low POS & Unscreened Self Pays Lack of Communication of End Results to PAS Redundancies in workflows No Accountability for Staff Staff uncomfortable to Ask for money

3 The Revenue Cycle Value Stream SELF PAY COLLECTIONS PAYMENT REVIEW (Voucher Processing) CUSTOMER SERVICE SCHEDULING AND PRE -REGISTRATION RECRUITING TRAINING/ SUPPORT REVENOMICS PRE CERT AND INSURANCE VERIFICATION QUALITY ASSURANCE REGISTRATION AND POINT OF SERVICE COLLECTION FINANCIAL COUNSELING CASH POSTING THIRD PARTY FOLLOW- UP MEASUREMENTS/ MONITOR CLAIM SUBMISSION TOOLS & TECHNOLOGY MEDICAL RECORDS CODING/CDI REVENUE INTEGRITY / CHARGE CAPTURE CASE MANAGEMENT

4 Traditional Patient Experience

5 The Overall Patient Experience The Overall Patient s Experience Today provides a Strategic Competitive Edge And is becoming a very important value for reimbursement

6 The Role of Patient Access Patient Access is the Foundation Of The Revenue Cycle & The First Impression Of The Hospital Patient Access starts the Access to Clinical Services & Provides Financial Clarity for Patients

7 What you need to know about Patient Access Overview of Patient Access Functions Key Skills Patient Access Vendors and Tools Patient Access Monthly POS Report Breakthrough Improvement in Patient Access

8 What you need to know about Patient Access! Patient Access in the Assembly Circle Ease of Access Patient Access Functions: Order Management- Medical Necessity & Validation Scheduling - Accurate Data Gathering Pre-Services Insurance Verification / Pre-Certification / Financial Clearance Financial Dialogue with Patients 3 to 5 Days In Advance Registration/Admission - Insurance Verification / Pre-Certification / Financial Clearance Regulatory & Compliance Documentation Obtained Required Signatures Financial Solutions & Assistance Programs Communicated Set Expectations Coverage Discovery payer Source(s) Point of Service Collections (POS) Provide Solutions Improve Customer Satisfaction with Communication of Expectations & Payment Solutions Resolved Prior to Service

9 Who Are Our Customers? On Average most Patients have more encounters with Rev Cycle Teams overall than with the Clinical Team

10 Many Hats of Patient Access Teams Listener CSI Investigator Greeters Educator Smile Lasting Impression Cashier Data Entry Compliance Police Tour Guide

11 Meeting Tomorrow s Challenges Today Change In Responsibilities Today s Environment PAS PAS HIM PFS... 2 Years HERE - NOW HIM PFS The Past

12 Pre-Access Key Skills Knowledge of Scheduled Exams (i.e., prep information and able to provide instructions, plus directions) Flexible and creative with meeting patients, physicians, and hospital executive management needs (i.e., urgent/stat exams, increased service volumes, new ambulatory center) Payer(s) & Compliance Requirements & Regulatory Knowledge (continually changing) Medical Terminology (i.e., medical necessity, experimental procedures) Facility s Policies and Procedures Knowledge including Credit & Collection Policy Multiple Systems and Technology Tools with limited training or integration Customer Service using A.I.D.E.T.+ Smart Side of the Desk Skills Understanding Patient Flows and Importance of POS Collections

13 PAS High Level Review Scheduling (3 to 4 minutes) Schedule Patient Physician or Patient Call Orders being sent from Referring Physicians (Outbound Calls) Complete required screening questions prior to scheduling exam Schedule exam & provide patient with Prep and Arrival instructions Collect demographic & insurance information - *Eligibility Verification is Key* Pre-Service Verify Insurance Eligibility & Benefits Verify that services ordered meet Medical Necessity by comparing ordered procedure with diagnosis Inform patient of current amounts due in addition to requesting payment of prior account balances (POS) Establish Expectations Notify physician when payer requires that authorization be initiated by them Ensure that authorizations are secured (Obtained from either payer and or Physician Practices) * Do you have any Hard Stops if payer s Requirements are not met??* Check-In Collection of Payment; Obtain Consents; Insurance Cards & IDs; Photo; and History documentation (history & medication)

14 PAS High Level Review Order Validation Oder Validation & Medical Necessity Ensure all required data is on electronic /physical orders prior to Schedule or Performing Service (Pt Name; DOB; CPT Code & Diagnosis Code; Physician Name; NPI Number & Phone Number; Signature of Ordering Physician) Checks Orders for Medical Necessity prior to service (If ABNs not signed can not bill Patients Thus charges would not be considered MCR Bad Debt) Request additional diagnostic information from Physician for orders that do not meet Medical Necessity Work & Return non-compliant orders, plus request required data needed by Healthcare Facilities Clinical Departments Should review Schedule 2 to 3 Days ahead of time to ensure the Procedures Ordered is the true Procedure to be completed for Patient if not will notify both Registration & Physician Office to obtain New Order(s) and to ensure Authorization is obtained for the correct procedure

15 The Current Job = More Complex The Need to Understand My Role, the Vendors and the Tools Which Make us Successful

16 The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency Bill Gates All information was provided by

17 Financial Clearance: Process Innovation Technology the KEY to Success Enhance interoperability between providers and payers Streamline eligibility, benefits, Authorizations, and claim data transactions Reduce the amount of time and resources providers spend on administrative functions time better spent with patients Exception Rule Base only touch what truly need to be worked Data Base Management How to get the most of your Resource Tools Utilization Optimization of each Technology Solutions for all End Users

18 Patient Access Vendors and Tools Pre-Registration work drivers Accounts stratified by urgency as visits scheduled. Add-on appointments move to top priority. Tracks number of staff attempts to contact the patient and provides staff productivity metrics Insurance Verification work drivers Accounts stratified by urgency and type (i.e., patient type changes from outpatient to inpatient). Add-on appointments move to top priority. Tracks the status of securing authorization for services Communication Management Solution Captures voice, fax, or electronic interactions and ties it to the patient record allowing for enterprise access. Secures online insurance verification proof to mitigate denials. Provides a quality assurance record for staff interaction with patients and physicians

19 Pre-Access Vendors and Tools Continued Real Time Eligibility Provides immediate and up-to-date response from payer on insurance coverage status. Assists staff with accurate insurance plan selection (i.e., Medicare vs. Medicare replacement) that has a downstream effect on obtaining authorization for services. Patient Payment Estimators Integrates with patient s specific coverage and services to provide an out of pocket cost estimate. Summarizes copayment, deductible, and coinsurance patient responsibility prior to service. Increases patient satisfaction knowing estimated cost up front.

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21 Order Management Screen electronic orders for required data Screen electronic orders for medical necessity Screen orders of non-staff physicians for OIG sanctions Return non-compliant orders and request required data to Referring Physicians Request additional diagnostic information on orders that do not meet medical necessity Initiate account creation in host system for patient to be scheduled

22 Schegistration Outpatient Diagnostic Ancillary Services Contact patient to schedule Correctly interpret the physician order to be certain the service the patient receives is the service ordered Complete required screening questions prior to scheduling exam Schedule exam and provide patient with prep and arrival instructions Collect demographic and insurance information Verify that services ordered are medically necessary by comparing the ordered procedure with the physician-provided diagnosis Inform patient of current amounts due in addition to requesting payment of prior account balances Ensure that authorizations are secured Coordinate schedules with ancillary departments to ensure seamless patient encounter Notify physician when payer requires that authorization be initiated by them

23 Pre-Registration Surgical and Interventional Procedures Identify and prioritize scheduled patients based on procedure date Initiate contact with the patient to secure and collect demographic and insurance information Identify procedures scheduled for the next week on a daily basis and ensure accounts are financially secured Those that are not financially secured will be escalated to ensure completion prior to patient arrival Self-pay patients needing to make a payment will be requested to stop at Patient Access to do so Create a forms packet for each patient and hand deliver to procedure areas Helps to minimize patient wait times on the day of service Patient can bypass Patient Access and proceed directly to the service area to check-in

24 Financial Clearance Complete Many insurance companies require prior authorization for hospital services. The Pre-Access department starts this process by notifying payers and securing authorizations for the proposed service.

25 Pre-Access Functions: What Information is Verified? An electronic work-driver is used for Insurance Verification (IV). Verify multiple pieces of information, including: When the patient became eligible for their insurance coverage and that the patient is eligible to receive the services on the (proposed) service date The amount of reimbursement expected; in turn this figure is used to estimate the patient s out of pocket liability and review of prior balances Whether there is any restriction on the patient s benefit i.e., Medicare / Medicaid converted to a Health Maintenance Organization (HMO) plan or Carve Outs

26 Pre-Access Functions: What Information is Verified? Continued We also verify: For Health Maintenance Organization (HMO) validate the patient is eligible to receive services at our location Lifetime Maximum benefits on the patient s policy and how much, if any, of this benefit has been exhausted For Medicare inpatients the number of days the beneficiary has available, at the beginning of their stay Where the claim is to be directed for payment In addition to verifying information, we: Refer patients with high dollar deductibles to Financial Counseling Notify case management when clinical precertification is needed

27 Pre-Access Functions: When is Insurance Verified? Scheduled Patients: The standard is to complete insurance verification before the patient presents for service Non-scheduled Patients: In many cases the insurance eligibility is verified electronically during the registration process for patients who are non-scheduled (i.e. walk-in, urgent, or emergent)

28 Pre-Access Functions: How is Insurance Verified? For most patients insurance is verified by: Accessing online systems Using payer websites to initiate authorizations, or By placing a telephone call to the insurance company. Electronically submitting the NOA for select payers.

29 The Revenue Cycle Value Stream CUSTOMER SERVICE SCHEDULING AND PRE -REGISTRATION PRE CERT AND INSURANCE VERIFICATION SELF PAY COLLECTIONS PAYMENT REVIEW (Voucher Processing) RECRUITING TRAINING/ SUPPORT REVENOMICS QUALITY ASSURANCE REGISTRATION AND POINT OF SERVICE COLLECTION FINANCIAL COUNSELING CASH POSTING THIRD PARTY FOLLOW- UP MEASUREMENTS/ MONITOR CLAIM SUBMISSION TOOLS & TECHNOLOGY MEDICAL RECORDS CODING/CDI REVENUE INTEGRITY / CHARGE CAPTURE CASE MANAGEMENT

30 Ease Of Access Goals Excellent rating counts in our patient satisfaction scores Accuracy Timeliness Efficiency Complete & Secure World Class Customer Service

31 Simple Economics (Strategic Market Shares ) Economics as a whole indicates: 86% of Consumers will pay more for better Customer Service and or for a better overall Experience 89% of Consumers have changed their loyalties to a competitor business due to poor Customer Service

32 The Overall Patient Experience (Strategically) Confidence in Provider = 33% of Patients Blaming Bad Experience on Diagnostic or Treatment Errors and or Financial Expectations Rating of Patients - Staff Working Together Well = 88% Clinical Rating of Patients - Positive Moments to Friendly Staff = 70% Rating of Patients as to Understanding their Financially Liability = 23% HFMA Leadership Spring 2014

33 LASTING IMPRESSIONS S M I L E

34 First Impressions 55% Perception What You See 38% Tone What You Hear (Attitude) 7% Words Used Verbiage

35 Smart Side of the Desk Competence Confidence Creditability Accuracy How do Patients See Your Patient Access Staff?

36 FINANCIAL CLEARANCE - CORE Financial Expectations clearly are communicated with Scheduled Patients during Pre-Reg Process (3 to 5 days prior to date of service) Verification of Patient Demographics (DOB; SS#; Address; Phone Number(s) home, cell, & work phones best phone number to reach Pt; Employer Name and Next of Kin) Verification of Insurance & Benefits Verification of Guarantor plus relationship Medical Necessity Check & Authorization Obtained (Ask for Patient participation should you still need assistance in obtaining Auths) Confirm & Ensure with Physician Practice that a new order is being sent thru Ordering Faxed Queue or faxed with new diagnosis codes (if needed) and document from whom you obtained Auth Number from Estimation of Charges and Patient Liability calculation for Coinsurance, plus deductibles /co-pays Negotiate Payment Solution (PmtPlan or Loan Program) Increase Window of time Replacement Revenue

37 Patient Access Functions: Registration/Billing Information Registrars are responsible for collecting and documenting information to facilitate prompt payment, including: Identification and selection of the correct insurance plan In the case of multiple insurance policies, correct sequencing of primary, secondary, and tertiary insurance Entry of occurrence and condition codes related to the patient s visit Identifying self-pay patients, attempting to collect, and for those unable to pay, providing them with a financial assistance application and or referring to Financial Counselors

38 Patient Access Functions: Order Entry/Medical Information Registrars are responsible for documenting medical information in the registration, including: Name of physician who ordered test or who will be treating patient Preliminary diagnosis (reason for test / service) Assigning the patient to the correct patient type / service type / location dependent upon the service provided Obtaining the name of the patient s Primary Care Physician (PCP) and his/her contact information

39 Registration: Regulatory In order to comply with all federal and state requirements Registration secures patient signatures on legal documents and provides explanation of these notices and forms Health Information Portability and Accountability Act Privacy Notices Patient Bill of Rights Consent for Treatment Valid Physician Order Photo Identification to Comply with Red Flags Advanced Directives / Living Will Health Information Exchange (opt-out?) Medicare Secondary Payer Questionnaire Important Notice from Medicare Advanced Beneficiary Notification

40 Patient Access Functions: Registration/Documentation Verify the patient s identity and insurance coverage and scan/copy the patient s personal ID and insurance cards. Run the Real Time Eligibility (RTE) Software to verify insurance for walk-in patients. Place the arm band on the patient confirming name and date of birth in accordance with the National Patient Safety standards. Enter an account note in the Electronic Medical Record (EMR) on each and every account. Scan necessary forms such as Consent Forms, Health Information Exchange Opt-In or Opt-Out Forms etc.

41 Patient Access Point of Service in the ED In some cases, Registrars are asked to attempt to collect patient liabilities during the patient visit. For uninsured Emergency Room (ER) patients, after the patient is stable, the Registrar requests a minimum down payment For insured Emergency Department (ED) patients with an identified copayment, the Registrar attempts to collect the copayment In addition to these, if the patient has any open prior balances, those are requested

42 POS Collections Insured and Un-Insured

43 Patient Access Functions: OP POS Collection For self-pay outpatients, most Healthcare Systems policy is to collect minimum deposit amounts prior to the patient receiving services. Deposits are based upon the service type. The Registrar must know how to obtain prices for services in order to estimate charges and down payment. For elective services, if the patient is unable to pay, prior to the date of service the Registrar must contact their leader who will contact the patient s physician to determine whether the service is urgent or whether it can be safely postponed.

44 BARRIERS TO COLLECTION Not scheduled INTERNAL ISSUES Not pre-registered Not obtaining insurance verification &/or benefits Dependability of Eligibility Tool Unable to estimate Service cost Out-of-pocket amount Unable to discuss with patient prior or at time of service Not Asking at Check-In PATIENT ISSUES Doesn t understand insurance benefits Has not been informed to pay in advance, thus not prepared to pay Not willing or able to pay high amount owed at time of service Accustomed to discounts provided after billing process Balance Not REQUIRED in the past

45 A Patient s Rational Studies show that a patient s feeling of obligation to pay for hospital services drops significantly after they leave the facility Patient s rationalize that because they did not plan to get sick/injured they shouldn t have to pay immediately A good comparison is car problems or accident They are unplanned, but payment is expected at time of service Homeowner Insurance or Auto Insurance what do you pay first?

46 The Patient s Priorities Cell Phone; Mortgage/Rent; Internet; Cable, Car Payment; Utilities Insurance; Credit Cards; Tuition/Educatio n Loans Healthcare Bills

47 When Patient s Priorities Change Healthcare Bills (at the time of occurrence) Mortgage/Rent, Cell Phone, Cable, Car Payment, Utilities Credit Cards, Tuition/Education, Loans

48 Collections And The AR Time Line $$$ Collected Probability of Collecting Opportunity to Collect Prior to Service 80% Opportunity to Collect less than 3% after 90 Days, Plus cost for 3 rd Party Vendor to collect Pre-Admission Arrival During Service At Discharge 30 Days 60 Days 90 Days

49 Know Your SOLUTIONS & TOOLS COBRA Pure Self Pay Self Pay Screening Medicaid Eligibility Other Coverages Self Pay Discounts Good Faith Deposit Payment Plans Loan Program Financial Hardship Charity Discounts Patient Responsibility After Insurance with no Secondary Insurance: Co-Pays Deductibles Co-Insurance Good Faith Deposit Payment Plans Loan Program Medicaid Screening Medicaid Eligibility Reps New Diag codes Previous Visits - Outstanding Balances

50 The Patient Experience (Financial Impact) Modern Healthcare reported charity-care spending in December 2013 for the Year of 2013: Breakdown for Charity Care numbers: Bottom 25% of hospitals spent 0.69% or less of budgets on charity care and the median hospital spent 1.52%. The top 25% reported spending 2.73% or more of expenses on charity care Breakdown for Bad-debt numbers: Bottom 25% of hospitals reported spending 1.43% or less of expenses toward bad debt. The median hospital reported bad debt totaled 2.45% of expenses. And the top 25% of hospitals spent 3.89% or more of expenses on bad debt American Hospital Association released its yearly look at what hospitals do not get paid. The aggregate amount for nearly 5,000 hospitals was $39.3 Billion How does this impact our Patients?

51 The Patient Experience (Financial Impact) We continue to have Growth of High Deductible Plans Growth in Under-Insured Growth in Cost of Medical Services "There is no scenario, looking forward, where bad debt goes down, a healthcare industry expert last month told a packed room of hospital financial executives. Paul Keckley, executive director for the Deloitte Center for Health Solutions June 2014 Millions of Americans have been impacted by Medical Bad Debt Over half of all Bankruptcies are filed in the US are related to Medical Debt Over 600,000 Individuals filed last year were based on Medical Debt

52 Case Study Results -KHN

53 EXCELLENT Registration! Excellence in Patient Access equates to improved financial outcomes and improved patient satisfaction scores.

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55 Multiple Workflows Creates Rework / Redundancies bill This is where the billing gets complicated 55

56 Patient Access Functions: Consequences of Entering Info Incorrectly Lost Reimbursement Denials No Payment Patient Safety HIPAA Red Flags Returned Mail Rework / Skip tracing Patient not informed of charges for services Duplicate Medical Record Numbers (MRN)

57 How Good is Good Enough! What can one simple error mean? 10,000 visits per month x 20% = 2000 errors 2000 x $ = $398,000 In Losses Per Month! ************************************************ Annual Losses $398,000 x 12 months = 4,776,000

58 KEY PERFORMANCE INDICATORS MOST Common Denials Majority are all avoidable DENIALS (Incorrect ICD10 Codes) Does Not Meet Medical Necessity Lack of Authorizations Termed Insurance Coverage Non-Covered Procedures Not Verified nor Communicated (No ABNs) CLAIM EDITS & REJECTED CLAIMS Patient Demographics / Identifiers (Subscriber ID or Social Security Numbers, Date of Birth, Group ID etc.) Delays in Cashflows &/or Write-offs for Services Performed

59 The Revenue Cycle Value Stream SELF PAY COLLECTIONS PAYMENT REVIEW (Voucher Processing) CUSTOMER SERVICE SCHEDULING AND PRE -REGISTRATION RECRUITING TRAINING/ SUPPORT REVENOMICS PRE CERT AND INSURANCE VERIFICATION QUALITY ASSURANCE REGISTRATION AND POINT OF SERVICE COLLECTION FINANCIAL COUNSELING CASH POSTING THIRD PARTY FOLLOW- UP MEASUREMENTS/ MONITOR CLAIM SUBMISSION TOOLS & TECHNOLOGY MEDICAL RECORDS CODING/CDI REVENUE INTEGRITY / CHARGE CAPTURE CASE MANAGEMENT

60 What you need to know about Financial Counseling and Financial Assistance! Financial Counseling and Financial Assistance in the Assembly Circle The Role of the Financial Counselor The In-House Interview Different Sources of Funding Coverage Discovery Financial Assistance/Charity Catastrophic Financial Hardship

61 The Role of the Financial Counselor The Financial Counselor (FC) screens uninsured and underinsured patient accounts to: Explore possible eligibility for sources to fund patient s healthcare Collect copays, deductibles, deposits, and coordinate payment arrangements

62 Financial Counseling Primarily focuses on the self pay population to: Collect payments and make payment arrangements For patients with an inability to pay they: Screen for funding sources i.e. Medicare and Medicaid eligibility and other governmentally sponsored healthcare funding

63 Patient Payment & Experience Key Skills Balance patient needs with financial outcomes Relationship building with patients, families, and clinicians Simplification of complex federal and state programs Compassion, understanding, and patience Customer Service using A.I.D.E.T.+

64 Financial Counseling Vendors and Tools Financial Counselor work drivers Non-Sponsored Accounts captured at time of admission to prompt FC to complete in-house interviews. Tracks number of staff attempts to interview the patient or guarantor and provides staff productivity metrics. Vendor Agencies and Tracking Second level review after initial MANG denial. Assist with obtaining necessary documentation for a complete MANG Application. Reporting scorecard to track inventory and performance. Additional Coverage Verification Tools Identifies billable Medicare, Medicaid and commercial insurances not known previously by vendors or internal staff.

65 The In-House Interview The Financial Counselor interviews the patient to: Evaluate if there are any possible reimbursement sources Collect known co-pays and deductibles Assess if the patient may qualify for Financial Assistance/Charity Care

66 Different Sources of Funding Medicaid & or Medicaid Managed Care Plans Medicare (Social Security/Disability) Commercial and or Exchange Insurances Liability Insurance Workers Compensation Crime Victim Coverage COBRA (Consolidated Omnibus Budget Reconciliation Act) Financial Assistance/Charity Care

67 Different Sources of Funding: Financial Assistance The FC will provide the patient with a copy of the Financial Assistance Application (FAA). This form is used: To inform the patient about documents necessary to validate and assess eligibility for Financial Assistance/Charity Care To calculate discounts due and to communicate eligibility determination to the patient To document income information provided by the patient to be reviewed by the FC To determine Presumptive Eligibility To calculate a Catastrophic Discount

68 Programs Available Financial Assistance Policy Guidelines: Qualified Patients Income Guidelines Federal Poverty Guidelines (FPG) are updated annually in conjunction with the published updates by the United States Department of Health and Human Services

69 Presumptive Financial Assistance Eligibility Presumptive eligibility may be determined on the basis of individual life circumstances. In these situations, a patient is deemed to be eligible for a 100 percent reduction from charges (i.e. full write-off.) A patient is presumed eligible and therefore does not need to complete a financial assistance application when sufficient evidence is provided that they meet one of several criteria. When a patient does not complete an application and there is adequate information to support the patient s inability to pay, these cases will be submitted to the ministry s Financial Assistance Committee (FAC) for approval. If approved, 100% write off to financial assistance will be granted for all open accounts. Assistance will NOT be granted for future dates of service.

70 Catastrophic Charity Adjustment A Catastrophic case is defined as a circumstance in which after application of the charity discount amount, the remaining out of pocket liability exceeds 15% of the family s annual income as determined during the Financial Assistance Assessment. In order to qualify as a catastrophic case, the patient must qualify for some level of the charity discount under the Presence Health Financial Assistance policy. Some insured patients are also eligible for a Catastrophic discount. If the patient s balances after insurance exceed 15% of the family s annual income, and the patient qualifies for some level of the charity discount under the policy, they fall under the criteria for having a catastrophic case.

71 Who Qualifies for Financial Assistance / Charity Care? Financial Assistance/Charity Care is based on family size and income according to the Federal Poverty Guidelines (FPG). In addition to the family size and income requirements the following must be provided: They have received a medically necessary hospital service They have cooperated with efforts to qualify for reimbursement sources such as Medicare / Medicaid They are able to provide documentation of household income and family size They currently reside in the given state, or Have catastrophic medical expenses

72 Key Points: Patient Payment & Experience Most Healthcare Facilities provides a 40% uninsured patient discount to all Self-Pay Patients for medically necessary service and an additional 10% prompt pay discount if payment made at time of service Capturing complete demographic/insurance data provides essential information to the Financial Counselor and is an asset to our reimbursement process Intervention by a Financial Counselor is a fundamental tool which can: Facilitate payment for Presence Health Build a positive relationship between Presence Health and the community

73 The Patient s Journey The Patient Experience is based on all Interactions from first phone call through Check-In; through Clinical Care; through Discharge; and the final resolve Bill Paid. Every step of the process impacts the Patient s Journey and builds the foundation for Patient Loyalty

74 Financial Clearance Solutions Benefits for the patient Informed of expectations Payment solutions resolved prior to service Patient participates with solutions (can make informed choices) Benefits to Facility Advance d Access Solutions Financial Clearanc e Prior to Service Receivabl e Mngt Services Post Service Solutions Satiability Financial Physician & Patient satisfaction Increased POS collections Maximum reimbursement every visit Reduced error = accelerated cash flows Improved net revenue = reinvestment back into patient care