GRANT & WEBER. Revenue Cycle and Receivables Management SINCE

Transcription

1 GRANT & WEBER Revenue Cycle and Receivables Management SINCE

2 TABLE OF CONTENTS CORPORATE OVERVIEW CONSULTING - FULL REVENUE CYCLE ASSESSMENT - SPECIFIC REVENUE CYCLE AREAS O PATIENT ACCESS O CASE MANAGEMENT O HEALTH INFORMATION MANAGEMENT (HIM) O PATIENT FINANCIAL SERVICES (PFS) REVENUE SOLUTIONS SERVICES - BILLING - INSURANCE FOLLOW-UP & RECOVERY - SELF PAY BILLING & CUSTOMER SERVICE FOLLOW-UP - SYSTEM CONVERSION ASSISTANCE WORKERS COMPENSATION RECOVERY SERVICES THIRD PARTY LIABILITY RECOVERY SERVICES DELINQUENT SELF PAY COLLECTIONS - CONSIDERING A COLLECTION AGENCY? MAKE AN INFORMED DECISION. - OUR SOFT TOUCH APPROACH TO HEALTHCARE COLLECTIONS RESOURCES - HUMAN RESOURCES - COMMITMENT TO ADVANCED TECHNOLOGY, CONFIDENTIALITY, AND CLIENT CARE - IN-HOUSE LEGAL 2

3 A PROFESSIONAL SERVICES CORPORATION SINCE 1977 GRANT & WEBER is a nationwide Revenue Cycle and Receivables Management corporation which has proudly served our business partners since With over 35 years of experience since our inception, GRANT & WEBER has established a reputation as a leading authority in the healthcare industry for all revenue cycle services including: Consulting, Insurance Billing & Follow-Up, Self Pay Billing & Customer Service Follow-Up, Delinquent Self Pay Collections, Third Party Liability Recovery, and Workers Compensation Recovery. GRANT & WEBER s principals and senior management combine for a vast range of experience and expertise in operating an integrated business office to best serve the changing healthcare industry. Like our clients, GRANT & WEBER has built its foundation on integrity and customer service. Our focus on client care, in-house training, and effective recovery solutions remain the hallmark of daily operations. We train our healthcare specialists, client service advocates, account executives, management, and administrative staff on a regular basis to ensure that our employees are kept abreast of current industry legislation, and instill best practices for the services we provide. We understand the importance of patient confidentiality. That s why GRANT & WEBER has been in strict compliance with the Health Insurance Portability and Accountability Act (HIPAA HITECH) since its mandate in All patient information and medical records obtained through the natural course of business is kept under the highest level of confidentiality and security. Due to our continued investment in technology, we have never had a data breach since our inception. We understand that the relationship between you and your patients is of the utmost importance. By utilizing our soft touch approach to healthcare services, GRANT & WEBER consistently delivers more revenue with less patient complaints. We are committed to excellence and continue to strive in fulfilling our mission statement: Provide superior service and support to our clients across multiple verticals, securing trust and confidence that our success is their success, as we improve our customer s financial health. 13

4 PROFESSIONAL SERVICES/CONSULTING GRANT & WEBER has established a reputation as a leading authority in revenue cycle services and strategic solutions. We manage our projects with an unfailing commitment to improve client performance. Our Consulting Division allows us to enhance the entire GRANT & WEBER offerings, maximizing our client s revenue cycle effectiveness and efficiency. Our consulting team has the perfect mix of both provider experience and consulting experience, as well as technical expertise, which is a very rare and valuable combination. We manage a variety of project types and sizes, from small single department assessments to large health system centralization and consolidation projects. GRANT & WEBER provides many revenue cycle solutions that help healthcare providers, along with their physicians and medical groups, to arrest the trend of declining payments and increasing denial rates. Our main focus is to increase net revenue by improving patient throughput, work and data flow, cash flow, and reducing avoidable write-offs. We have the ability and technology to gather and analyze a significant amount of data and translate it into valuable information. This information is then used to identify areas of opportunity that our consultants use to develop real, sustainable solutions. We work collaboratively with our client s leadership and staff to identify and define areas within the revenue cycle where improvement opportunities are present, as well as develop and implement recommendations. By combining both a highly skilled consulting and management team with over 35 years of revenue cycle experience across the United States, GRANT & WEBER delivers a practical, reliable, flexible, and highly customizable solution, resulting in significant net revenue improvement for our clients. CONSULTING SERVICES OFFERED: FULL REVENUE CYCLE ASSESSMENT Our Consulting services span the entire continuum of Revenue Cycle We understand the entire revenue cycle requires a complex balance of people, process, and technology in order to achieve the highest level of revenue collection while controlling cost. Financial and clinical services must be coordinated, and corresponding data and documentation must be synchronized. Revenue cycle leadership has to be in constant communication with ancillary Revenue departments, Case Management, Health Information Management and Finance departments to ensure all services are appropriately charged, billed, and reimbursed. With so many department dependencies and a complex external healthcare environment, it is easy for even a simple problem to result in revenue loss. Our Consulting team is capable of evaluating data, process, method, and technology in every area of the revenue cycle to identify opportunities, discover the root causes for deficiency and develop and or implement sustainable solutions. SPECIFIC REVENUE CYCLE CONSULTING SERVICES PATIENT ACCESS - REACH PROGRAM Our REACH Program (Registration, Eligibility, Authorization, Concierge, Hospitality) provides a full suite of patient access resource tools and work flow processes with proven results in reducing errors and denials, increasing Point of Service Collections for all patient entry points, and ensuring the highest percentage of patients, scheduled and non-scheduled, receive financial clearance discussion (with liability payment and or financial assistance options) prior to service. The REACH Program also has value-added benefits to healthcare providers, such as proven results of increasing physician and patient satisfaction scores. 4

5 CASE MANAGEMENT/UTILIZATION MANAGEMENT Healthcare Case Management poses significant challenges in managing operational efficiency with increased focus on appropriate patient status and use of resources, while increasing clinical quality. Effective Case Management combines clinical and financial services, and balances significant coordination and communication between nursing, physicians, and all revenue cycle areas. Our Consulting team reviews the entire spectrum from patient throughput and status, resource management, Recovery Audit Contractor (RAC) programs, denial, and underpayments to ensure proactive operations. HEALTH INFORMATION MANAGEMENT While the move from ICD-9 to ICD-10 is certainly a significant event, the daily functions of the Health Information Management (HIM) department have a financial impact on the revenue cycle. Clinical documentation issues, hybrid documentation, new services, and de-centralized data can cause inaccurate coding resulting in denials or reduced payments. Our Consulting team looks at all aspects of HIM, including both internal and external processes and records. We have a variety of HIM resources, including subject matter experts in coding audits, ICD-10 training and ICD-10 implementation timelines. PATIENT FINANCIAL SERVICES (PFS) Once thought to be entirely responsible for revenue cycle, PFS has evolved into a communication and information hub in addition to performing the final, key functions within the revenue cycle critical to cash collection. Even with significant advances in technology supporting PFS functions, the department typically remains heavily dependent on manual processes. It is imperative that systems are utilized to their fullest capacity, staffing levels are appropriate, and procedures are in place to achieve maximum efficiency with minimal cost. Our Consulting team utilizes a variety of analytical tools, reports, and data to identify any opportunities, and works collaboratively with our client s leadership to address distinctive gaps. 5

6 REVENUE SOLUTIONS SERVICES In January 2010, GRANT & WEBER expanded their services to include a Revenue Solutions Division that works as an integrated business office and as an extension of the healthcare provider s business office. The model focuses on the consolidation of processes, taking advantage of the ability to identify trends within the entire inventory to improve cash flow and enhance patient satisfaction. Our focus on patient satisfaction, client care, in-house training, and effective recovery solutions are critical in the daily operations. The Revenue Solutions operational team, based in the state of Washington, provides full service first party Accounts Receivable (A/R) management solutions for hospitals and large physician practices, including: Billing Insurance Follow-up & Recovery Self Pay Billing & Customer Service Recovery Follow-up A/R System Conversion Services GRANT & WEBER uses advanced technology partners to support and consolidate A/R management activities. We have developed custom work flow enhancements that operate in synchronization with the healthcare provider s hosted patient accounting system. Interfaces are established to most major patient accounting systems, which allows the GRANT & WEBER Revenue Solution specialists to service accounts directly in our specialized patient accounting follow-up system. This offers the latest solutions for our clients at no additional cost, reducing overhead to help justify outsourcing A/R. Ongoing enhancements to our systems and software include state-of-the-art technology improvements, such as: online account customer service portals, customized work flows to meet each facility s needs, programmable integrated voice response system and a predictive/blended dialer system, insurance eligibility, and sophisticated charity care. Our revenue solutions services include: Knowledgeable healthcare customer service representatives Patient-friendly billing statements Insurance eligibility batch processing for multiple payers Real-time insurance eligibility / claim status web portal Advanced bi-directional data interface process with electronic synchronization & reconciliation Phone technology records inbound and outbound calls available for review by client Customer service phone survey Skip tracing services Personalized patient customer service online payment products HIPAA HITECH compliance / routine SAS70 compliance audits (SSAE 16) / PCI Compliance Language Line Services to provide interpretation in 200 languages Integrated onsite help desk and Information Technology department Insurance follow up services Denial Management services 6

7 W O R K E R S C O M P E N S AT I ON RECOVERY SERVICES Our nation s healthcare system is set up to encourage the medical community to provide medical care for an injured worker and, furthermore for the injured worker to have accessibility to quality medical care and a wide selection of medical providers who practice industrial medicine. However, these laws and protections are not easily given up by insurance companies and that is why providers depend on GRANT & WEBER to ensure just compensation for its medical services. We offer customized workers compensation billing and recovery services throughout the revenue cycle. Our workers compensation recovery services are handled in following stages: Workers Compensation Billing Support: Where GRANT & WEBER billers are responsible for generating all hospital inpatient and physician outpatient/clinic workers compensation claims from the healthcare provider s claims billing editor once the charge entry has been completed. Our goal is to ensure that each bill meets clean claim guidelines, has the correct billing amount for services rendered, includes accurate coding and billing modifiers, and is sent to the correct payers with all supporting documentation. Workers Compensation Recovery Follow-up: Follow-up typically begins days after final bill date for claims that have not received a payment or denial. Our workers compensation follow-up specialists are responsible for reviewing claims before timely filing deadlines to ensure maximum reimbursement of workers compensation claims. The department is also responsible for identifying underpayments for claims paid, advising clients of silent PPO concern, notating all account work history and facilitating maximum recovery for claims billed. 7

8 Workers Compensation Denial Management: A denied claim or a denied treatment does not mean the provider does not receive payment; the injury may be compensated based on additional medical report(s) or other facts ascertained through the court process. Workers Compensation Denial Management specialists are responsible for filing reconsideration appeals or negotiating with bill review for claims that received a first or second denial. Our denial management specialists are highly skilled at problem solving and negotiating a timely resolution on denied claims, which in turn, increases recovery and lowers unnecessary aging of workers compensation claims. Workers Compensation Legal Management: Legal management often differs from state to state. For example, in California GRANT & WEBER stands in the forefront in litigating before the Workers Compensation Appeals Board (WCAB) to get medical providers the monies they are entitled. We stand ready to litigate on your behalf when necessary to collect the total amount rightfully due to your organization. Our in-house legal staff is a value added service that controls cost, provides legal advice and makes litigating smaller-balance accounts more cost-effective, significantly enhancing your rate of recovery. In some states, like Texas, our legal management is responsible for filing a Medical Fee Dispute for claims denied for reimbursement reasons, or a Benefit Review Conference for claims denied for a claim related reason, or request an Independent Review Organization for claims denied for medical necessity. Reimbursable claims not fully adjudicated will continue in the legal process by filing appeals with the District Court State Office of Administrative Hearings (SOAH) by submitting any additional proof, evidence or arguments in order to obtain a favorable decision. Workers Compensation Closed File Review: GRANT & WEBER provides the planning, qualified human resources and technology necessary to promptly and effectively identify underpayments through our comprehensive closed or zero Balance workers compensation resolution methodologies in order to reconcile inaccurate financial transactions within assigned accounts. Account reconciliation includes written or verbal communication with the payer, employer, or the patient/ guarantor. Once an account has been reconciled, assessment for follow-up action to pursue collections is made. Steps will then be taken to realize collection on the reconciled account. 8

9 THIRD PARTY LIABILITY RECOVERY SERVICES GRANT & WEBER has structured a series of investigative procedures that enable us to identify and retrieve accounts that might otherwise fall through the cracks as they pass through a facility s operational protocols. The GRANT & WEBER Third-Party Liability Services Division (TPL) has affected the collection of millions of dollars in claims on behalf of our clients, and has been intimately involved in the development of TPL policies, procedures and recoveries during the past two decades. Our numerous years of experience in this industry afford us the expertise to determine Best Business Practices relating to TPL recoveries. We offer: Initial review Contract review for TPL applicability Lien preparation Timely and complete response to requests for bills/paperwork from plaintiff or defense attorneys HIPAA compliance in all procedures Negotiation for settlement and monitoring of the process Ongoing communication & reporting to interested parties In-house legal counsel GRANT & WEBER has thorough procedures in place when reviewing Medicare accounts at 120 days to determine whether or not accounts are eligible for TPL status and if they should be billed accordingly. These accounts are reviewed tenaciously by our in-house legal counsel and paralegals, trained to specifically identify TPL accounts. We also provide detailed reporting to specify the status of each account reviewed by our TPL professionals. With over 50 years of combined experience in healthcare litigation, GRANT & WEBER offers a training program for its clients and its staff on TPL issues at no extra charge. We will return accounts not identified as TPL and better educate our clients to help them understand what qualifies for TPL. The GRANT & WEBER experienced, knowledgeable and resolute TPL division has delivered a high rate of recoveries and a professional manner of dealing with attorneys, payers, and liable parties while remaining sensitive to the reputations and integrity of our clients. 9

10 DELINQUENT SELF PAY COLLECTION SERVICES GRANT & WEBER recognized long ago the benefits of specializing in the accounts receivable recovery process and the essentials needed for standard self-pay collections. Through years of experience, GRANT & WEBER has developed certain fundamental practices when handling delinquent self-pay collections with continued proven success. The wealth of experience and qualification we hold at GRANT & WEBER ensures that we have the resident expertise to provide an outstanding service to our clients at a productive rate of return while always remaining in compliance with all federal, state, and local regulations affecting the professional collection industry. Whether you specialize in the fields of healthcare, insurance, higher education, legal judgments, credit union or financial institutions, or commercial accounts, GRANT & WEBER is dedicated to quickly and effectively collecting your delinquent accounts receivable and improving your bottom line. GRANT & WEBER utilizes the most up-to-date tools for its skip-tracing and credit reporting functions. Social security tracking, online property searches, voter registration records and thorough phone directories are among the many sources we have for identifying and locating hard to find and evading debtors. GRANT & WEBER has the ability to provide its clients with an opportunity to have its assigned collection accounts litigated in-house. We employ our own in-house legal counsel and paralegals to help prepare lawsuits, secure judgments and execute post-judgment work to aid in the recovery of outstanding debts. While we try to avoid litigation whenever possible, we sometimes may have no other choice. GRANT & WEBER will never start any legal proceedings without first performing an in-depth asset search of the debtor. If proper funds are available to pursue, we then request the expressed written consent of the client before commencing litigation. GRANT & WEBER is licensed and bonded to conduct business nationwide, allowing us the benefit to pursue out-of-state debtors who have either relocated or reside in a state different from that of your services. This opens up a significantly wide range of areas, which could not be pursued otherwise due to differentiating laws between states. GRANT & WEBER pays close attention to these differences in state collection laws, with the help of our in-house legal counsel, to ensure that we always act in a legal and professional manner. Upon referral of an account GRANT & WEBER will send its first notice to the responsible party and then allow an opportunity for reciprocal contact. Our collectors are trained to initially attempt full payment, keeping in mind that each person may have a special circumstance to be taken into consideration. GRANT & WEBER employs only the best collectors to handle your accounts. Our staff is trained to pursue debt collection while sustaining relationships and, as such, our collectors address each debtor with understanding, compassion and respect at all times; as is displayed through our soft touch approach to healthcare collections. 10

11 CONSIDERING A COLLECTION AGENCY? MAKE AN INFORMED DECISION. There is a vast array of choices when it comes to deciding which collection agency is right for you. Experience Counts When choosing a collection agency, you should be assured that the collection agency has experience specializing in collecting accounts receivable in your industry. For example, an agency unfamiliar with healthcare terminology, regulatory issues or patient/provider concerns cannot be as effective as one that has served that industry for years. Knowing proper terminology helps our collectors to quickly relate information to the patient/debtor, helping them to better understand the charges due. Trust It is imperative that your collection agency secures the money that it collects on your behalf. The following three security issues should be addressed prior to your decision to use an agency: 1) A Trust Account: Your agency should deposit all the dollars it collects on your behalf into a trust account kept separate from their operating account. When an agency co-mingles your money with theirs, there may be temptation to borrow operating funds from your gross collections in anticipation that more of your receivables will be collected throughout the remainder of the month. 2) Insurance: Your agency should deposit all the dollars it collects on your behalf into a trust account kept separate from their operating account. When an agency co-mingles your money with theirs, there may be temptation to borrow operating funds from your gross collections in anticipation that more of your receivables will be collected throughout the remainder of the month. 3) Bond: As additional security against an agency absconding with your funds, you should require that they be adequately bonded so that you have recourse in the event the agency goes out of business or otherwise attempts to keep money which rightfully belongs to you. 11

12 People Who Care Your collection agency should provide a scope of services that complements your specific needs and requirements. For example, your agency should provide a client services support staff responsible for a variety of tasks such as: assisting in the account assignment process by traveling to your office(s) to copy charts and files if necessary; being available to respond to your inquiries regarding any individual account; or following through with special requests like customized reporting. Assurance A qualified collection agency should employ in-house legal counsel. In-house counsel can easily and cost-effectively file lawsuits on your behalf when a debtor who acknowledges they owe money and have adequate assets to pay their bill, refuses to cooperate and, forces the agency to utilize the court system in order to protect your financial interests. The value of using in-house counsel, versus contracting with a law firm, is that the agency can be more aggressive in their recommendation to litigate since they are more in control of the costs of litigation. Distinctive Work Standards You must be confident that your collection agency is as effective as possible with regard to the recovery of your delinquent accounts receivable. The best way to determine the effectiveness of your agency is to audit your accounts to make sure they are systematically worked and that the appropriate amount of attention is given to each account, regardless of the balance of the account. All collection agencies should be able to provide details about the collection methodologies they employ and the standards they strive for, thereby providing you with a basis upon which to determine their effectiveness. Results The rate that a collection agency charges is much less important than the overall collection effectiveness and service which the agency provides. Your organization should be much more willing to contract with an agency focused on maximizing the return of your dollars than with an agency simply offering a lower rate. The following Net-Back example illustrates why we submit that rate is a lower priority than the items previously listed: AGENCY A $1,000,000 $150,000 25% $37,500 $112,500 Assignments Total Collections Contingency Rate Contingency Fee Net-Back AGENCY B $1,000,000 $100,000 18% $18,000 $82,000 In reviewing this example, it is easy to quickly assess that it would make more sense for you to contract with Agency A which charges a 40% rate rather than to contract with Agency B which only charges a 20% rate. The rate that an agency charges directly impacts the level of effort they can put forth on every account, thereby increasing the probability that they will collect the accounts receivable owed to your organization. In summary, your organization needs to be diligent in its efforts to determine which collection agency will perform best. Our hope is that in using this guide, you will be better able to make an appropriate decision with regard to choosing the most productive agency and maximize the recovery of your delinquent accounts receivable. 12

13 OUR SOFT-TOUCH APPROACH TO HEALTHCARE COLLECTIONS We Care GRANT & WEBER s unique practice of collecting healthcare accounts is based on a simple philosophy: We believe in and have respect for your patients. We believe that patients with delinquent accounts have what they believe to be legitimate reasons for allowing their accounts to become delinquent. Our goal is to find that reason. Perhaps they thought their bill was fully covered by their primary and/or secondary insurance. They may want to dispute some or all of the charges. Maybe they do not fully understand their billing statement or Explanation of Benefits (E.O.B.) They just cannot afford to pay the bill right now, and don t know how best to handle the situation. Whatever the reason, we respect your patient s point of view. We Listen Once we make contact with a patient, we listen patiently and respectfully to their story with an ear toward finding solutions. We let them know we understand their situation and that we will work with them. Because they feel heard and understood, they are more open to exploring solutions. Then we ask questions, the right questions, which lead us to results. We learn as much as we can about the patient s current financial status, the reasons for the delay, and the possibilities for payment. We use this information to work out the best possible recovery/payment resolution. We Collect Of course, the best possible resolution for our clients is immediate payment in full, which we collect whenever possible. However, when arrangements must be made, we negotiate realistic payment arrangements that are likely to be kept. Working with patients to develop a plan they can live with, even if it takes a little time, ultimately protects and maximizes recovery for our clients; because it s a real plan, not an empty promise. In fact, most patients ultimately keep the arrangements they make with GRANT & WEBER. 13

14 RESOURCES AND COMMITMENTS HUMAN RESOURCES The staff members we hire to support our operations are seasoned healthcare professionals with extensive business office experience. These staff members are led by several Director-level personnel that are actively involved in the day to day operations of A/R management experience. Our employees are all trained and work on the same system and can be deployed as needed to cover large volumes of claims, attack backlogs, and ensure that patient and client needs are handled. We have both the physical and intellectual work force to provide scalability to any size project. GRANT & WEBER recruits full time employees and, because of the nature of our business, we adhere to a strict policy and thorough background screening. Each potential GRANT & WEBER employee is subject to a social security verification and criminal background check. Only after they have passed will an offer of employment be made. COMMITMENT TO ADVANCED TECHNOLOGY GRANT & WEBER is committed to employing the most advanced systems and solutions to support our clients needs. GRANT & WEBER constantly invests in advancing hardware and software solutions so that we can operate efficiently in an electronic processing environment. GRANT & WEBER utilizes several customized revenue cycle management software systems that provide the proper rules-driven work standard protocol for each line of business. We incorporate a sophisticated patient account system for our healthcare integrated business office services, and intelligent third party collection software for our collection management. We have interfaces developed to most major patient accounting systems, which allows GRANT & WEBER to service accounts via its own specialized follow-up system or systems. These system support tools include: online account services, modified workflows to meet the facility s needs, customizable Integrated Voice Response system, a Predictive/Blended Dialer, Insurance eligibility Quick links, sophisticated Charity Care Modeling to determine real time pre-qualification, full integration with trusted vendors, such as TransUnion, Experian, FHSCorp, Accurint, CompuMail, RevExpress, and many more. Reports are easily generated; collection and account status is ascertainable through a friendly interface that supports an intuitive workflow. Accounts can be easily uploaded into our systems and assigned for work effort through the use of an Electronic Data Interface (EDI). 14

15 COMMITMENT TO CLIENT CARE Customer satisfaction is the key to success. Effective revenue solutions involve more than just collecting money; it requires an ongoing process that includes communication, reporting, project management, and education. GRANT & WEBER believes that it takes more than good results for our clients to be happy with service. This philosophy is the main reason we employ dedicated, full-time Client Service Managers and Account Service Representatives to be personally assigned to you for a direct line of communication with GRANT & WEBER and a constant source of information to keep you connected with the activity of your assignments. We also assign dedicated account management representatives who remain onsite in your business office or will make periodic trips to your location to pick up and or drop off any files that may not be exchanged electronically and to help us build a more personal relationship with you, our client. This service can be scheduled regularly and/or as needed, and is provided to you at no extra charge. IN-HOUSE LEGAL As a full service organization, we employ in-house legal counsel to monitor all state and federal regulations on behalf of our clients, saving them thousands each year in indirect legal costs. The GRANT & WEBER staff are supported and monitored by our legal counsel throughout the revenue cycle process to ensure our best practices meet all current legislation, protecting both parties from unnecessary legal matters. The values of using the GRANT & WEBER in-house counsel versus contracting with an external law firm are: We can be more aggressive in our recommendation(s) to litigate since we are more in control of the costs of litigation. Our skip-tracing abilities complement our unique approach to file analysis and allow us to locate debtors and serve legal process in a timely manner. We bring a powerful national network of attorneys to bear. Our expertise in collections and collection law makes recovery and litigation a seamless and integrated process. 15

16 GRANT & WEBER REVENUE CYCLE AND RECEIVABLES MANAGEMENT Consulting Billing Insurance Follow-Up Workers' Compensation Recovery Third Party Liability Recovery Self Pay Billing & Customer Service Follow-Up Delinquent Self Pay Collections System Conversion Assistance