How can Banks Influence the. How can Banks Influence the. Landscape

Transcription

1 How can Banks Influence the How can Banks Influence the Healthcare Healthcare Payments Payments Landscape Landscape Presenter: Lester Monteiro, VP TD Bank, NA

2 Topics Discussed What are the issues facing Healthcare Revenue Management? Reduction of Paper and Manual Processing expenses Increase processing efficiencies with electronic tools Lockbox, and the benefits of outsourcing receivables processing to Banks Online storage versus paper storage 2

3 The State of Healthcare 60 to 80 Million Claims are generated everyday Claims are generated for: Hospital Emergency Room Visits Doctor Services Pharmacy Services Ambulatory Care X-Rays, Sonograms, Ultrasounds technician services 3

4 Seems like a Puzzle? Posting receivables from Explanation of Benefits (EOBs) is a very paper intensive process Long term storage of the paper Explanation of Benefits leads to continuously increasing paper storage costs Manual data entry from very busy EOBs leads to higher than expected rates of keying errors Extremely prohibitive administrative costs associated with managing denials, and secondary billing opportunities Ever increasing write-offs due to lack of adequate audit trails 4

5 Like it or not this can be a Puzzle Thousands of payers with multiple formats 5

6 Revenue Cycle Management Organized Workflow Appointment Scheduling Patient Registration Patient Exam Documentation & Coding Legal Collections A/R Follow up Payment Processing!! Charge Processing 2 Secondary Claims/ Guarantor Billing Resubmission & Appeals Claims sent to Insurance Company Claim & Statement Production 6

7 Revenue Cycle Management Feels Chaotic!! Documentation & Coding Payment Processing Scheduling A/R Follow-up Charge Processing Resubmission & Appeals Registration Legal Collections Claim & Statement Production Secondary Claims 7

8 Are You Profitable? How happy is your CFO? Are you reconciling receivables information fast enough? Are your secondary billing opportunities captured? Are denials management getting extremely complicated? Are you budgeting more for ever increasing write-offs due to lack of appropriate audit trails? Is your Credit Rating below average due to collection of payments inefficiencies? 8

9 Healthcare Payments Environments Environments Paper EOBs ERAs Patient Pays Payments Payments Payments Arrives Together or Separate Arrives Together or Separate Arrives Together Patient Management System Balance by Environments and Patient Information 9

10 So What s Confusing about Payments? Payments rarely arrive together with Remittance Information Providers need to have Cash Suspense Accounts and must monitor the arrival of Remittances which could arrive a few days later Provider must then manually input Remittance Information and match this to the Payments received a few days ago Arrives Day One Arrives up to 5 days later Manual keying of data into Patient accounts The propensity for misapplied payments just got bigger!! 10

11 Payments to Remits Reconciliation Can this be done accurately & efficiently? Sunday Monday Tuesday Wednesday Thursday Friday Saturday ERAs Paper EOBs 11

12 How can Banks help? The Lockbox Solution! How can Lockbox help with your paper dilemma and make revenue management more efficient? Go from THIS Send all your receivables mail to your Bank s Lockbox Send all claims information to the Bank s Lockbox for receivables matching Paper checks and remittances can be scanned on high speed scanners at an average rate of 20,000 pages an hour Scanned images are available over the internet via secure access Images can be archived digitally for 7 years or more 12

13 How can Banks help? To THIS All images can be indexed making searching online for checks or remittances extremely user friendly Scanned images can be converted to 835 files and directly uploaded to the Provider s Patient Management System Providers can choose from multiple long term storage options: CD ROMs, DVDs, Dedicated SAN (Storage Area Network) Providers can download Accounts Receivables files as well as images of their Lockbox work directly from a secure Online Portal 13

14 Medical Lockbox Workflow (1) Lockbox receives all Paper Remittance, Checks & ACH (2) EOBs/checks are scanned & deposited via Lockbox (3) Checks/EOBs, ACH files & all Deposit Data images are created by Lockbox BANK SFTP Healthcare Provider Provider sends Bank a copy of the 837 claim file for improved reconciliation of payments received (4) Images are archived online (4.1) Providers log into a secure site to view & research payments information (4.2) HIPAA compliant ANSI X file created by the Bank (4.3) ANSI X file is transmitted to the Healthcare Provider 14

15 Banks - helping solve the Puzzle! No Capital Investment typically since this solution is outsourced entirely to the Lockbox Processor the Bank Shorter implementation time since the solution is technology driven, using standard scripting and optical character recognition (OCR) Most Banks providing Lockbox service can customize to the Healthcare Provider s business rules Simplified research and training capabilities are available online 15

16 Trending towards Profitability!!!! Faster collection of Payments and enhanced Receivables Management Reduction in staff expenses dedicated to manual paper processing Staff can be moved towards processing of secondary billing opportunities & denial management (therefore more payments collected) Reduction in paper storage expenses since images are stored online at a much reduced cost Reduction in billing write-offs since online audit trails are available on-demand for a number of years Happier CFO and/or Treasurer!! 16

17 Thank You! 17