Best Practice POS Cash Collections. Ryan Wheeler, President and GM Early Out and Patient Finance Division

Transcription

1 Best Practice POS Cash Collections Ryan Wheeler, President and GM Early Out and Patient Finance Division

2 Agenda Current Landscape Post-ACA Building a Point of Service Cash Collection Program Integrated Process and Technology Mission Driven Organization ACA Compliance Measure, Manage and Incentivize Sample Scripts Q&A 2014 Cardon Outreach 3

3 Understanding patient QHP non-enrollment

4 Hospitals must adjust to accommodate BAI

5 Ballooning volume of patients with BAI

6 ACA adds upper and lower bounds on cost sharing

7 Growing percentage of dollars paid by patient 2014 Cardon Outreach 3

8 Understanding patient non-payment of hospital bill Source: McKinsey Health Survey

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10 Time value of Cash Collections Source: RelayHealth

11 Financial leakage

12 Integrated Point of Service Cash Collection Technology Assisted Process Patient Financing Eligibility and Benefits Measured Managed Incentivized $ POS Cash Patient TPL / Work. Comp. Mission Driven Charity Disability ACA Compliant 2014 Cardon Outreach 12

13 Technology Assisted Patient Access Patient Identity Verification Holistic Patient Liability Estimate Past Balance Deductible Hospital UB-04 Physician HCFA 1500 Estimates to accommodate bundled payments Electronic Eligibility and Benefits Presumptive Charity (technology/service) Propensity to pay analytics Measure and Manage Patient Access Volume per associate; Avg time per encounter Accuracy by associate Quality by associate (real time capture, Press Ganey) 2014 Cardon Outreach 3

14 Revenue Cycle circa 2010

15 Early Intervention Drives Results Scheduling Physician referral Verify Coverage & Benefit Eligibility Search Educate Patient on Financial Responsibility Estimate with an attempt to collect for imaging Schedule Clinical Service Registration Verify Insurance and Demographics Review Estimate Discuss Payment Options Discuss Patient Finance Option Collect Patient Payment Inpatient Bedside Charity evaluation Harvest Demographic, Guarantor Info, Signatures Educate Patient On Process to Financial Resolution Electronic/Paper Eligibility Filing Pre-Registration Verify Insurance Coordination of Benefits Produce Patient Liability Estimate Attempt to collect payment after charity ruled out Discuss Payment Options Discuss Patient Finance Option Emergency Department Harvest Patient Demographics Verify Insurance Rule Out TPL/WC Charity Evaluation Patient Signatures Attempt to Collect From Patients Post Discharge Continue Insurance Discovery Continue Eligibility and Disability Scan Continue TPL Scan Hand-off to Self-Pay Team Non-Recourse Patient Finance 2014 Cardon Outreach 15

16 Mounting Regulatory Pressure Most Appropriate Coverage Under ACA, a duty exists to ensure patient is enrolled in most appropriate coverage: 42 CFR ACA Section 1413 (c)(3)(b) Rigorous application of MAC maximizes recovered revenue and is compliant Section 501(r) of the tax code Articulate financial assistance policy to patients Place limits on charges for care under fin. assist. policy Determine eligibility for financial assistance before collections Hospital 501(c)(3) non-profit status is at risk if non-compliant CMS Payer of Last Resort U.S. Settles Lawsuit Against Harris County Hospital District The United States and the State of Texas have settled a hospital lawsuit for more than $15 million. The plaintiff alleged that the hospital routinely submitted claims to Medicare and Medicaid without first seeking reimbursement from primary carriers as required by each program's rules and regulations. Patient Experience HCAHPS scores suffer when patients are dissatisfied with their experience 2014 Cardon Outreach 16

17 Compliance with 501 ACA Compliance establish written financial assistance and emergency medical care policies, limit amounts charged for emergency or other medically necessary care to individuals eligible for assistance under the hospital's financial assistance policy, make reasonable efforts to determine whether an individual is eligible for assistance under the hospital s financial assistance policy before engaging in extraordinary collection actions against the individual, and conduct a community health needs assessment (CHNA) and adopt an implementation strategy at least once every three years. (These CHNA requirements are effective for tax years beginning after March 23, 2012).

18 Emergency Department Point of Service Cash All ED co-pays should be collected while patient is at facility POS collections in ED can occur at various points during visit: Compliance with EMTALA is highest priority When patient presents If patient offers to pay during initial registration, accept co-pay If bedside registration is completed co-pay can be collected bedside At discharge/check out All patients should be directed to check-out counter prior to departure Check-out counters are most effective if positioned between ED treatment areas and exit. Ideally with one exit Cardon Outreach 3

19 Minimizing the Pit of Despair Mission Driven 2014 Cardon Outreach 3

20 Shifting the engagement adoption curve Mission Driven Executive sponsorship Robust Policies and Procedures Broad staff engagement Communication of the shared mission and collective teamwork required Discussion and inclusion of intrinsic motivation and team mission Incorporate into the employee development and engagement program Incorporate individual cash and non-cash rewards Celebrate group achievement Leaderboard Employee of the month Service awards 2014 Cardon Outreach 3

21 Monitor, Measure, Manage Metric Owner Frequency Total uncompensated care as a percentage of cost Total uncompensated care as a percentage of gross revenue Total Patient Pay (co-pay, deductible, past due balance, balance after insurance) Total patient liability collected at Scheduling, Pre-Reg, Registration Pre-service liability collection rate: (total patient liability collected/total possible pre-service collections Revenue Cycle Revenue Cycle Revenue Cycle Revenue Cycle Patient Access Monthly Monthly Monthly Weekly Daily Total Patient Pay A/R >90 days PFS, Rev Cycle Monthly POS Cash Collections Patient Access Daily Rebates returned to patients Patient Access Monthly C a r d o n O u t r e a c h 3

22 Motivating the right behaviors Develop and deploy Policies and Procedures Train, test and reward for successful scores (>90%) Communicate broader hospital mission and teamwork Incorporate Leaderboard for test performance Reward successful completion and testing (gift card drawing) Measure and reward volume performance Begin by measuring patient liability estimate production Leaderboard for estimates produced Reinforce and reward volume and accuracy Measure and reward quality We adopted 50% of bonus tied to quality measures Measure and reward cash collection 2014 Cardon Outreach 3

23 Patient Just send me the bill and I ll pay it then. I just bought insurance on the state insurance exchange; my insurance will cover this. Sample Script Our new hospital policy is that patients are responsible for co-pays on the day of service. The amount is $. Do you prefer to pay by cash, check or credit card? As a courtesy to you, we contacted your insurance company to verify coverage and you are responsible for a portion of the bill. The amount is $. Do you prefer to pay by cash, check or credit card? I have come to this hospital for years and I have never had to pay before I see the doctor. To prevent surprises, we estimate your patient responsibility in advance of care. We started collecting patient balances so you don t have to worry about the bill coming later. I didn t bring my checkbook. I would be happy to accept cash or credit card payment. My ex-spouse always pays the doctor bills for our child. I understand you may have a payment agreement with your ex-spouse. I would be happy to provide a receipt so you can be reimbursed for today s ED visit Cardon Outreach 3

24 Integrated Point of Service Cash Collection Technology Assisted Process Patient Financing Eligibility and Benefits Measured Managed Incentivized $ POS Cash Patient TPL / Work. Comp. Mission Driven Charity Disability ACA Compliant 2014 Cardon Outreach 24