MAXIMIZING COLLECTIONS

Transcription

1 MAXIMIZING COLLECTIONS Janice Rutter, Director, Support Services, Merge Healthcare Jon Neal, Ph.D., Vice President, InstaMed Mark Snow, Vice President, RevSpring (formerly PSC Info Group) Tracy Sanders, Project Manager, MEGAS-Alpha II Tuesday, August 28, Merge Healthcare

2 session objectives 2 Share opportunities and ideas for maximizing collections within financials system Review and educate on engaging third party products to reduce FTE time and improve collections Review and educate on creating metrics to drive collection improvements

3 MAXIMIZING HEALTHCARE PAYMENTS COLLECTIONS Applying Best Practices

4 state of the healthcare payments industry The costs to collect from a patient are twice as much as collecting from a payer Up to 20% of revenues are lost due to uncollected patient bills & unremitted reimbursements In Since 2010, 2008, bad debt employerbased health reached insurance decreased by 4.6% Healthcare prices rose 5x faster $65 than billion inflation from Sources: 0Cybersettle.pdf 9EFD6928E5253E05C8D2ACB

5 payment responsibility trends 24% 22% 20% 18% 16% 14% Payer Responsibility for Billed Charges 21% 20% 18% Payer Responsibility for Billed Charges (in Percentage) 30% 25% 20% 15% 10% Patient Responsibility for Allowed Charges 21% 24% 26% Patient Responsibility for Allowed Charges (in Percentage) 12% 5% 10% % Source: InstaMed s Trends in Healthcare Payments Annual Report: 2012

6 nonpayment drivers Top Drivers of Payer Nonpayment Member ID not found/claim not on file Government-driven changes MPPR PQRS incentives turn to payment penalties RACs According to the AMA, radiologists lose up to 5.5% of professional income daily due to incomplete documentation and under-coding Payers are driving claim denials and exceptions with automation Top Three Drivers of Patient Nonpayment Patient confusion 41% of patients do not have confidence that their bill is accurate Patients do not expect to make a payment when services are performed Not accepting preferred payment options Claims processing errors cost $17 billion annually 74% of patients are able to pay their healthcare bills Source:

7 inefficiencies in billing Payer Too many and not enough time to follow up on unpaid claims Prevent effective follow-up on front end rejections Paper claims take too long to pay Costs associated with filing appeals It is humanly impossible to know over 400,000 edits (NCD/LCD, CCI, etc.) Claims are underpaid based on coding errors Delays from date of service to claim filing Patients Providers only collect 10-12% of self-pay patient payments Passive mindset in collecting patient payments at point of service (POS) Patients are not billed in a timely manner Patients do not understand their statements Sources: McKinsey and American Medical Association

8 best practices Payer Leverage system automation Auto coder Automated re-files Utilize electronic claims Leverage products to maximize coding compliance Implement Claims Manager Analyze and eliminate errors Expose and improve correcting and tracking front end rejection Execute work queue strategy Follow up on unpaid claims Maximize FTE time on appeals Patients Screen patients for eligibility Set patient financial expectations upfront Outsource patient statements Reduce time to bill Produce clear and concise statements to patients Create a patient payment portal Accommodate patient payment preferences Establish a payment plan

9 leverage financials automation 9 Charge exceptions decrease time to code Auto coder Auto-coding, ICD9 codes, modifiers, add on codes Buckets for segregating charges/demo requiring adjustments Measure/reduce time to post /bill Claims decrease time to payment Collaboration compass take advantage of electronic availability primary and secondary Paper outsource send with electronic Eliminate administrative costs Claim review QA adjustments

10 leverage financials integrated tools 10 Consider an automated coding product Imports go directly to Review & Post Coding director controls costs and allows configuration for procedures to be manually coded Consider Merge Clinical Edits reduce claim denials LCD/NCD, CCI, PQRS, claim formats Edits apply based on setup Charges edited at time of posting and claim filing Analyze front/back end rejections and re-work Consider implementing Claims Manager Identify those that can be eliminated with process/procedure/training Identify those that can be eliminated with appropriate coding

11 develop & re-develop work queue strategy 11 Develop and perfect Work Queue Strategy, tactics and approach Monitor Operations Work in Progress Follow up on past due claims that pay within 15 days more timely Assign payers to specific users Build relationships Capitalize on repeat processes improving efficiency Analyze work queue productivity Set goals for accomplishments Consider time devoted to insurance vs. patient Considering best return on time spent Eliminate leaving money on the table based on lack of follow-up Insurance past due Appeals not re-filed

12 clinical coding edits improving clean claims 12 Merge Financials allows corrections to be made in both Charge Exceptions and Claim Review making it easy to correct in the workflow process individual charge lines as they are committed to the data base At a claim level Proprietary medical necessity data, Medicare LCD/NCD policies and commercial medical necessity edits for Aetna and Cigna are included achieving guidance for virtually all ICD-9/CPT code combinations RVU sequencing is applied to ALL claims before the claim is produced No file maintenance required Content files are updated quarterly or as needed

13 clinical coding & compliance edits improving clean claims 13 Up-to-date PQRS edits ensure you comply and avoid payment penalties Edits will provide the coding edits that were not able to be caught by manual coding or by other applications front end edits Not all front end coding solutions (e.g., CodeRyte, A-Life, etc.) code everything, still requiring manual review by a coder and chances of errors occurring CMS has designated 2013 as the reporting period for the 2015 PQRS payment penalty. Therefore, if CMS determines that an eligible professional or group practice has not satisfactorily reported data on quality measures for the reporting period of January 1 through December 31 for purposes of the 2015 payment penalty, then the fee schedule amount for services furnished by the participating professional or group practice during 2015 would be 98.5% of the fee schedule amount that would otherwise apply to such services.

14 clinical coding & compliance edits improving clean claims 14 Code searches are performed using physician language Look up codes using the official name, common name, acronym, or site Links to additional codes related to the current diagnosis are included Codes to ultimate specificity Designates applicable modifiers by CPT/HCPCS code Eliminate coding errors with enhanced code searches Eliminate bundling/unbundling errors Improve use of modifiers Integrated CCI edits and the ability to detect unbundled procedures

15 implement a payment portal & patient payment estimator 15 Merge s Patient Payment Portal, powered by InstaMed, provides a simple-to-use way to present statements electronically, collect patient payments, and post payments back into Merge

16 implement a payment portal & patient payment estimator 16 Patient Payment Estimator combines eligibility checking with the InstaMed Patient Estimator module, to determine patient responsibility at the point of service and automate collection of patient responsibility post claim adjudication

17 implement a payment portal & patient payment estimator 17 Best Practices: Increase ways for patients to pay. By increasing the number of ways to collect, and making it easier to collect, patients are more likely to pay, and will pay faster. Achieve Payment Assurance prior to the patient walking out the door. Set expectations up front and capture payment vehicles at the point of service.

18 outsource patient statements 18 Consider time spent on generating statements vs. follow up on work queues Data analytics Clear, concise, patient friendly billing Communications One platform Print, digital, telephony, mobile Billing, ecommerce and marketing Targeted TransPromotional communications Integrated customer relationship management Increase cash flow Reduce administrative costs Improve patient experience and satisfaction

19 Brilliant, vibrant documents get noticed Color increases payment response by up to 30% Color increases readership by 80% Information in color can be located 70% faster Personalized messaging Customize statements with targeted messages Enhance brand recognition TransPromo marketing Sell ad space to affiliates, partners, advertisers

20 Dynamic Documents TransPromo marketing Special services promotion Use color to highlight Amount Due Multiple Payment Options and QR Code

21 Dynamic Documents Duplex Variable Data Fields Billboard space for advertising

22 sample letters 1:1 communications

23 results achieved 23 Improve clean claims while reducing back end re-work Improve payer collections Reduce days in AR Promote FTE efficiencies Increase patient collections 200% Reduce administrative costs Reduce bad debt Improve patient experience and satisfaction

24 QUESTIONS? Janice Rutter, Merge Healthcare

25 THANK YOU!