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, 2012
session objectives
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
Applying Best Practices
MAXIMIZING HEALTHCARE PAYMENTS
COLLECTIONS
Sources: http://www.kaiserhealthnews.org/Stories/2012/May/21/higher-health-care-prices-hospitals.aspx http://smequity.squarespace.com/storage/dcMEDPAY%20Powered%20by%2 0Cybersettle.pdf http://www.gallup.com/poll/152621/fewer-americans-employer-based-health-insurance.aspx http://www.patientcollect.net/app/ptms/why_practice;jsessionid=58B8C2E8F 9EFD6928E5253E05C8D2ACB
Healthcare
prices rose 5x
faster than
inflation from
’09 – ‘10
Since 2008,
employer-based health
insurance
decreased by
4.6%
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 2010, bad
debt reached
$65 billion
10% 12% 14% 16% 18% 20% 22% 24% 2009 2010 2011
Payer Responsibility for Billed Charges Payer Responsibility for Billed Charges (in Percentage) 20% 21% 18% 0% 5% 10% 15% 20% 25% 30% 2009 2010 2011
Patient Responsibility for Allowed Charges Patient Responsibility for Allowed Charges (in Percentage) 26% 24% 21% Source:
InstaMed’s Trends in Healthcare Payments Annual Report: 2012
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
Source:
http://www.apexprint.com/how-to-improve-collections-from-self-pay-patients/
Top Three Drivers of Patient Nonpayment
74% of patients are able to pay their healthcare bills
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 Drivers of Payer Nonpayment
Claims processing errors cost $17 billion annually
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
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
Payer 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 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
Payer Patients
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
9
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
10
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
11
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
12
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
13
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.
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 Integrated CCI edits and the ability to detect unbundled procedures
14
Eliminate coding errors with enhanced code searches Eliminate bundling/unbundling errors
Improve use of modifiers
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
15
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
16
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.
17
outsource patient statements
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
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
Dynamic Documents –
TransPromo marketing
Use color to highlight Amount Due
Multiple Payment Options and QR Code
Dynamic Documents –
Duplex
Billboard space for advertising
sample letters
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
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Janice Rutter, Merge Healthcare [email protected]
