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Putting the Revenue Back in the Revenue Cycle: Financial Triage Southwestern Ohio HFMA

Putting the Revenue Back in the Revenue Cycle: Financial Triage Southwestern Ohio HFMA Ric Perez, Product Director - Passport Health March 14, 2014. Agenda. Two Parts Effective Screening Effective Collections Discuss Challenges What You Can Do Now Applying Technology

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Putting the Revenue Back in the Revenue Cycle: Financial Triage Southwestern Ohio HFMA

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  1. Putting the Revenue Back in the Revenue Cycle: Financial Triage Southwestern Ohio HFMA Ric Perez, Product Director - Passport Health March 14, 2014

  2. Agenda • Two Parts • EffectiveScreening • Effective Collections • Discuss Challenges • What You Can Do Now • Applying Technology • Focus on the Benefits

  3. The Challenges Not all guarantors are the same….

  4. Missed Opportunities

  5. Challenges…The Numbers • Uninsured Americans – 16%, 45 to 50 million people • 18% of uninsured Americans qualify for Medicaid; Will grow with Medicaid Expansion in 2014 • Nearly two thirds of Medicaid-eligible children were not enrolled (2011) • Up to 15% of self-pay accounts had missed Medicaid coverage • Up to 6% of self-pay accounts had missed Medicare and commercial coverage

  6. More… • Charity Mission / Tax-exempt Status IRS Form 990H • ACA Section 9007 / IRC 501 (r) Identify charity at POS, match insurance charges, community needs assessment /#ixzz22ED8UUX4 • Aggressive Collections HFMA: Compassion, Respect, Effectiveness • Rising Bad Debt Survey: 23% of hospitals reported bad debt of 5.1 – 10% in 2011

  7. Effective Screening What you really need is….

  8. Help Is On the Way…Already Here • ACA Section 9007 / IRC 501 (r) Identify charity at POS, match insurance charges, community needs assessment /# • 2013/14 – Health Insurance Exchanges • 2014 – Individuals required to carry insurance • 2014 - Medicaid expansion to 138% FPG • 2014 – Express lane enrollment; presumptive eligibility

  9. What You Can Do Today • Clear and concise policies and procedures • Understand and agree with charges • Know and offer all options • Educate, educate, educate • Real-time is key • Fair, balanced, compassionate • Scripts! • Embrace technology and available data sources

  10. Technology: Financial Triage Process • Leverages hospital’s financial assistance policy • Real-time verification, calculations, and estimates • Identify charity and Medicaid eligibility at POS • Clear, concise, compassionate

  11. Data: Propensity-to-Pay • Use available, verifiable information • Determine propensity-to-pay using guarantor’s own information • Discuss payment options at POS

  12. Key Benefits of Technology • Fair and balanced >> Improve patient relationship • Real-time options >> Better guarantor compliance • Automation >> Staff more efficient • Easy-to-use >> Staff more productive • Proven process >> Staff more confident • Charity screening >> Achieve charity mission • Validated financials >> Increase collections (20% +) BALANCE OF REVENUE AND MISSION

  13. Effective Collections: A Tale of Two Cities BART

  14. Metro – Los Angeles Rapid Transit

  15. Best Practices for POS Collections

  16. Amount Consumers Are Paying Is Growing Does not Include Bad Debt • Consumer payment responsibility is growing • As consumer debt grows… so does bad debt • As bad debt grows… so does the cost to collect 7% Annual Increase 3% Annual Increase $420* $265 $250 -- CONSUMER TO PROVIDER -- -- CONSUMER TO PROVIDER -- 2007 2015 2005 Breakdown of U.S. Healthcare Consumer Responsibility U.S.$ billions, estimates *Source: 2007 & 2009 McKinsey analysis

  17. Self-Pay Trends: Barriers to Point-of-Service Collection • ________________________ • ________________________ • ________________________ • ________________________ • ________________________

  18. Driversof Consumer Non-Payment Stated Reasons for Non-Payment Percent of insured respondents 33 “LACK OF FINANCING OPTIONS” 29 “I JUST RECEIVED MY STATEMENT” 92% of insured consumers are both able and willing to pay their out-of-pocket medical expenses for annual liabilities of less than $500 per year. “I FORGOT TO PAY OR WAS CONFUSED ABOUT WHAT I OWE” 18 “HEALTHCARE IS A RIGHT AND I SHOULDN’T HAVE TO PAY MY BILL” 10 10 OTHER REASONS Source: 2008 McKinsey consumer healthcare payment survey

  19. Self-Pay Trends: Barriers to Point-of-Service Collection • ________________________ • ________________________ • ________________________ • ________________________ • ________________________

  20. 20 Self-Pay Trends: Barriers to Point-of-Service Collection More than half of respondents say difficulty estimating cost of charges is a significant barrier to collecting at time of service.

  21. Estimated Recovery %’s By Control Point

  22. Elements of a Successful Healthcare Collection Tool

  23. Meet Your Patients Where They Pay

  24. Impact of Integrated vs. Stand Alone Collection Tool • 100% more transactions. • 9.4% more collected per transaction. • 120% more dollars collected overall. • 3% saved in collection costs for every dollar collected. • Pushes collection event closer to the front of the cycle, where probability of collection is near 100% as opposed to 40% at the end. • Streamlines workflow, minimizes errors, increase patient satisfaction.

  25. The New Norm….

  26. Thank you! Ric Perez ric.perez@passporthealth.com 312.231.2783 assporthealth.com jorge.wong@passporthealth.com

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