Spring Into Quality Indiana Rural Health Association / March 3, 2011

1. & Spring Into Quality Indiana Rural Health Association / March 3, 2011

2. eHC Solutions Revenue Cycle Technology Solution Provider • Formerly eHealthClaim.net • Incorporated 2002 • Based in Indianapolis, Indiana • Service providers of all sizes • Critical Access • Multi-Facility Systems • Owned/Operated/Managed Physician Practices

3. eHC Solutions • Electronic Claims Management • Real-Time Eligibility Verification • Medicare DDE Automation • Accelerated Medicare Secondary • Payer Remittance Management • Denial Management Solution • RAC Audit Analysis and Response • Electronic Payment Solution

4. Topics eHC • Healthcare Reform and Indiana • How it will force us to improve Quality DECA • Collections Update

5. Health Care Reform Patient Protection and Affordable Care Act • Require Coverage • Exchange for Individuals • Subsidized up to 400% FPL • Exchange for Small Business • Prevent Health Status Denials • Expand Medicaid Coverage • 133% FPL • <65 years old Expanding Health Insurance Coverage

6. Intended Impact • Reduce uninsured by 50% • Expand coverage to 32 million people by 2019 • Medicaid/CHIP enrollment 16 million • 24 million to obtain coverage through exchanges • 16 million new coverage • 8 million replace open market coverage • 19 million subsidized

7. Insurance Coverage Indiana compared to US as a whole Health Insurance Coverage of the Nonelderly, 2008-2009 The Kaiser Commission on Medicaid and the Uninsured

8. Medicaid Coverage Indiana compared to US as a whole FY 2007, www.statehealthfacts.org

9. Medicaid Expansion Indiana compared to US as a whole 2019 Estimates, Kaiser Commission on Medicaid and the Uninsured

10. What will it mean?

11. What could it mean? Sometime after 2019, states will have to assume financial responsibility for new enrollees States could: • Increase budgets • Decrease payments How do we prepare now for potentially decreased per-patient or per-procedure payments by Medicaid?

12. What can we do? • Front End Information Capture • Coverage/Benefit Verification • Probability to Pay • Charity Care Evaluation • Qualification Screening • Charge Estimation • Point of Service Collections Increase efficiency in dealing with Self Pay

13. Front End Information Capture • Demographic • Insurance Coverage • Financial Q: Registration Accuracy Auditing • Validity/Completion • Worklist for Exceptions • Measure Productivity/Performance • Provide Training/Testing

14. Coverage/Benefit Information • Insurance Coverage Information Obtained/Verified • Deductible/Out-of-Pocket Max Status Q: Pre-Registration of all Non-Emergency Encounters Q: Eligibility Verification for all Encounters • Consolidated Interface • Standardized Response • Medicaid checks on Self Pay

15. Payment Likelihood • Scoring • Based on Credit and Asset information • Income and FPL% extrapolated • Most useful for consumers with credit Q: Probability to Pay Scoring • Increase payments at Pre-Reg and Point of Service • Work high probability in-house and outsource low

16. Charity Care Evaluation • Application • Information Gathering • Probability to Pay Scoring • Credit Data minimal where need is most Q: Charity Care Scoring • Socio-Economic Score • FPL% Estimate • Asset Information

17. Qualification Screening Use gathered information to determine eligibility for Local, State, Federal Programs • Medicaid • Disability • Condition-Specific Program • Charity Q: Extend programs whether in-house or outsourced to Emergency Department

18. Patient Responsibility Estimation • Estimate charges based on historical data • Estimate patient responsibility • Contract • History • Incorporate eligibility information • Present patient with statement at time of service Q: Estimate responsibility on all encounters possible and incorporate payment request

19. Point of Service Collections • If we know what they will owe and we understand their ability to pay, ask for payment Q: Consolidated electronic payments • Web-based payment gateway • Empower all non-clinical staff with the ability to take payment • Off-site locations • Patient Payments from the web

20. Minimize Self Pay • Screen all Self Pay Accounts for Medicaid • Multiple times prior to Bad Debt Write Off • 5%-15% Eligible • Impact on Self Pay, Bad Debt, Charity Care • Increased Efficiency Q: Batch Eligibility Processing • Weekly • Monthly • Set Frequency

21. Collections Are you making the most of your accounts receivable management strategy? • Early-out • First, Second, Tertiary – Competition/check & balance • Debt Purchasing – Benefits & Drawbacks • Debt Leasing – Benefits & Drawbacks

22. Collections Modeling Maximizing your account receivables • Scoring Methodology – Everyone claims to have one, but do they stand behind it? • Geolytics • Performance Measurements • Strategic front-end solutions • Express Consent • Collection fee on top of balance - leverage