Keys to Successful Financial Clearance, Pre-Registration, and Pre-Service Collections

1. Keys to Successful Financial Clearance, Pre-Registration, and Pre-Service Collections Monday, October 17th, 2016

2. Steward Health Care Patient Assistance Center • Centralized business office function dedicated to financial clearance and pre-registration services for: • 8 Acute Care Hospitals • 3 Ambulatory Surgical Centers • Large Network of Affiliated and Employed Physicians Facility Registration Denial Prevention Analyst II Denial Prevention Analyst I

4. Scope of Services

5. Driving Consistent & Predictable Results • Formal On-Boarding Process • Dedicated Coach/Trainer • Promoting Top Performers from Within • Quality Assurance Program • Daily & Weekly Reporting • Creative Staffing Models • Leverage Worklisting Tool • Investing in Key Technology • Tools for Driving Pre-Service Collections

6. Recruiting & Retaining Key Talent • Hiring efforts focused primarily on pre-registration representatives • Formal on-boarding program • Dedicated trainer • Competitive bonus program • Weekly quality assurance reports • Financial Clearance vacancies pulled from top performing pre-registration representatives

7. Managing Performance Across the PAC Pre-Registration Daily Scorecard

8. Managing Performance Across the PAC Financial Clearance Daily Scorecard

9. Daily Reports

10. Weekly Dashboard Review • Standing meeting to review prior week performance • Key metrics for all teams • Primary focus: • Cash collections • Call Volume • Completion Rates • Authorizations • Deferral Notifications

11. Quality Assurance & Customer Service • Balance production with quality • Robust QA program that evaluates 100% of accounts worked • Ability to add new criteria as reporting opportunities are identified • Manual review of rep phone calls • Appropriate greeting • All required questions reviewed • Cash collection script followed & attempt made • Able to respond to all patient questions appropriately • Overall tone of voice and interaction

12. Creative Staffing Models: Financial Clearance 5 Reps cross-trained to cover both functions and float between teams 2 Reps cross-trained to cover both functions and float between teams

13. Creative Staffing Models: Pre-Registration

14. Systems Supporting Our Process Medical Necessity Prior Authorization Pre Register Worklist Accounts Pre-Service Collection Eligibility Verification Estimate Liability Craneware Passport eCareNext Cisco Call Queue & Recording Revenue Protect ePay Payment Processor Experian Passport MedAssetsCarePricer

15. Shared Services Model • Scheduling of services • Coordinating potential service deferrals • Communicating to appropriate resources on site at each facility • Transitioning incomplete work to hospital staff

16. Daily Strategies for Driving Cash Performance • Dedicated cash collectors assigned to call on estimated patient responsibilities greater than $500 • Assigning new reps only to call on balances under $100 • Campaign Hours • Competitive in nature – This is a way for Reps to perform at an optimum level • Incentivizing • Raffling gift cards to boost our collection performance • Providing instant gratification to the young professional demographic • Constant motivation and reinforcement • Encouraging reps to achieve daily goals will ensure quality performance and staff gratification

17. Cash Collection Scripting • Providing a guide to handling all types of interactions with collections • Asking “How would you like to ” instead of “Would you like to” has proven to be extremely effective • Providing different payment options. (i.e. Payment Plans, Post-dating and Partial Payments) • Laminated “hand-holder” guide for all reps to remind of keywords, phrases, and explanations

18. Challenges We Face • An ever-growing list of procedures that require prior authorization. • More of a lean on the patient for cost-sharing responsibilities. i.e. Copays, Deductibles and Co-insurances • Timeliness of authorization payer reviews, some taking up to 2 weeks. • Establishing accountability from all parties: • Providers: Ordering exams that are not medically necessary. • Payers: Delayed authorization approvals. • Patients: Unaware of insurance benefits and their responsibility.