Delivering Accurate Patient Estimates

1. Delivering Accurate Patient Estimates Presentation Prepared for AHHAM Conference September 22, 2016 Jamie Hurst—Financial Educator Sharon Scruggs, Manager Revenue Cycle

2. Estimation of Co-Pay/DeductiblesHistory • One of the key elements was that one department head was the Manager of the Contracting with Payers, Self-Pay Collections and Charge Description Master. • Manager had access to all negotiated payer plans and in 2007 met monthly with the Insurance Brokers, Large Employer Groups in Fairfield and surrounding counties and with the Fairfield Chamber of Commerce. • We collaborated with these groups and a Community Resource group to develop a communication of the cost for scheduled procedures at FMC.

3. Tools Available • We developed grids based on the procedure with CPT codes, the cost of the procedure, the payer contract and the Physician(s) • Central Scheduling provided a Financial Representative Team access to all scheduled procedures. • Team utilized Payer sites to identify deductibles and confirm co-pays. • Merged process of data elements into a personalized letter for a dedicated Financial Representative.

4. Point of Service: The Manual Process • We developed the point of service letter that was sent to the patient letting them know when their procedure was, the cost of their procedure, what their out of pocket cost would be as well as the discount amount we offer if they pay at or prior to service. • We provided a dedicated Financial Representative by Service Line.

5. I would like to introduce myself as your personal Financial Representative and wish to thank you for choosing Fairfield Medical Center for your healthcare needs. We are committed to providing the highest level of services, which includes navigating through the financial process.We received information for your procedure scheduled on «DOS». As of today, your anticipated financial responsibility defined by your insurance carrier, «Ins», or your Self-Pay status is calculated below:Scheduled Procedure: «Procedure» Anticipated Cost of Procedure: «Anticipated_Cost» Co-Pay «CoPay» Deductible «Deductible» Co-Insurance «Co_Ins» Your Anticipated Financial Responsibility: «Financial_Resp»*20% Savings Opportunity:«Savings» Total Including Discounted Savings: «Due_after_Disc»The savings opportunity is applied if *paid on or before the date of service. It is important that you recognize the amount of savings could change based on how your insurance company processes your claims. If the anticipated responsibility should change, your savings amount will be recalculated and reviewed for additional saving or a refund.I am available to help you navigate through the multiple options available which include:Financial assistance on amount owed0% Interest loan for the first 12 monthsAssistance with applying for Medicaid and/or other resources.Please contact me at 740-681-7404. If I am not available, a Financial Representative can assist you by calling 740-687-8025

6. Point of Service: The Advantages of a Manual Process • The majority of our patients were very pleased to see what they would be facing financially – Patient Satisfaction • Financial Representatives became very knowledgeable of the cost of service lines due to the research to quote. • Payer or employer changes were identified quicker relating to co-pay or deductibles. • Increased our point of service collections • Collections went from an average $200,000 a month to an average of $1,044,858.13 combined (uninsured and insured) - Sustainability • No cost for software or monthly support fees.

7. Point of Service: The Disadvantage of a Manual Process • Time consuming for staff • Not able to keep up with the add-ons to the schedule or changes to procedures • Not able to do real time quotes by Registration Staff or others not trained in researching spreadsheets • Manual process of keep up spreadsheets did not link directly into our Contract System • Multiple Systems look ups to view letter

8. Point of Service: Moving from Manual to Electronic - The Benefits • We were really good with the manual process, but needed to be more efficient with notifying all scheduled procedures, allow the estimation of cost to be provided at all access points—providing transparency and meeting regulatory requirements. • After 7 years of our manual process we moved to an electronic format.

9. Estimator: Generates Patients Out of Pocket Expenses According to: • Multiple electronic search tools are used to assign the appropriate DRG or CPT codes from the Charge Master or DRG data to generate an estimate cost of procedure according to scheduled procedure • Payer contracts are linked to define contractual adjustments and current patient benefit information to generate a printable estimate

10. Key Requirements As We Moved Forward • Maintain accuracy • Maintain high customer satisfaction • Maintain high level of sustainability • Maintain an ease of daily operation process of providing the cost of procedure to our patients • Enhance transparency • Regulation alignment – identifying financial assistance in real time

11. Current Key Performance Indicators • Current A/R Days: 42.3 Days • Top Quartile: 45.0 Based on HBI • Current Bad Debt: 1.2% • Top Quartile: 1.5% Based on HBI • Point of Service Collections As % of Net Revenue: 1.55% • Top Quartile: 0.7% Based on HBI

12. Questions?