Presentation Transcript

1. Financial Counseling Best Practices

   Aaham spring meeting May 17, 2013
2. Financial Counseling best practices LearningObjectives Describe the difference between “financial clearance” and “financial counseling” Describe financial screening and counseling KPIs Understand the difference between “front-end” and “back-end” counseling Understand when the financial counseling process should begin Identify key financial clearance policies and procedures Describe the financial counseling process Show why application integration and automation is dramatically impacting the counseling staffing model
3. What is Financial Counseling? Does this sound like your organization? You still use the term “charity program” You don’t determine patient payment responsibility prior to service delivery for walk-in patients? Only certain employees are assigned to determine patient payment responsibility? The person who does estimates or insurance verification is called a “financial counselor”? Your “counselor” sometimes strays outside of your written guidelines when approving financial assistance? You have a backlog of patients awaiting Medicaid approval so financial assistance decisions are delayed? Your counseling process has little integration or automation? Form completion is manual?
4. Performance metrics
5. Key performance indicators
6. What is financial counseling? How many in this session feel that you don’t have enough financial counselors to meet the key performance targets we just reviewed? What if you were told that if you have 2 or 3 dedicated counselors, you probably have more than enough?
7. What is financial counseling? At many healthcare organizations, the answer to this question depends on the person or department that's asking….....
8. What is financial counseling? “The way we see the problem is the problem” Stephen R. Covey
9. Self-Pay Financial Clearance Financial Counseling Definitions 9
10. What is self-pay? Self-Pay (Also referred to as Patient-Pay)- That portion of the bill that is to be paid in part or in full by the responsible party from their own resources, as it is not payable by a third party (i.e. insurance carrier). This means that “self-pay” no longer simply refers to patients with no insurance coverage
11. What is Financial clearance? Financial Prerequisites (Financial Clearance) Assuring that all the appropriate payers have been identified and requirements have been meet, and their has been communication with the patient about their financial obligations prior to service Source: NAHAM Patient Access Continuum – CHAA Study Guide
12. What is financial counseling? Financial Counseling A “step in the billing process during which credit is extended to self-pay patients” Michael Nowicki, The Financial Management of Hospitals and Healthcare Organizations
13. What is financial counseling? Financial Counseling: A means of providing financial educationto help the patient understand his/her insurance coverage and financial responsibility for healthcare services
14. What is financial counseling? Financial Education components include: Informing the patient of the hospital’s financial policies Assessing the patient’s ability to pay Reviewing payment alternatives Achieving account resolution by helping the patient satisfy his or her payment obligations
15. Who is responsible? Financial counseling duties may be assigned to: General registration personnel Insurance verification specialists Dedicated counselors
16. Who is responsible? Patient Access Counseling Patient Accounts Counseling Counseling prior to billing: Scheduling Pre-registration Walk-in registration Emergency Department Scheduled procedures Decentralized departments Counseling after billing: Late payments Denied claims Questions or dispute resolution Bad debt issues Bankruptcies, Liens, etc. 16
17. When does counseling start? Tip: Since financial counseling situations will usually arise when patient payment responsibilities are identified, it is critical that access management personnel are prepared for their role in the financial counseling process. Examples include: An uninsured patient wishes to receive services An underinsured patient is made aware of payment responsibilities A managed care patient wishes to have unauthorized services A Medicare patient wishes to have services deemed medically unnecessary by national or local coverage determinations (NCD/LCD) 17
18. When does counseling start? Tip: It is less costly for our customers and our organizations if we collect self-pay or “patient pay” dollars prior to service, at the point of service or at discharge. If “patient pay” dollars are not collected at the point of service or discharge, the cost-to-collect providers incur can range from 4% to 10% of the balance. Cost-to-Collect 18
19. Payment responsibility When does payment responsibility begin? A patient’s responsibility for payment begins on the date that services are rendered. Successful organizations set this expectation during the registration process before services are delivered. How? By educating the patient on your financial policies! 19
20. Financial practices policies Financial Practices policies of healthcare organizations should clearly state that: Payment is expected on the date of service and Emergency care will be provided without regard to a patient’s ability to pay Financial assistance is available if you cannot afford to pay
21. Financial Counseling Policies Patient financial education Screening Financial Screening: Activities an organization engages in to establish patient payment responsibility Financial Practices Financial Clearance Verification of Payer Coverage Up-Front Collections 21
22. Patient financial education Counseling Financial Counseling: Activities an organization engages in to help patients meet their financial obligations Financial Assistance Payment Plans Waivers of Co-Payments and Deductibles Self-Pay and Bad Debt Processing 22
23. Patient financial education Screening Counseling Financial Practices Financial Assistance Financial Clearance Payment Plans Verification of Payer Coverage Waivers of Co-Payments and Deductibles Up-Front Collections Self-Pay and Bad Debt Processing
24. Account resolution Account Resolution Involves reviewing payment options in a controlled, sequential manner to move the patient to an acceptable resolution of the financial obligation.
25. Account resolution Counseling Sequence Greet the patient Review your financial policies Review insurance benefits if any Review expected charges and calculations Review payment options
26. Account resolution Payment Options Full payment no later than the date of service Short-term payment plans Bank loan programs Government programs Financial assistance program
27. Account resolution Payment Options Full payment no later than the date of service Including: Cash Check Credit Card Electronic Funds Transfer Date-limited Prompt Pay Discount
28. Account resolution Payment Options Short-term payment plan Features: Monthly payments Interest-free Plans are based on propensity-to-pay Timeframes don’t crossover into bad-debt criteria
29. Account resolution Payment Options Bank Loan or other Credit Programs Features: Payment made directly to hospital up-front Patient maintains payment schedule with lending entity
30. Account resolution Payment Options Medicaid Eligibility Design Options: Onsite state or county workers Outsourcing Firms Internal referrals to state or county assistance Streamlined process includes “presumptive approvals”
31. Account resolution Payment Options Hospital Financed Assistance Features Sliding scale discounts % of Federal Poverty Guidelines Use of term “charity” eliminated Streamlined process includes “presumptive approvals” 31
32. Financial Assistance Automation 32
33. A New Day Healthcare organizations are using a plethora of technologies to reduce costs and improve service delivery. When implemented as stand-alone applications as has often been the case with financial assistance applications, these organizations are experiencing bottom-line improvement. However, when implemented as components of a well-considered revenue cycle vision, the overall results can be greater than the sum of individual parts.
34. Transformed Level 4 (Integration leveraged between all applications) Application Evolution Integrated Level (Integration improves with ADT Application Applications have evolved along a fairly predicable path Batched Level (Some Batch and Direct Processing) Niche Application Level (Application Silos are formed) While progress has occurred at every level, transformation of work processes has been elusive
35. Financial Assistance Automation Benefits Proactively identify eligibility to entitlement programs Reduce unnecessary outsourcing to self-pay vendors Improve charity/bad debt classification Improve customer service and community benefit reporting 35
36. Financial Assistance Automation The Old Approach Manual application and subjective approval processes Reconciliation manual and cumbersome Features To Look For Now: Pre-populate applications from ADT information Medicaid applications Financial assistance applications *Integration with propensity-to-pay systems and e-pay systems Pre-define payment plans Presumptive eligibility and approvals Automate financial assistance rules and workflows 36
37. The Vision Dilemma “We don't see things as they are, we see them as we are.” Stephen R. Covey 37
38. Scheduling Physician Self-Scheduling: Clinical pre-cert edits applied Patient Self-Scheduling: Financial Screening edits launch A 4th Generation Vision Pre-Registration Automated home & email address confirmation Automated home & cell phone verification Eligibility Scheduled service is verified: Payment responsibility is determined Automated estimate is instantly prepared
39. Payment Calculation Instant-estimate includes contract rates and site-specific discounts Pop-up patient-friendly collection scripts available to registrar or online to patient A 4th Generation Vision Propensity-to-Pay Propensity to pay determined using SSN, DOB and contact information All categories pre-approved but “Can afford to pay but doesn’t category” Financial Counseling Technology & scripting allow registrars to handle most scenarios Financial counseling sessions auto-scheduled for exceptions
40. E-Cashiering Payment estimates flow directly to e-cashiering application Online pre-payment processing for credit cards, e-checks A 4th Generation Vision Self-Payment Options Patient is presented with pre-established payment plan options Patient may route directly to a financial counselor (FC) Exception Management Patients triggering site-defined edits, e.g., bad debt history, auto-route to FC FC determinations auto-approve or auto-route for manager approval
41. The New math The Formula for Transforming the Financial Counseling Vision Technology Accelerators Integration Between all Applications Transformational Performance 4th GenerationVision + + = 41
42. Questions? 42
43. Contact information John Thompson, PMP, CHAM, CRCR Principal, Access Management and Technology Innovation Services jthompson@coalitionrc.com (301) 802-3078