Issue link: https://beckershealthcare.uberflip.com/i/821337
16 CFO / FINANCE 8 Pieces of Advice on Improving Claim Collection Rates By Kelly Gooch W ith the rise of high-deductible health plans and pressure on reimbursement rates, many hospitals and health systems are trying to improve collection rates to maintain or boost their financial performance. Here, revenue cycle experts share their advice on how organizations can improve collections, both from payers and patients. Note: Responses have been lightly edited for style and clarity. Sondra Akrin, Vice President of Revenue Cycle Transformation at Hayes Management Consulting. "Focus on revenue loss/leakage. Start by looking at write-offs for denials that you couldn't appeal because a process failed (i.e. timely filing) or you were missing critical data (i.e. authorization). ese write-offs are essentially lost revenue and drive down your collection efficiency. By focusing on refining processes and ensuring appropriate upfront data collection can prevent or minimize the loss of revenue. Also, focus on patient collections. ere has been a significant shi to higher deductible/cost sharing plans that place a lot of responsibility on patients for payment. ere is a lot of competition for patient dol- lars, making it challenging to collect those dollars. Focusing efforts to improve upfront patient collections can improve collection rates for 'aer insurance' balances." Tom Furr, CEO of PatientPay. "Evaluating methods used by other industries can yield meaningful results for healthcare providers of all types. Unlike most other business sectors, electronic billing and pay- ments have historically been underutilized as a form of payment in consumer healthcare transactions. Ample evidence can be found. One study determined nearly nine out of 10 healthcare bills are sent to pa- tients in paper form via the U.S. Postal Service. Remarkably, Deloitte's annual survey of U.S. healthcare consumers found 70 percent of re- spondents would prefer to get their bills electronically. Billing patients in ways they prefer cannot be understated. Changes in healthcare have made patients the third largest payer behind Medi- care and Medicaid. Unlike the other two, the patient is much harder to collect from and takes more time and money to secure payment. Electronic bills and payment capabilities will improve collection rates, especially when they are readily understood. A survey conducted for Citibank found 71 percent of respondents would promptly pay their bills if they were understandable and, more importantly, matched a payer's explanation of benefits. Without delving into the why's and how's, healthcare bills to patients have been getting bigger. Instead of swallowing hard as write-offs grow, build in automated payment plans into your process for those people who want to pay but need assistance to accommodate their income. Peo- ple, for the most part, are not deadbeats. ey'll pay proper and correct bills and will be more willing to do so if it can be done in bite sized pieces. Patients will balk at paying a bill if it does not make sense or match their EOB. A too frequent situation is a statement showing a payment unex- pectedly applied to a 'different' balance otherwise known in healthcare as posting a payment to the oldest balance due. e way to avoid this slowdown in payment is to utilize automatic reconciliation so the right payment amount is assigned to the right balance of the right patient. If hospitals move to multiple forms of billing including email, text, in- teractive voice recognition and, as a last resort, paper they will be able to enjoy the sort of financial performance and efficiency seen in other industries. If there is still a question as to whether there is a better way, I suggest you look at PayPal, an organization that employs technology to let people and businesses better move and manage money and, in the process, be its industry leader." Bruce Haupt, President and CEO of ClearBalance. "Traditionally it's been difficult for financial counselors to have the 'money conversation' with patients and collect an up-front payment — no matter how small. Now health systems are empowering front-line staff with estimation tools and zero-interest payment plan options that make a difference. e key is to balance collection funnels from the front- to back-end of the revenue cycle. Our health system partners have increased point-of-service collec- tions dramatically while significantly reducing bad debt. For example, [Winston-Salem, N.C.-based] Novant Health increased patient collections more than $41 million from 2015 to 2016 and with its extended payment plan from ClearBalance, reduced patient pay bad debt by $15 million." Bill Knox, Vice President of Product Management at nrive. "Im- proving denials management will significantly improve collection rates. e first step to tackling denials is accurately identifying their root cause which can be difficult for many hospitals to do, and is best done using a powerful analytics platform to surface trends in the data. Causes can change over time, so a tool that allows hospital leadership to keep their finger on the pulse of shiing trends — a regularly reviewed dash- board — is ideal. e next step is defining best-fit workflows that route those denials to the appropriate team, at the appropriate time, for resolu- tion. Workflow automation increases collector efficiency and allow more accounts to be worked per collector, and integrating claims and contract management unifies the data and streamlines further." Jim Lazarus, Managing Director of Strategy and Innovation with e Advisory Board Company's revenue cycle division. "I see organizations increasingly working to grow point-of-service collections from patients given the rise in deductibles. What organizations need to be doing is to work to automate as much of the patient access workflow as possible to let their staff focus on working with patients to help them understand and pay their out-of-pocket obligation. We see organizations increasingly get- ting much smarter and much more rapid in their follow up with back-end collections, especially with insurance companies. So we see organizations using workflow automation to follow-up with insurance companies with- in days of sending a bill rather than waiting one, two or three months. ere's really powerful data called claims status data that organizations can automate into their collections process where they can know within two to three days, without anybody taking action, whether the insurance com- pany is planning to pay and therefore focus their staff on cases where the insurance company is not planning to pay in full to accelerate collections and improve their overall cash and bottom line performance. Additionally, I see a lot of organizations now increasingly meeting patients where they are. A lot of organizations are giving patients ways to get an estimate of their obligation off of their organization's website well in advance of receiv- ing care or even to get that without having any care scheduled. e patients know what they're going to owe even before they are presenting for care or before somebody from the hospital calls them. All three of those are driving meaningful improvements in overall col- lections. Two of them more patient focused and one of them is much more about holding the payers accountable. Organizations have to be working on workflow automation. ey actually have to have their staff do less of the manual tasks and activities that exist in the revenue cy- cle process, whether it's payer or patient, so the staff spends their time focusing on accounts that were never gotten to or helping payers and