Issue link: https://beckershealthcare.uberflip.com/i/821337
17 CFO / FINANCE patients make that payment earlier. Organizations also have to break out of this kind of manual, siloed process of collecting and they have to pursue automation to let them actually have a more in-kind per- formance. at's how they break the cycle. at's how they improve performance." Frank Moreno, Vice President of Product Marketing at Da- tawatch. "Effective revenue cycle management is only attainable when healthcare organizations have a full view into all of their patient and operational data. Finance cannot wait for IT to provide detailed re- ports, or spend countless hours manually pulling data from EMRs, 835 and 837 remittance and other files, yet that's what is happening at organizations across the country every day. Instead, by using self-ser- vice data preparation and analytics solutions, finance teams can easily unlock hidden data to better manage cash flow, see revenue across ser- vice lines, drill down into claims, review aging claims and identify gaps in the revenue cycle process. In minutes rather than hours or days, individuals can determine where corrections need to be made to re- capture potential lost revenue." Ashley Scott, Client Services Manager at MediRevv. "Focusing on process improvements in small steps will make a big, positive impact on collection success. Look at timeliness first. On the insurance side, are clean claims going out in a timely way? If not, determine whether providers are docu- menting daily/weekly/monthly, evaluate whether coders are keeping up, and identify any issues prohibiting claim edits from being resolved in a timely manner. Similarly, on the patient pay side, what is holding patient statements from being sent in a timely manner? Look for un- necessary patient statement holds or delays, check the volume of mail returns on patient statements, determine if registration issues exist and ensure patient disputes are processed in a timely fashion. Second, scrutinize both payers and patients. Why aren't they paying? Identify denial trends, determine if payments are being posted correct- ly and in a timely way and take every opportunity to switch away from paper claim submissions. Keep in mind that claim/appeal submission processes vary by payer, and sometimes payment is interrupted sim- ply because a lockbox isn't properly set, or W-9s are not current with all payers. Similarly, on the patient pay side, ensure that patient state- ments are accurate and easy to understand and that patients have easy access to payment options — 24 hours a day, seven days a week and 365 days a year. And, don't wait for the phone to ring. A well-planned, stra- tegic outbound calling campaign to engage patients, answer questions and ask for payment will improve collection outcomes. Finally, take a hard look at why aged accounts receivable is so high. De- termine whether the current strategy is actually focused on the right ac- counts receivable and scan for any payers with short timely filing guide- lines requiring special attention. With patients, hum "Frozen" character Elsa's tune "Let it go, let it go!" when assessing whether accounts pro- cessing to collections are timely. Make sure payment plan guidelines still make sense and identify unnecessary patient statement holds or delays. Perhaps most imperative, understand the intrinsic value of the insur- ance and patient pay accounts receivable follow-up teams. Communi- cate expectations clearly and invest the time it takes to ensure they tru- ly understand the overarching accounts receivable follow-up strategy. (And ask regularly, are they following it?)" Leonard Wenyon, Vice President of Solutions at IKS Health. "A sim- ple start to improving your collection rates is to look at your first pass payment ratio. If you can ensure most of your bills are paid the first time you submit, you save a lot of man hours and drastically improve your cash on hand. e first thing you want to do is understand your denials. Consider the following: What is controllable? What can be solved by training? What enterprise performance management system edits can you make? Can you get edits from your clearinghouse? Is it possible to do online eligi- bility verification? I also recommend that people look at what claims are not on file with the payer when you check on line/call to follow up? Sometimes the claims never make it to the payer and you can identify and address these patterns. For instance, if you have a typo in the address of a payer, you might be sending all of your claims to the wrong location. We also find that you can send primary or secondary claims electron- ically, and in some cases you may get paid on the secondary claim be- fore the primary. Finally, we suggest you confirm you were paid correctly. Where con- tracts require you to bill the fee schedule, a best practice is to bill 20 to 30 percent higher than you contract. is minimizes the chance you have not picked up changes in the fee schedule. If the payer pays your billed amount you may be billing under your contracted rate. If you are billing under the contracted rate the payer will only pay the billed amount on the claim and not the total contracted amount. is means you have le the balance on the table for the insurance company." n Uninsured Accounts Pay About 6% on the Dollar, Analysis Finds By Kelly Gooch T he more patients owe in out-of-pocket costs, the less likely hospitals are to collect their payment, according to an analysis by Crowe Horwath. For the analysis, the public accounting, consulting and technology firm examined benchmarking data on pa- tient accounts from 172 hospitals with more than 125 beds each. Researchers examined true-self pay accounts from uninsured patients, as well as self-pay after insur- ance (SPAI) accounts from insured patients. Here are four findings. 1. The analysis found true self-pay patients generally pay approximately 6.06 percent on the dollar, while SPAI pa- tients pay 15.51 percent overall. 2. Crowe also found SPAI patients on average pay ap- proximately 10.9 percent across inpatient accounts, while SPAI outpatient accounts pay approximately 18.2 percent. 3. Inpatient SPAI patients who owe below $1,200 have a payment rate of 40.1 percent, according to the analysis. However, inpatient SPAI patients who owe between $1,201 and $1,450 only have a payment rate of 17.6 percent. 4. For inpatient SPAI accounts, the payment rate is more than 25 percent among patients with higher-deductible health plans with balances from $1,451 to $5,000. The payment rate is only 10.2 percent for higher-deductible patients with balances of $5,001 through $7,500, 4.1 percent for $7,501 through $10,000, and 0.9 percent for accounts with a self-pay balance at more than $10,000. n