MELBOURNE RBOMELBOURNE RBOPatient Account Patient Account Representative Representative ResponsibilitiesResponsibilities

PAR Focus and PurposePAR Focus and Purpose

• Reduce DSO’sReduce DSO’s• Increase teamworkIncrease teamwork• Identify Payor problems and trendsIdentify Payor problems and trends• Speed process of turning accounts Speed process of turning accounts

over to self pay statusover to self pay status• Accelerate account resolutionAccelerate account resolution

Daily PAR Daily PAR ResponsibilitiesResponsibilities

• Specific facilities will be assigned by the Specific facilities will be assigned by the Collections Coordinator to each PAR Collections Coordinator to each PAR according to the number of accounts in according to the number of accounts in each facility.each facility.

• COLLECT!COLLECT!• Run and work 222 tickles toward resolutionRun and work 222 tickles toward resolution• PAR tickles should be worked dailyPAR tickles should be worked daily• Resolve Credit Balances from CBRResolve Credit Balances from CBR• Run PAR ProductivityRun PAR Productivity

Incoming CallsIncoming Calls

• All PAR’s will be a part of the phone All PAR’s will be a part of the phone hunt group.hunt group.

• Everyone must be able to take Everyone must be able to take patient and insurance calls.patient and insurance calls.

• If a call is complicated and needs If a call is complicated and needs facility involvement, refer the facility involvement, refer the information to the assigned facility information to the assigned facility PAR.PAR.

Additional PAR Additional PAR ResponsibilitiesResponsibilities

• DOC Link – work through documents DOC Link – work through documents and insert to correct accountsand insert to correct accounts

• Mail all patient letters and note HPAS Mail all patient letters and note HPAS accordingly.accordingly.

• Print “COL” tickles for assigned Print “COL” tickles for assigned facilities and turn in to Collections facilities and turn in to Collections CoordinatorCoordinator

• Other PAR duties as assigned by Other PAR duties as assigned by Collections CoordinatorCollections Coordinator

PAR PROFICIENCY PAR PROFICIENCY LEVELSLEVELS

Four Possible Ratings: Four Possible Ratings:

with 4 being the highestwith 4 being the highest

Level OneLevel One: Probational Employee – those : Probational Employee – those employees that are new hires, or current employees that are new hires, or current employees that are not meeting minimal employees that are not meeting minimal Collection PAR abilitiesCollection PAR abilities

Level TwoLevel Two: Employee maintaining minimal : Employee maintaining minimal requirements but not fully aware of all requirements but not fully aware of all protocols or policies. PAR not fully protocols or policies. PAR not fully independent.independent.

PAR PROFICIENCY PAR PROFICIENCY LEVELSLEVELS

Level ThreeLevel Three: Employee that works : Employee that works independently, is fully aware of all policies, independently, is fully aware of all policies, procedures, and regulations. Employee is able procedures, and regulations. Employee is able to complete all assigned duties, maintains good to complete all assigned duties, maintains good office and facility relationships, and hits all office and facility relationships, and hits all goals and benchmarks with efficiency.goals and benchmarks with efficiency.

Level FourLevel Four: Employee acts as an informal leader : Employee acts as an informal leader within the team and has extensive knowledge of within the team and has extensive knowledge of all RBO departments and protocols. Employee all RBO departments and protocols. Employee builds team and facility relationships, maintains builds team and facility relationships, maintains a high level of competency in all activities, a high level of competency in all activities, takes on new assignments and projects takes on new assignments and projects willingly, and exceeds all goals.willingly, and exceeds all goals.

PAR BENCHMARKSPAR BENCHMARKSL1L1 L2L2 L3L3 L4L4

ProductivProductivityity

Less Less then 30then 30

30-45 30-45 accountsaccounts

45+ 45+ accountsaccounts

55+ 55+ accountsaccounts

Audit Audit ScoresScores

Below Below 70%70%

Btwn 70-Btwn 70-85%85%

85%+85%+ 95%+95%+

AttendaAttendancence

More More then 5 then 5 U/S daysU/S days

3+ 3+ Missed Missed DaysDays

Less Less then 2 then 2 U/S daysU/S days

No No Missed Missed DaysDays

A/R A/R DaysDays

75 + 75 + daysdays

75-50 75-50 daysdays

50-44 50-44 daysdays

Less Less then 43 then 43 daysdays

Facility Facility Cash Cash GoalGoal

Below Below 80%80%

Below Below 95%95%

95%+95%+ 100%100%

Directions for Running PAR Directions for Running PAR QueueQueue

• Choose the following menu options Choose the following menu options from HPAS:from HPAS:– Billing MenuBilling Menu– PAR Bill Tracking QueuePAR Bill Tracking Queue

All accounts that have been billed but All accounts that have been billed but with no payment received, will show up with no payment received, will show up on this queue after a designated on this queue after a designated number of days have passed.number of days have passed.

Generally the default is 30 days for all Generally the default is 30 days for all insurancesinsurances

Queue will be run by assigned facility Queue will be run by assigned facility and can be sorted by days and can be sorted by days

outstanding, FSC, Location (satellite) outstanding, FSC, Location (satellite) and/or by payor.and/or by payor.

Accounts need to be worked using the Facility Billing Queue. EachPAR will run their accounts daily. If the facility has a specific payor problem, running the queue specifically for just this payor will group all patients together allowing for a more effective collections call to the payor as well as list the number of outstanding accounts pending. If running by FSC, the date range that is appropriate for that FSC is provided below.

FSC 2 = 45 – 455FSC 3 = 30 – 455FSC 5 = 30 – 455FSC 6 = 30 – 455FSC 7 = 30 – 455FSC 8 = 30 – 455FSC 9 = 15 – 455

FSC 10 = 30 – 455FSC 11 = 30 – 455FSC 14 = 45 - 455

Account Follow-upAccount Follow-up

• In order to assure a continuation of In order to assure a continuation of follow up in every account, the PAR follow up in every account, the PAR queue must be utilized for tickling.queue must be utilized for tickling.

• Using a personal tickle would defeat Using a personal tickle would defeat the purpose of working by the the purpose of working by the queue.queue.

Queue Policies and Queue Policies and ProceduresProcedures

• Work accounts daily through QueueWork accounts daily through Queue• Proper follow up consists of one or more of the Proper follow up consists of one or more of the

following:following:– Phone Call or Web site claim statusing to insurance Phone Call or Web site claim statusing to insurance

co.co.– Patient letter or phone callPatient letter or phone call– Facility ContactFacility Contact

• Review account for outstanding DOS, Review account for outstanding DOS, incorrect/missing adjustments, misapplied incorrect/missing adjustments, misapplied payments, credit balances, and possible patient payments, credit balances, and possible patient responsibilityresponsibility

• Use Tickle system within queue to prompt Use Tickle system within queue to prompt timely follow uptimely follow up

• Note account as to specific actions taken that Note account as to specific actions taken that dayday

Account Notation Account Notation ProtocolProtocol

From any patient screen, Hit F10 to access Note Screen then F3 From any patient screen, Hit F10 to access Note Screen then F3 to Add a noteto Add a note

• Enter DateEnter Date• Enter User InitialsEnter User Initials• Enter Note Type (F1 for Listing- see following page for Enter Note Type (F1 for Listing- see following page for

definitions)definitions)• Body of NoteBody of Note

– Name of the Person you spoke withName of the Person you spoke with– Name of Insurance Co / Law Firm / Patient as applicableName of Insurance Co / Law Firm / Patient as applicable– DOS you are calling on with Total or Partial charges involvedDOS you are calling on with Total or Partial charges involved– Outcome of CallOutcome of Call– PAR name and last initial at the endPAR name and last initial at the end– Tickle account when appropriateTickle account when appropriate

• Tickle DateTickle Date• Skip over Visits FieldSkip over Visits Field• Brief Description (if adjustment- code and $ should be noted)Brief Description (if adjustment- code and $ should be noted)• Review note for accuracy and Hit F9 to accept noteReview note for accuracy and Hit F9 to accept note

Account Follow- up & Account Follow- up & Notation PoliciesNotation Policies

• Left Messages are not considered adequate Left Messages are not considered adequate follow up. All messages require a follow up follow up. All messages require a follow up tickle in 2 days.tickle in 2 days.

• Statusing of an account is appropriate when the Statusing of an account is appropriate when the claim was sent within 30 days for all FSC codes. claim was sent within 30 days for all FSC codes. Waiting longer then 45 days could potentially Waiting longer then 45 days could potentially prolong payment and result in a non-favorable prolong payment and result in a non-favorable PAR audit.PAR audit.

• Notes on accounts should be brief and devoid of Notes on accounts should be brief and devoid of personal emotion. Notes are official company personal emotion. Notes are official company records and not the environment to critique records and not the environment to critique other’s actions nor a platform for personal other’s actions nor a platform for personal disputes.disputes.

NOTE TYPESNOTE TYPES

• II = Insurance calls, either incoming or outgoing = Insurance calls, either incoming or outgoing• P = PAR initiated calls to patients, NOT a return P = PAR initiated calls to patients, NOT a return

phone callphone call• T = Incoming patient phone call or returning a call T = Incoming patient phone call or returning a call

to a to a patient that left a messagepatient that left a message• L = Requesting a patient bill / letterL = Requesting a patient bill / letter• R = Requesting the re-filing of a claim (electronic R = Requesting the re-filing of a claim (electronic

or or paper), paper), with or without recordswith or without records• O = All other actions, insurance calls, mailing bills O = All other actions, insurance calls, mailing bills

or or claims, etcclaims, etc• S = any continuation note (if your first note does S = any continuation note (if your first note does

not fit into not fit into one screen and you need to start a one screen and you need to start a second note)second note)

Approved AbbreviationsApproved Abbreviations2nd or 2ndary =Secondary CONSD=Considered

ADJ=Adjustments CORS=Correspondence

ALLWD=Allowed CPN=Copay Notice (to be billed)

ATTY=Attorney DED=Deductible

B/C=Because DOS=Dates of Service

BC/BS=Blue Cross/Blue Shield EOB=Explanation of Benefits

BOC=Business Office Clerk F/U=Follow UP

C/S=Customer Service INS=Insurance

CMB=Call Me Back LM=Left message

COB=Coordination of Benefits LOE=Letter of Exhaustion

Approved AbbreviationsApproved AbbreviationsLOMN=Letter of Medical Necessity RECD=Received

LOP=Letter of Protection TC=Total Charges

M/C=Medicare TT=Talked TO

MMI=Max Medical Improvement W/=With

PD=Paid W/C=Work comp

PIF=Paid in Full W/U=Wrote UP

PMT=Payment

PR=Patient Responsibility

PT=Patient

NOTE TAKING? GOOD OR NOTE TAKING? GOOD OR BAD?BAD?

01/01/0601/01/06 PAR CODE: MO1 NOTE PAR CODE: MO1 NOTE TYPE: OTYPE: O

CALLED INS CO REG OUTSTANDING CALLED INS CO REG OUTSTANDING DOS- STATED CLAIMS PENDING DOS- STATED CLAIMS PENDING INFO.- WILL GIVE MORE TIME TO INFO.- WILL GIVE MORE TIME TO PROCESS. DMRPROCESS. DMR

BRIEF- CLAIMS PENDING INFOBRIEF- CLAIMS PENDING INFO

NOTE TAKING? GOOD OR NOTE TAKING? GOOD OR BAD?BAD?

01/01/06 01/01/06 PAR CODE: MO1 NOTE TYPE: IPAR CODE: MO1 NOTE TYPE: I

CALLED AETNA INS-SPK W/ SUSIE Q. CALLED AETNA INS-SPK W/ SUSIE Q. REG DOS 11/2/5 FOR $120- STATES REG DOS 11/2/5 FOR $120- STATES PENDING ACCIDENT DETAIL- BILLING PENDING ACCIDENT DETAIL- BILLING PT LTR 5. DAVID RPT LTR 5. DAVID R

BRIEF: DOS 11/2 PEND ACC DTL- PT BRIEF: DOS 11/2 PEND ACC DTL- PT LTR5LTR5

Goal & Bonus PlanGoal & Bonus Plan

It’s up to you!!It’s up to you!!Following these steps will help us Following these steps will help us

achieve our goals, and potentially put achieve our goals, and potentially put more $$ in your pocket!more $$ in your pocket!

Cash GoalCash Goal

DSO ReductionDSO Reduction

Credit Balance ReductionCredit Balance Reduction