Strategies for Self-Pay in Healthcare
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Transcript of Strategies for Self-Pay in Healthcare
Learning Objective
2
Evaluate your current self-pay strategy
1 Explore how practice management can support your self-pay strategy2
Increase in Patient Deductibles2009-2011
4
20%Increase
20%Increase
20%Increase
47%Increase
Midwest
West South
Northeast
Deductibles are a significant percent of your contracted rate
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11%DEDUCTIBLES
FamilyPractice
7%DEDUCTIBL
ES
Pediatrics
9%DEDUCTIBL
ES
InternalMedicine
8%DEDUCTIBL
ES
OB/GYN
11%DEDUCTIBL
ES
OrthopedicSurgery
8%DEDUCTIBL
ES
Surgery
50% of overall patient responsibility goes uncollected.
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Source: Online Resources Corp. (ORCC), “Short on Money, Will Your Customers’ Pay Your Bill?” December 2008.“The ‘Retailish’ Future of Patient Collections,” Celent, February 2009
Bills Consumers are Least Likely to Pay if Lacking Funds to Pay All Bills
40%
35%
30%
25%
20%
15%
10%
5%
0%Credit Card
PhoneHealthcar
eOther
UtilityLoan
InsuranceMortgage
Oct 07
Apr 08
Oct 08
% o
f onlin
e h
ouse
hold
x
Deductible and coinsurance dollars take longer to collect…
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12
0
10
0
80
60
40
20
0
Average Insurance Claim
CoPaymentDeductible
Coinsurance
No InsuranceDays in AR
…and are more likely to be written off!
8
12
0
10
0
80
60
40
20
0
Average Insurance Claim
CoPaymentDeductible
Coinsurance
No InsuranceDays in AR Percent Written Off
35
%
30
%
25
%
20
%
15
%
10
%
5%
0%
Understanding the consumer is key to success
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* Trends in Healthcare Payments Annual Report: 2011. InstaMed.
A 2011 survey of patients offers the following insights.
32%Don’t know
their payment responsibility
when they leave the
office.
70%Are interested
in making payments
online.
63% Would use a
payment plan if it was made
available.
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Create a Self-Pay Policy1 Use technology to build efficiencies and automation into your self-pay efforts2Make self-pay collection part of your practice workflow3
Essential Parts of a Self-Pay Policy
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Section 1: Describe what the policy covers.
Section 2: Describe generally that you hold patients responsible for the fees that they properly owe.
Section 3: Tell the patient when you expect payment.
Section 4: Clearly describe any late payment charges or any discount plan you may offer, making sure that you communicate all conditions and limitations recommended by your legal advisor. Section 5: Consider describing the consequences of non-payment (e.g., possible referral to a collection agency or an attorney). Section 6: Patient acknowledgement (optional).
Title: Announce the policy to the patient.Consider the following:- “Financial Policy” or
- “Policy on Patient Responsibility for Fees”
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Create a Self-Pay Policy1 Use technology to build efficiencies and automation into your self-pay efforts2Make self-pay collection part of your practice workflow3
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Reminder
Calls
Payment Estimator
Credit Card
Processing
Text Message
Reminders
Live Operator
Patient Portal
Bill on EOB
What your HIT vendor should do…
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Pre-visit scheduling Check-in Intake Exam Orders Check-out Follow-up
• Provide scripts to help staff collect co-pays, deductibles, and previous balances
• Provide access to real time adjudication
• Enable processing of credit card, HSA/FSA card, and checks
• Enable secure storage of credit card information to pay future balances
• Enable creation of automatic credit card payment schedules
• Provide portal to accept payment, deliver summarized EOB and statement
• Provide 2 automated follow-up calls every statement cycle
• Provide 2 automated follow-up emails every statement cycle
• Provide live operator services for after-hours bill payment
• Mail up to 4 printed statements if needed
• Enable insurance card scanning
• Enable processing of payments via credit, HSA/FSA cards, and checks
• Enable secure storage of credit card information to pay future balances
• Enable creation of automatic credit card payment schedules
• Provide patient portal to communicate self-pay policy, post anticipated co-pay amounts, and take payments
• Enable swift insurance eligibility checking
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Create a Self-Pay Policy1 Use technology to build efficiencies and automation into your self-pay efforts2Make self-pay collection part of your practice workflow3
Make self-pay collection part of your practice workflow
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It is important to work with your staff on self-pay best practices: • Help them understand the importance
of collecting self-pay amounts
• Provide scripts for your front desk staff to help them ask for co-pays, deductibles, and previous balances
• Identify and appoint collection “aces” – these people should be in client-facing roles. And remember, asking for money is a talent. Keep this in mind when recruiting new staff
• Explore incentives or recognition opportunities for self-pay staff achievements
Consider policies and measures to encourage payment
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Here are some policies that you might consider (with the help of your legal advisor):
• Time-of-service payment discount
• Cash discount
• Extra charge if bill is not paid at time of service or by a certain deadline
• Separate internal policy to cover fee waivers, discounts, and write-offs
What your practice should do…
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Pre-visit scheduling Check-in Intake Exam Orders Check-out Follow-up
• Use scripts to help staff request co-pays, deductibles, and previous balances
• Ask if patient wants credit card info securely stored to pay future balances
• Request payment for existing balances or establish electronic payment plan if payment can’t be made immediately
• Allocate time for billing inquiries
• Collection agency management and account selection for collection agencies
• Confirm demographics
• Collect co-pays & deductibles
• Scan insurance cards
• Collect completed HIPAA forms
• Create materials to clearly communicate policy to patients
• Consider policies for special circumstances
• Make reminder call in advance of apt
• Remind patient to speak with front desk about payment
When all else fails, employ a collection agency
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Once a month, review all patient balances that have aged over 120 days and send those accounts to your collection agency.
You also need to monitor your collection agency’s recovery rate and customer service skills in order to make sure that they are being both courteous and effective.
We offer five services which combine to help caregivers thrive
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athenaCollector® Life Cycle of Claim
• 32% average improvement in client DAR• 6% average improvement in collections• Reduced administrative work
• 95.4% Meaningful Use attestation in 2013• 1,329 clinical documents processed on average per
physician per month (PPM)• 98% adoption rate
• 8% average decline in no-show rates• 121 patient interactions via portal per PPM• 2.6% decrease in self-pay days in accounts receivable
• Increased volume and revenue capture from patients and insurance companies• Reduced administrative work for both sender and
receiver
• Mobile medical software for drug interaction, EHR, drug prices, dosing, disease, medical dictionary, ICD9 Code, Medicare Part D, and CME
athenaClinicals®
Life Cycle of the Chart
athenaCommunicator®
Life Cycle of the Patient Relationship
athenaCoordinator ®
Life Cycle of the Order
EpocratesPoint of Care Medical
Applications
2000
2006
2010
2011
2013
WHY IT MATTERS
A Success Story – San Antonio Orthopaedic Group
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Prior to implementing athenaCommunicator: • Self-pay DAR of 147.1
• No patient portal
• No online credit card processing
• No automated reminder call service
• No ability to take payment by phone outside of business hours
With athenahealth:• Self-pay DAR of 62.3
• athenaCommunicator sends e-mails to patients that allow them to review their statement and pay their bill online in the portal
• In 2012, the practice sent 42,676 automated self-pay reminder messages which resulted in 772 payments within 72 hours totaling $91,638.91
“athenahealth has improved our ability to collect and has streamlined the billing process for our practice and patients.
- Chris KeanChief Operating Officer
The athenahealth Solution
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Reminder
Calls
Payment Estimator
Credit Card
ProcessingText Message
Reminders
Live Operator
Patient Portal
Bill on EOB
Self-Pay Success
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93MSelf-pay reminder
notifications sent out in 2013
$34.8M collected on our Patient Portal in
2013
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6% increase in collections
8% decrease in no show rate
95.6% Meaningful Use attestation rate
32% reduction in days in accounts receivable
97% provider adoption rate