Streamlining the Financial Assistance Process

Sarah Knodel, CHFP, CRCE-I, CHAM Vice President Revenue Cycle, Baylor Scott & White Health, North Texas Division

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Outline

• Organizational Overview • Streamlining the Charity Process

– Presumptive Charity – Interactive Charity

• Outcomes • Lessons Learned

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Organizational Overview

o Official headquarters for Baylor Scott & White Health is located in Dallas. Official headquarters of Baylor Scott & White Health Service is in Temple

oMission: Baylor Scott & White Health exists to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing.

oVision: To be the most trusted name in giving and receiving safe, quality,

compassionate health care.

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Baylor Scott & White Health Merger

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BSWH-NTX Revenue Cycle Management Organizational Structure

RCM

Access Services

Facility Registration

Pre-Service Call Center

Financial Counseling

Clinical Resource Management

Utilization Review

Denial Resource Center

Central Business Office

Billing/Collections

Customer Service

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Streamlining the Charity Process

Project Objective: To automate and streamline the financial assistance process to improve the overall patient experience, reduce cost, and refine uncompensated care reporting

Prior to FY 2013

100% Manual Paper Process

FY 2013 Presumptive Charity

Process Fully Implemented

FY 2014 “Interactive Charity”

Process Implemented

FY 2014 Centralized charity approval process

to CBO Significant leap in automation and

improved patient experience

First step towards increased

automation

Increased standardization

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Presumptive Charity Care Overview

o Definition: o Presumptive charity care is the process of proactively and objectively classifying

patients as charity-eligible based on predictive analytics when financial information and documentation is limited or unavailable

o Benefits: o Increase charity write-offs through accurate classification of uncollectable accounts o Identify patients who were missed or did not participate in the traditional financial

counseling process that should be classified as charity vs. bad debt o Reduce cost-to-collect by stopping unproductive collection efforts on uncollectible

accounts sent to bad debt o Increase total community benefit reported under federal and state laws

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BSWH-NTX Presumptive Charity Care Flow

Post-Discharge Collection Process

Income Verification with Third Party Data

Charity Determination Documentation

Entire process automated, resulting in no manual work

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Current Presumptive Charity Scope

o ED Patients o Low propensity to pay (as defined by Experian) o All Payers (Insured and Uninsured) o 75+ Days From 1st Statement Date o Financially Indigent (<= 200% FPL)

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Presumptive Charity Documentation

Documentation supporting the charity determination posted in Imaging and Patient Accounting System

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Presumptive Charity in Financial Assistance Policy

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Interactive Charity Care Overview

o Definition: o Interactive charity care is the BSWH-NTX division process that automates the

traditional charity application process through an electronic application and approval through validation with third-party data sources

o Benefits:

o Provide patients with real-time charity qualification o Reduce cost-to-collect by streamlining a time-intensive, paper-driven process

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Interactive Charity Care Flow

Patient Indicates Inability to Pay

Patient’s Written or Verbal

Attestation

Income Verification with Third Party Data

Charity Determination Documentation

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Interactive Charity Documentation

Electronic Financial Assistance Application pre-populated with basic demographic information from HIS. Additional info

obtained through conversation with patient.

Charity Determination Form used as Proof of Income and contains data from HIS and

information from Experian Healthcare

Documents interface into imaging system upon approval resulting in no manual scanning of charity applications and proof of income

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Automation of Financial Assistance

100% Manual Process (Before New Technology)

Paper Process

30%

20%

50%

70% Automated Process (After New Technology)

Paper ProcessPresumptive CharityInteractive Charity

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BSWH-NTX Financial Assistance

$205,880,459

$254,251,181

$292,726,785

$390,948,377

$577,813,844

539,491,920

9%

10%

12%

16%

23%

21%

0%

5%

10%

15%

20%

25%

$-

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

$3,000,000,000

FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014

Net Revenue Charity Charity as % Net Revenue

Start of new processes

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Lessons Learned

1. Actively look for tangible solutions, prior to receiving external mandates

2. Obtain buy in from senior leadership before making large changes. Ensure recommendations are data-driven.

3. Focus on implementation processes and maintain strategic plan with dedicated check points

4. Audit new processes closely to ensure accuracy and that automation is working as expected

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Checklist

Utilize technology to streamline and improve the financial assistance process

Centralize and standardize functions where possible Draft clear current state and future state process flows before

making changes Automate as many steps in the process as possible – adjustment

posting, comment posting, and imaging of documentation Test, Test, TEST before going live with new process Ensure audit processes exist to monitor performance Perform financial analysis to define presumptive charity scope