1. 1. Information Request for Revenue Cycle and Accounts Receivable Management Services
2. 2. 1 Professional Contact Center, Accounts Receivable and Revenue Cycle Management Solutions 2016Copyright AllRightsReserved Revenue Cycle and Accounts Receivable Management Revenue Cycle and Accounts Receivable Management For over 39 years we have been one of the most trusted business partners in the healthcare Revenue Cycle and Accounts Receivable Management industry. We have partnered with over 127 healthcare facilities nationwide providing increase patient satisfaction. Our facilities manage over $500 million in bad debt annually, $65 million in new monthly self pay placements, provide Medicaid eligibility services in 15 states, and offer a host of consulting and extended office billings services for our clients. Our innovative approach is designed to offer clients and patients a patient-centric experience while maintaining the highest levels of compliance standards and patient lifetime value. Extended Business Office o Preservice coverage and cleanup o Full physician billing o Charge entry o Insurance coverage and benefits determination Insurance Billing and Follow Up o Insurance billing and rebilling primary and secondary o All payors government and commercial o Denial and no response follow up o Denial management and trending Federally Qualified Healthcare Facilities o Custom cleanup projects o Remittance integration and analysis o Medicaid Eligibility and Self Pay collection o Managed Care enrollment Self Pay o Self Pay follow up o Early out programs for Self Pay of all ages, customized to each client including: Self Pay resolution/payment monitoring and follow up Insurance identification, verification and filing Self Pay Plus o Point-of-Service Training o Operations assessment and recommendations on process improvement o Ongoing staff training for those involved with patient management Medicaid Eligibility & Verification o Eligibility assistance provided to patients o Ongoing support and education for patients o Appeal and Fair Hearing support
3. 3. 2 Professional Contact Center, Accounts Receivable and Revenue Cycle Management Solutions 2016Copyright AllRightsReserved o Medicaid Eligibility determination and claim submission Bad Debt o Primary, Secondary, Tertiary o Late Stage o Probate Contact Services o Health Risk Assessments o Inbound and Outbound member support services o Wellness Outreach o Provider support
4. 4. Services
5. 5. Copyright 2016, all rights reserved NEW105A By utilizing our expertise, healthcare facilities can focus on thier patients. Multi-system proficiency provides a seamless transition for our clients. KPI and trend analysis reporting, and continuous process improvement. We offer a broad portfolio of customizable solutions. Revenue Cycle & Accounts Receivable Management At Alltran, we passionately believe theres a better way to help people resolve their financial challenges. For over 38 years we have been a transformational force in the healthcare revenue cycle management industry. We have built a diverse portfolio of clients including: Healthcare Systems Medical Centers Public and Private Hospitals Specialty Clinics Services We assist our clients in managing their accounts receivables so they can provide greater access to healthcare. With customized strategies and best-in-class technology systems, and we offer services that are specifically aligned with our clients revenue cycle and accounts receivable management goals. Ares of specialization include: Billing and Insurance Follow Up Self Pay Eligibility Services Extended Business Office Managed Care Bad Debt Collections Compliance Alltran staff includes experts in regulatory requirements across the healthcare industry. We believe in adherence to the letter and spirit of the law, and proactively educate our clients as changes occur. With 100% commitment to treat every client and patients with respect and professionalism, we offer: Dedication to Compliance and Regulatory Management Professional Strategy Experienced Staff and Veteran Management Team Extensive Training Cutting-Edge Technology 200 14th Ave East | Sartell, MN 56377 | 877-5197446 | www.alltran.com
6. 6. 200 14th Ave East | Sartell, MN 56377 | 877-5197446 | www.alltran.com Extended Business Office Copyright 2016, all rights reserved NEW103A By utilizing our expertise, healthcare facilities can focus on their patients. We offer a broad portfolio of customizable solutions. Multi-system proficiency provides a seamless transition for our clients. KPI and trend analysis reporting, and continuous process improvement. At Alltran Health, we passionately believe theres a better way to help people resolve thier financial challenges. For over 39 years we have been a transformational force in the healthcare revenue cyce and accounts recieveable management industry. We have built a diverse profolio of clients including: Healthcare Systems Medical Centers Public and Private Hospitals Specialty Clinics The Need for a Solution With the changing face of healthcare, facilities and providers must expend added resources and attention to the billing and collection efforts. Decreasing financial capabilities and the continuously evolving regulatory and technological landscape, further impede facilities and providers from focusing on the entire revenue cycle, including patient satisfaction. We offer a tested and proven extended business office solution that spans the spectrum of services from initial billing, rebilling and appeals to credentialing and reporting. Our Program Includes: Preservice coverage and cleanup Preservice financial counseling for newly insured patients Insurance coverage and benefits determination Insurance billing and followup services Ability to work on your system or provide services through our system Customer-focused services by experienced professionals Custom cleanup projects Compliance Focused Alltran Healths staff includes experts in regulatory requirements across the Healthcare industry. We believe in adherence to the letter and spirit of the law, and proactively educate our clients as changes occur. With our 100% commitment to treat every client and account holder with respect and professionalism, we offer: Experience staff and veteran management team Professional strategy Extensive training
7. 7. FQHC ExtendedBusinessOffice Copyright 2016, all rights reserved NEW103A By utilizing our expertise, healthcare facilities can focus on thier patients. We offer a broad portfolio of customizable solutions. Multi-system proficiency provides a seamless transition for our clients. KPI and trend analysis reporting, and continuous process improvement. At Alltran Health, we passionately believe theres a better way to help people resolve thier financial challenges. For over 38 years we have been a transformational force in healthcare revenue cycle and accounts receivable management industry. We have built a portfolio of clients including: Healthcare Systems Medical Centers Public and Private Hospitals Specialty Clinics The Need for a Solution With the increasing demand for community-based health care services, it is imperative that Federally Qualified Health Centers (FQHC) have the necessary resources and tools to minimize administrative and billing challenges, allowing them to focus on clinical and patient care issues. We offer a tested and proven FQHC extended business office (EBO) solution that spans the spectrum of services from initial billing, rebilling and appeals to credentialing and reporting. Our Program Includes: Seamless, timely and collaborative implementation processes Experienced and knowledgeable FQHC representatives Custom clean-up project and consulting services Initial billing, rebilling, and appeals; remittance integration and analysis; customize business intelligence reports; medicaid eligibility and self pay collection; benefit determination; managed care enrollment; and patient statement production Compliance Focused Alltran Healths staff includes experts in regulatory requirements across the Healthcare industry. We believe in adherence to the letter and spirit of the law, and proactively educate our clients as changes occur. With our 100% commitment to treat every client and account holder with respect and professionalism, we offer: Experience staff and veteran management team Professional strategy Extensive training 200 14th Ave East | Sartell, MN 56377 | 877-5197446 | www.alltran.com
8. 8. Copyright 2016, all rights reserved NEW107A By utilizing our expertise, healthcare facilities can focus on thier patients. We offer a broad portfolio of customizable solutions. Multi-system proficiency provides a seamless transition for our clients. KPI and trend analysis reporting, and continuous process improvement. Insurance Billing and Follow Up At Alltran, we passionately believe theres a better way to help people resolve thier financial challenges. For over 38 years we have been a transformational force in healthcare revenue cycle and accounts receivable management industry. We have built a portfolio of clients including: Healthcare Systems Medical Centers Public and Private Hospitals Specialty Clinics The Need for a Solution The implementation of the Affordable Care Act (ACA) has further complicated insurance billing. Effectively collecting outstanding insurance payments, requires healthcare facilities to maintain a fully functional and extensively trained billing and collections staff that can efficiently manage the full spectrum of insurance billing, claims management, and collection services. Our proven insurance billing and follow up process can be customized to meet the unique needs of our clients. Our Program Includes: Accounts Receivable services such as: - Primary and secondary claim submission (including Coordination of Benefits) - Claim edits - Denial management including trending and reporting Self Pay Billing Services such as: - Self pay statements and follow-up - Engagement notice generation and mailing - Bad debt determination and write-off Compliance Focused Alltrans staff includes experts in regulatory requirements across the Healthcare industry. We believe in adherence to the letter and spirit of the law, and proactively educate our clients as changes occur. With our 100% commitment to treat every client and account holder with respect and professionalism, we offer: Experience staff and veteran management team Professional strategy Extensive training 200 14th Ave East | Sartell, MN 56377 | 877-5197446 | www.alltran.com
9. 9. At Alltran, we passionately believe theres a better way to help people resolve thier financial challenges. For over 38 years we have been a transformational force in the healthcare revenue cyce and accounts recieveable management industry. We have built a diverse profolio of clients including: Healthcare Systems Medical Centers Public and Private Hospitals Specialty Clinics The Need for a Solution A growing portion of healthcare facility and provider office payments are now generated through direct payments by patients. Given the myriad of other financial commitments that patients may have, collecting on these financial responsibilities is increasingly challenging, resulting in the need for bad debt collection. Using a well-defined, predictive reporting process and highly experienced and trained collection agents, our bad debt collection process has demonstrated significant increases in overall collection and reduced accounts receivable days. This results in higher collection rates for clients. Our Program Includes: Use of sophisticated predictive reporting process that identifies patients at high risk of bad debt Active outreach to collect on bad debt, using customer-focused processes Ability to manage a wide range of payment plan options Operational excellence 100% call monitoring and call transparency professionals Compliance Focused Alltrans staff includes experts in regulatory requirements across the Healthcare industry. We believe in adherence to the letter and spirit of the law, and proactively educate our clients as changes occur. With our 100% commitment to treat every client and account holder with respect and professionalism, we offer: Experience staff and veteran management team Professional strategy Extensive training Copyright 2015, all rights reserved NEW103A Healthcare Collections By utilizing our expertise, healthcare facilities can focus on thier patients. We offer a broad portfolio of customizable solutions. Multi-system proficiency provides a seamless transition for our clients. KPI and trend analysis reporting, and continuous process improvement. 200 14th Ave East | Sartell, MN 56377 | 888-340-7243 | www.alltran.com
10. 10. By utilizing our expertise, healthcare facilities can focus on thier patients. We offer a broad portfolio of customizable solutions. Multi-system proficiency provides a seamless transition for our clients. KPI and trend analysis reporting, and continuous process improvement. Copyright 2016, all rights reserved NEW104A Medicaid Eligibility Program At Alltran, we passionately believe theres a better way to help people resolve thier financial challenges. For over 39 years we have been a transformational force in the healthcare revenue cyce and accounts recieveable management industry. We have built a diverse portfolio of clients including: Healthcare Systems Medical Centers Public and Private Hospitals Specialty Clinics The Need for a Solution The increasing number of Medicaid patients, eligibility determination complexities, and Medicaid billing challenges have adversely impacted the ability of healthcare facilities to receive appropriate reimbursement for services. The introduction of the Affordable Care Act (ACA) in 2010 further complicated an already daunting process. Our program will increase patient satisfaction, decrease unpaid bills or charity care referrals, increase hospital cash flow and net revenue, and reduce business office A/R management expenses. Our Program Includes: Decrease days in accounts receivable with nationally certified Medicaid CACs Hands-on, onsite eligibility assistance to patients on behalf of your facility Assistance completing the Medicaid application and obtaining needed supporting documents, often converting self pay to Medicaid Establish working relationships with Social Security Disability Insurance (SSDI) and Medicaid offices, increase of follow up to ensure timely eligibility determination Supporting patients in cases of Appeals and Fair Hearings Compliance Focused Alltranss staff includes experts in regulatory requirements across the Healthcare industry. We believe in adherence to the letter and spirit of the law, and proactively educate our clients as changes occur. With our 100% commitment to treat every client and account holder with respect and professionalism, we offer: Experience staff and veteran management team Professional strategy Extensive training 200 14th Ave East | Sartell, MN 56377 | 877-519-7446 | www.alltran.com
11. 11. Copyright 2016, all rights reserved NEW105A By utilizing our expertise, healthcare facilities can focus on thier patients. Multi-system proficiency provides a seamless transition for our clients. KPI and trend analysis reporting, and continuous process improvement. We offer a broad portfolio of customizable solutions. Out-of-State Medicaid Provider Enrollment and Claims Management 200 14th Ave East | Sartell, MN 56377 | 877-5197446 | www.alltran.com At Alltran, we passionately believe theres a better way to help people resolve their financial challenges. For over 39 years we have been a transformational force in the healthcare revenue cycle and accounts receivable management industry. We have built a diverse portfolio of clients including: Healthcare Systems Medical Centers Public and Private Hospitals Specialty Clinics The Need for a Solution The increasing number of Medicaid patients and Medicaid billing challenges has made it difficult for healthcare facilities to receive appropriate reimbursement for services, particularly when a patient is out of state. We provide the lifeblood every healthcare system needs to thrive payment for servicesand our approach results in higher re- turns for our clients. Our Program Includes: Follow up on inventory accounts until payment is secured Billing of out-of-state Medicaid primary accounts Researching state filing requirements and verifying claims meet the requirements Editing and submitting all claims to appropriate out-of-state payer Completing Medicaid participation agreements or enrollment forms Researching and providing information needed for posting out-of-state payments Compliance Focused Alltran staffs experts in regulatory requirements across the Healthcare industry. We believe in adherence to the letter and spirit of the law, and proactively educating our clients as changes occur. With our 100% commitment to treat every client and account holder with respect and professionalism, we offer: Experience staff and a veteran management team Professional strategy Extensive training
12. 12. Self Pay Copyright 2015, all rights reserved NEW107A By utilizing our expertise, healthcare facilities can focus on thier patients. We offer a broad portfolio of customizable solutions. Multi-system proficiency provides a seamless transition for our clients. KPI and trend analysis reporting, and continuous process improvement. At Alltran, we passionately believe theres a better way to help people resolve their financial challenges. For over 38 years we have been a transformational force in the healthcare revenue cycle and accounts receivable management industry. We have built a diverse portfolio of clients including: Healthcare Systems Medical Centers Public and Private Hospitals Specialty Clinics The Need for a Solution With increasing healthcare costs, patients are taking on greater self-pay responsibilities in the form of higher premiums, deductibles, and co-payments. A growing portion of healthcare facility and provider office payments are now generated through direct payments by patients. Using highly experienced and trained service representatives, our self pay process has demonstrated significant increase in overall collection, reduced accounts receivable days, and improved financial assistance capture, resulting in higher collection rates for clients. Our Program Includes: An ability to work on your system or provide services through our system A sophisticated autodialer technology outreach to patients Preservice financial counseling for newly insured patients Well-defined business intelligence modeling Compliance Focused Alltrans staff includes experts in regulatory requirements across the Healthcare industry. We believe in adherence to the letter and spirit of the law, and proactively educate our clients as changes occur. With our 100% commitment to treat every client and account holder with respect and professionalism, we offer: Experience staff and veteran management team Professional strategy Extensive training 200 14th Ave East | Sartell, MN 56377 | 877-5197446 | www.alltran.com
13. 13. Self Pay Plus An innovative approach to maximize Self Pay revenue Copyright 2015, all rights reserved NEW100A By utilizing our expertise, healthcare facilities can focus on thier patients. We offer a broad portfolio of customizable solutions. Multi-system proficiency provides a seamless transition for our clients. KPI and trend analysis reporting, and continuous process improvement. At Alltran, we passionately believe theres a better way to help people resolve their financial challenges. For over 38 years we have been a transformational force in the healthcare revenue cycle and accounts receivable management industry. We have built a diverse portfolio of clients including: Healthcare Systems Medical Centers Public and Private Hospitals Specialty Clinics The Need for a Solution Most hospitals have recognized the impact high deductibles and co-payments have on healthcare receivables. Our goal is to teach healthcare organizations how to maximize point-of-service collections and self pay revenue so they meet their financial goals. Our proven self pay process can be customized to meet the unique needs our clients and is designed to reduce accounts receivable days, and improve financial assistance capture, resulting in higher collection rates. Our Program Includes: Implementation of an effective point-of-service process Assessment and recommendations on process improvements in facility-based point-of-service collections process Initial and ongoing staff training for those involved with patient management, point-of-service, and billing services Full responsibility for Day One self pay follow up and collection Identifying and rebilling new insurance coverage and increasing quick pay dollars Compliance Focused Alltrans staff includes experts in regulatory requirements across the Healthcare industry. We believe in adherence to the letter and spirit of the law, and proactively educate our clients as changes occur. With our 100% commitment to treat every client and account holder with respect and professionalism, we offer: Experience staff and veteran management team Professional strategy Extensive training 200 14th Ave East | Sartell, MN 56377 | 877-5197446 | www.alltran.com
14. 14. Whitepapers
15. 15. Healthcare Compliance: Affordable Care Act 501(r) and IRS Final Rule When Section 501(r) was added to the Internal Revenue Code in 2010, focus on the Affordable Care Act (ACA) regulatory changes shifted to non-profit hospitals, namely imposing requirements to maintain tax-exempt status. The amended ACA affects organizations with one or more hospitals, which are reviewed on a facility-by-facility basis. Final IRS ACA 501(r) regulations apply to taxable years beginning after December 29, 2015. These regulations will affect patient transactions from financial assistance to collections. Hospitals must: Establish and widely publicize a Financial Assistance Plan (FAP) and emergency care policies. Limit amounts charged for emergency or other medically necessary care to patients eligible under a FAP. Make reasonable efforts to determine whether an individual qualifies for a FAP before engaging in extraordinary collection actions. Conduct and publish the results of a community health needs assessment at least once every three years. One of the biggest issues under 501(r) is how your collection partner will contact patients regarding outstanding bills. Hospitals need policies that describe how and when theyand their third-party collection partnerscontact patients. To that end, the content in this document Financial Assistance Plan and Extraordinary Collection Activities provides an overview of ACA 501(r) and highlights specific requirements in each section that pertain to medical billing and collections. It also maps how Alltran can help you plan for compliance with this complex regulation. We partner with clients to create and monitor collection procedures that meet tax-exempt requirements and strengthen your position as a provider of compassionate, quality care. The final 501(r) regulations require hospitals to offer a plain language summary of the organizations established FAP during the intake or discharge of patients. In addition, billing statements must include a conspicuous written notice that informs patients of your established FAP and its availability. Beginning on the date of their first post-discharge billing statement, patients are granted a notification period of up to 120 days to determine whether they would like to apply for financial assistance and start the application process. The patient then receives an additional 120-day application period to submit the application forms. An important aspect of FAP is that absolutely no extraordinary collection activities (ECAs) may occur during the combined 240-day notification and application periods, unless reasonable efforts have been satisfied by the healthcare facility. Moreover, hospitals are required to process applications submitted within this window of time. What Constitutes an ECA? The regulations define ECAs to include the following: Employing legal or judicial process to obtain payment for a bill covered under FAP Selling debt to a third party Reporting adverse information to credit agencies Deferring or denying medical care based on non-payment for previously FAP-covered care Requiring payment before providing medically necessary care
16. 16. Securing Your ACA 501(r) Compliance Financial assistance policy (FAP) and emergency medical care policy A plain language summary of the FAP A FAP application form and instructions hfma National Institute ECA Protocol and Reasonable Efforts ECAs may only commence when the hospital, its third-party collection vendor, or its legal partner has made a reasonable effort to determine a patients FAP eligibility, and that patient is deemed ineligible. Should a hospital intend to proceed with an ECA, it must make a reasonable effort to determine whether the patient is eligible for FAP assistance. While the finer requirements of reasonable effort remain unclear under the ACA 501(r), it appears, at a minimum the following steps are neces- sary to complete this requirement: Include plain language summary with all (and at least 3) billing statements and written communications about the bill during the notification Inform patients about FAP in all oral communications about their bill during the notification process of FAP assistance Provide the patient with at least a 30 day notification of the intent to perform ECAs and listing out the specific ECAs that may be completed The most critical aspect of this regulation is that all ECAs are suspended between the completed FAP application submission and In addition to implementing processes and procedures that reflect the language of ACA 501(r), hospitals can turn to a third-party to collect patient debt. Your tax-exempt status is critical and has implications that extend beyond business practicalities. It is one factor that allows you to provide the utmost service to your patients and community. The complexities of new regulations and what is at stake make it ever more critical to select a vendor that is 100% compliance-ready. Alltran views ACA 501(r) as an opportunity to protect your tax-exempt status while solidifying your positive standing with the patients and communities you serve. Your patients likely reside in your area and should feel comfortable to turn to you again for future needs. Our experience has shown that account resolution, when handled appropriately, improves the overall patient- provider relationship. Through innovation, education, and support, we can assist your patients in resolving their accounts in a manner that protects you and your patients. Compliance-Ready Resources and Training Important Decisions: What ECAs will your facility allow Alltran to perform? How will your facility ensure that reasonable efforts have been completed for each date of service? What dates are you able to supply to Alltran to identify the notification and application period? How should Alltran direct your patients to apply for FAP? a formal determination of eligibility. ** Note - that if your facility never intends to pursue any ECAs you do not need to prove reasonable efforts.
17. 17. How will your facility communicate any new and ongoing FAP applications to Alltran? A partnership with Alltran means that patients expressing financial hardship will receive professional assistance that reflects your values. When you provide us with your toll-free number and/or website address, our collection agents are able to act seamlessly on your behalf, helping patients resolve their debt. Alltran collection agent, supervisor, and management training and continuing education programs are essential to total compliance. All new Collection Agents are required to attend our comprehensive, in-house training. We track progress and conduct annual tests to evaluate program completion and effectiveness. Curriculum topics include: What is 501(r)? How does 501(r) affect non-profit hospitals? How does 501(r) affect Alltran? Client-Specific Handling FAP Handling Extraordinary Collection Activities 501(r) Timelines Alltran managers regularly complete the same training tests as their team members to stay current on industry changes and be optimally prepared to field employee questions. Our Collection Agents assigned to your accounts will be prepared to use your provided, plain-language FAP summary. Our initial written communication with a patient will include this language: The Healthcare Services Provider(s) listed above may provide financial assistance for eligible persons who cannot afford to pay for medical care. Financial assistance eligibility is based upon documented family circumstances and family size. If you need assistance in contacting the Healthcare Services Provider regarding their financial assistance policy, please contact us at and we will provide contact information for the appropriate Healthcare Provider(s). Collection agents will also be equipped with carefully written and approved scripts. Any changes or special alerts appear instantly on the agents screen.
18. 18. Make Alltran Your Partner in ACA 501(r) Compliance When we assist you with 501(r) compliance, our people, processes, and technologies minimize your administrative and resource burdens. Let us partner with you so that you are free to focus on what you do best. About Alltran Alltran provides highly effective and Compliance-Ready Inventory Management with Artiva Alltran leverages the Artiva collection system from Ontario Systems to design and automate workflows for optimal compliance within a changing regulatory landscape. The technology allows us to record and monitor calls and substantiate the delivery of alerts and/or scripts. The results of monitored calls are maintained in a Complaint and Dispute Management Application (CDMA), which provides 360-degree complaint and dispute resolution. Account numbers can be individually loaded such that reporting is delivered to you based on individual episodes of care. Importantly, data fields can be designated 200 14th Ave E, Sartell MN 56377 1.800.692.7374 info@alltran.com Copyright 2016, all rights reserved NEW Alltran leverages the Artiva collection system from Ontario Systems to design and automate workflows for optimal compliance within a changing regulatory landscape. The technology allows us to record and monitor calls and substantiate the delivery of alerts and/or scripts. professional third-party debt collection services. Since its onset in 1977, Alltran has excelled in the healthcare market. Our sensitivity to patient satisfaction and dedication to sound business practices are evident in the results we deliver to our loyal clients. We want to partner with your healthcare organization so that you can focus on what you do best. Your success is our mission.
19. 19. Compliance Management Systems: a Process, Not a Product From conferences to sales pitches to webinars -- its likely that at some point youve seen the phrase Compliance Management System or its acronym CMS. This is not to be confused with a Contact Management System or a Complaint Management System which also share this acronym. Compliance Management Systems are required by the Consumer Financial Protection Bureau (CFPB) for collection agencies of all sizes. In fact, the CFPB has been very clear that organizations can build and scale a CMS that matches the size and complexity of their organization, while addressing the unique risks inherent to the companys collections or services. A small companys CMS does not have to be identical to that of a large-market participant. The goal is to get to the same end- point which is to maintain compliance with regulations and treat consumers fairly and with respect. An important clarification is necessary in that a CMS does not describe a software program which is simply purchased and installed within the organization. Its not that easy, reputable CMS vendors will not only supply you software but also engage your organization in using that system to develop an effective CMS program. CMS software will help you manage your compliance procedures, but it is not the most important element of a successful CMS. A CMS describes a complement of policies, procedures, and, in some cases, software components. As stated in the title of this article: a CMS is a process, not a product. The CFPBs Supervisory and Examination Manual spells out four interdependent control components for a CMS: Implementing board and management oversight Implementing a compliance program Consumer complaint handling Conducting compliance audits Well take a quick look at these components, and offer some tips. Implementing Board and Management Oversight This doesnt necessarily mean you have to have a board of directors, especially if youre a small collection agency. The expectation of the CFPB is that there is an established governing body that holds regular meetings where compliance and operational oversight are topics. The governing body should have the authority to make operational decisions for the organization. Your compliance officer or committee representative will report any information about nonconformities, requirements for policy and procedure updates, a review of complaint analytics, and litigation information involving the organization. The Board of directors or governing body is expected to adopt and approve the policies and procedures regarding consumer compliance. The CFPB expects the governing body to drive compliance and to allocate resources to support the size and complexity of the organization so that it can comply with the consumer financial laws and avoid consumer harm. Implementing a Compliance Program Your compliance program should include documented policies, procedures and processes which are true representations of what your organization believes and how it conducts business. The organization should be able to demonstrate that the policies, procedures, and processes are followed on a daily basis. If audited, it will be more damaging to your organization if the policies and procedures are not in compliance than if no documentation existed. The lack of compliance to your own beliefs will call your entire documentation suite into question. Consumer Compliant Handling The CFPB broadly defines complaints as a consumers expression of dissatisfaction with a product or service. As a first step it is important to define the difference between a complaint and a dispute and document how your organization disseminates and tracks each. Your CMS processes should also have a policies and procedures which call for a review of any complaint received and outline your communication schedule to consumers when a complaint is logged.
20. 20. Conducting Compliance Audits The CFPB expects that collection agencies will perform internal (in-house) and external (3rd party assessment) compliance audits. This will likely will be a time consuming process but one that will provide useful insight into your organization and will expose the gap between what is written down and what is actually happening. Where possible, leverage your host recovery system to provide you with an analysis of your accounts against the expected outcomes. Investments in systematic alerts and a reports are well worth money to ensure that you are in compliance. A Compliance Management System describes the processes your agency is engaging with in pursuit of compliance and consumer protection. There is no simple way to launch and manage an effective Compliance Management System. It is a lengthy and expensive endeavor to engage in but one that is well worth it when done well. Complaint tracking and trend analysis is an important element of your CMS and should be included in your analysis and procedure management. Part of your regular board meetings should include a review of consumer complaints and the efforts/actions that went into resolving them. 200 14th Ave E, Sartell MN 56377 1.800.692.7374 info@alltran.com Copyright 2016, all rights reserved NEW Derek Scheskie Director of Operations Derek has more than 20 years of Accounts Receivable Management (ARM) experience. Since joining JCC in 2004, his aptitude for collections systems technology, strategic planning and management, and client relations has resulted in significant growth within Alltrans financial collection division and consistent performance among our scored portfolios.
21. 21. Medicaid Eligibility: The High Price of Free Healthcare The four saddest words in todays healthcare industry: Put it in writing. Healthcare has become a sea of paper and supporting documentation (or e-records). In spite of efforts to the contrary, ink bleeds into every corner of the industry, both on the clinical and revenue cycle side. It will come as no surprise to anyone in healthcare that the difference between getting paid or writing off an account to bad debt can be as little as a signature on a single form or providing appropriate documentation. When it comes to government healthcare programs--especially the subject of this article, Medicaid--bureaucracy has and continues to drive the financial engine. While some healthcare providers became adept on the mechanics of the process, patients were overwhelmed. From its inception in 1965, Medicaid has required that patients and/or their families fill out an application and provide financial and medical information, depending upon what aegis of the program they fell under. If the boxes were not checked, the fields not filled out, the signature not made, documentation not provided, outstanding treatment dollars for Medicaid patients slid into bad debt and patients did not receive the ongoing coverage for care they desperately needed. Over time, providers lost significant Medicaid reimbursements because of misunderstanding changing regulations, missing patient information, lackofpatientengagementandconsent.Acottage industry of patient advocacy firms grew up to better connect the dots between provider, patient and the government. Now, along comes the Patient Protection and Affordable Care Act, which included the opportunity for the states to expand Medicaid along with offering healthcare insurance coverage. Thirty-two states and the District of Columbia agreed to some version of expansion, and take up the federal government on its offer. One of the purported benefits, in addition to greater federal reimbursement (at least initially) was that the application process would go online, and, in theory at least, become more streamlined. TheprocessofmovingMedicaidapplicationsonline has mirrored the health insurance exchanges/ marketplaces. Some states have elected to create their own portals, some operate portals jointly with the federal government, and others have opted to havethefedsruntheportalaltogether.Wearenow two years into Medicaid expansion and our clients in those states that accepted it are seeing some measurable improvement in the level and quality of care for certain low income populations. While moving the application process online has been an improvement, the need for patient advocacy has not disappeared. Many Medicaid- qualified patients still fail to properly fill out forms or continue to submit incomplete or inaccurate financial and medical information. Many times the data accessed electronically is inaccurate or simply doesnt exist.
22. 22. While the application process has been streamlined,thechallengesfacedbypatientswho potentially qualify for Medicaid have not entirely changed, among them: Lack of access or understanding of the technology. Despite the omnipresence of the internet, several Medicaid eligibles dont have access to it or, what is probably more common, an aversion to using it due to confusion about the process. Cultural bias. There are those who may be qualified Medicaid patients whom are immigrants and potentially considered (depending upon the program and status) qualified aliens. However, they may originate from countries where they have learned from an early age not to trust the government, a belief to have matters handled within their own family or community as well as language barriers. Higher priorities elsewhere. Several Medicaid eligibles have to make difficult choices about utilizing their limited resources and time. Do I go to work or complete a financial assistance application? Do I spend money for food or on a taxi to get a birth certificate? Do I pay a medical bill or keep the lights on for another month? Medical conditions limiting patients ability to comply with the application process. Many times qualified Medicaid eligibles have a medical condition (physical or behavioral) which hinders their ability to complete the process to obtain coverage. This in essence, can be the difference between getting healthy and dealing with a much more serious health dilemma that can be fatal. If therearenofamilymembersorguardianswhocan be the voice of these patients, they continue to be at risk. As healthcare providers have learned, the need for patient intervention is not going away with expanded Medicaid. If anything, it has become more nuanced and in some cases more difficult due to the misconception of ease. At the same time the stakes have grown much higher since reimbursements from other revenue sources are shrinking dramatically. In the next article, well look at ways that providers can fine-tune their patient championing efforts to get the most from their limited resources. The Challenge for Healthcare Providers The challenge for healthcare providers is not Medicaid eligibility; the challenge is making sure 200 14th Ave East | Sartell, MN 56377 | 888-340-7243 | www.alltran.com
23. 23. those that are eligible for Medicaid get enrolled correctly. I outlined some of the obstacles healthcare providers face enrolling Medicaid eligibles. Despite the advances that resulted from the Patient Protection and Affordable Care Act, specifically by moving the application process online, many qualified Medicaid patients continue to slip between the cracks and from there slide into bad debt. For healthcare providers, the ACA is mostly good news with relation to Medicaid, at least in the 32 states and District of Columbia that consented to some version of expanding the program. By increasing the income range under which patients qualify a greater number of low income individuals can get the level of care they require and better clinical outcomes. Healthcare providers are still required to work with patients to assist with the financial assistance process. Even though more people qualify for Medicaid, they still are required to complete applications and have some level of income verification and, depending upon the program, supporting evidence of qualifying medical conditions. While providers understood that the number of Medicaid eligible patients under the ACA would increase, there also was a perception by many that the new streamlined application process would absorb the need for any additional resources to manage the growing volume. Thisresultedinmanyproviderstakingthefollowing steps: Some reduced staff and resources to those departments or individuals responsible for patient application intervention with the expectation that the new streamlined process will result in fewer Medicaid eligibles getting away. Others relied on Navigators or in-person assisters provided by the state or federal governmenttobeavailabletopatientswhohave questions or dont understand the process. Still others maintained or even increased budgets for patient advocacy efforts, but found that despite the increased resources the number of Medicaid eligibles slipping into bad debt has increased. At least in our experience, many healthcare providers are coming to the realization they underestimated potential website, data, and application limitations and the sheer volume of potentially qualified applicants. They found that the new online application process, though more efficient, has not eliminated the need for patient intervention to help complete applications, obtain supporting documentation, and correct application errors. There is still a need to track the states progress on making timely and correct decisions due to increased volume. Many have observed that this has not been an entirely smooth transition and unfortunatelythereisstillaneedtofilefairhearings and appeals. The challenge for healthcare providers is not Medicaid Eligibility; the challenge is making sure those that are eligible for Medicaid get Copyright 2015, all rights reserved NEW 203A Author: Sherry Dobbs Manager, Medicaid Eligibility Operations 200 14th Ave East | Sartell, MN 56377 | 888-340-7243 | www.arlltran.com
24. 24. AdaptingTo AChanging Healthcare Climate WithPatient Access 200 14th Ave East | Sartell, MN 56377 | 888-340-7243 | www.alltran.com
25. 25. Systemic changes in how healthcare is deliv- ered and paid for have increased the volume and complexity of transactionshigh deductibles, co-in- surance, and co-paysand shifted payment respon- sibility to the patient. The resulting business issues have left many hospitals grappling with decreased patient-portion collections, high collection costs, and bad debt. Many are also observing coinciding, troubling drops in patient satisfaction. Trinity Health was perhaps especially impacted by the changes due to its largely transient patient pop- ulation. The sheer volume of patients coming and going made patient-portion collection difficult. Fur- thermore, thoroughly educating patients about their financial responsibilities in the transitioning environ- ment was near impossible. The processes they had in place did not match the updated payment climate, causing an unpredictable revenue stream and ebbing patient satisfaction. These circumstances did not al- low for optimal organizational health. Leadership at Trinity Health recognized that to con- tinue delivering the best care, its operations must be healthy, too. Cash flow is a strong indicator of organi- zational health, and management knew they faced a critical challenge to align the consistently high quality of patient care for which they are known with basic operational imperatives. We realized the immediate need to get in front of our patients, sooner than later, with a point-of-service modelthatwasbothcustomerfriendlyandfinancially sound for Trinity Health, explained Trent Chastain, vice president, Revenue Cycle. After careful vender analysis, Chastain and his team selected Alltran Health as their partner to design and implement a patient access model that would improve outcomes and decrease costs
26. 26. of payment collections. Alltrans consulting groupled by Chuck Seviour, Vice President of Consulting waschosenduetotheirexperiencewith identifying the most urgent challenges, creating integrated plans that address issues systemically, and implementing long-term solutions with innovative policies, processes, and tools that exactly match the defined business needs. The two enti- ties initiated the patient access engagement with these guiding principles: Maximize cash collections at patient access Identify community care opportunities early in the billing process Improve patient satisfaction through communication and education Solution Design Staff Identification and Buy-In For the patient access engagement to be a success, Seviour and his consulting team needed participa- tion and buy-in from the key Trin- ity Health managers and staff of relevant patient access areas. This included department leaders with spe- cific responsibilities related to self-pay and patient access opportunities from these areas: Case Management Support Services Physician Services Patient Access Pre-Certification Nursing Critical Care ETC They then analyzed areas with poten- tial for cash collections and further detailed the staff involvement list to include team members and managers from: Clinic Registration Clinic Scheduling Outpatient Surgery Emergency Department Admitting Financial Counselors Once key players were identified, the AlltranHealthteamexplainedthevision for the project, the potential changes, and how each group would be affected by these changes. They also detailed how the successful adaptation of these changeswouldmakewayforsubstantial improvement in day-to-day and overall operations. Setting Parameters for New Policies and Procedures Critical to the patient access engage- ments success was working with each department to ensure that any pro- posed changes would be absolutely necessary and create the intended outcome. Setting parameters began with an audit of current procedures to assess what needed to change versus what was currently working well. The consulting team examined and pri- oritized the previously identified areas for potential cash collection while also soliciting feedback from those whose roles would be most impacted by the changes. Below is a sampling of the ini- tial, agreed-upon adjustments for staff within clinics as well as the hospitals Emergency and Same-Day Surgery De- partments. Leveraging the Role of Financial Counselors Trinity Health has long recognized the significant role financial counselors play in day-to-day self-pay operations. In the quest for increased cash flow and improved patient satisfaction, the responsibilities of financial counselors willbecomeevenmoreimportantatev- ery point of contact along the payment continuum. One integral aspect moving forward is that financial counselors will take on tasks typically shared between coun- selors and call center representatives. For example, counselors will make calls to all scheduled patients regarding up- cominginpatientandoutpatientproce- dures. They will discuss fiscal responsi- bility and request that the payment be made at the time of service. They will also follow up with Clinical or Surgery Department patients who did not pay their co-pay amount at the time of the visit. This approach is intended to en- hance relationships by offering a single- point-of-contact for concerns about self-pay responsibility and payment ability or options.
27. 27. Department Alignment Midway through the Trinity Health- Alltran Health engagement, the teams arranged an onsite visit to confirm continuity with clinics, hospital ar- easincluding prior authorization and pre-certifications staff that compiles out-of-cost potentialand financial counselors. Alignment activities were centered on communication and training. Communication Staff members were interviewed to determine their awareness and understanding of the pending changes. When it was clear that the initiative to increase patient access collections was fully understood, the consultants and Trinity team leaders solicited feed- back to identify and address potential impediments to a smooth acceptance and implementation of these chang- es. They also highlighted the positive impact increased cash flow would bring for each specific area. Training Alltran Health designed the train- ing according to the needs and func- tions of staff in each department and role. In addition, all staff re- ceived uniform training regarding the compassionate, courteous, and digni- fiedtreatmentofTrinityHealthsvalued patients. Training will be ongoing, yet it has already been an advantageous op- portunity for further communica- tion, as well as a trial run to determine whether additional changes or tweaks to the new procedures will be neces- sary. For example, the Support Ser- vices group represented the largest re-alignment of responsibilities and was considered to have the most impact on Trinity operations, its finan- cial counselors, and its patients. The comprehensive training included instruction, Q&As, videotaped sessions, and role-playing with pre- written patient-interaction scripts. Whats Next? Not long ago, Trinity Health went live with the revamped patient access procedures. Trinity Health and All- tran Health agreed that a reason- able period of time must be al- lowed for patient education to strengthen and take hold before data collection will accurately reflect the impact of the changes on patient ac- cess cash collection. Still, Trinity Health and its patients are already benefit- ting from the initial effects of these changes. The two entities mutually embrace the philosophy that true and lasting organizational change relies on the consistency of effort toward matching strategies with the overarching vision and clearly defined goals. Trinity Health management monitors day-to-day activities to ensure that policies are followed and patient interac- tions are conducted accord- ing to the previously agreed-upon scripts. The Alltran Health team remains in regular contact to support the implementation, flag opportunities for additional training, and field ques- tions or thwart possible roadblocks to progress. Future plans for the project include tracking and quantifying data to analyze the programs efficacy and leveraging data toward its long-term success. Leadership will also create incentives for current and new staff members to reach their individual, departmental, and organization-wide goals. As more areas within Trinity Health are working to collect self-pay dollars from patients at point-of-service, the organization is already demonstrat- ing that its unbending commitment to patients is compatible with operational efficiency and efficacy. Collecting self-pay patient requirements will increase cash flow. Educating patients about their financial responsibilities will help patients better understand their out-of-pocket costs and obligations. The results so far point to improved processes, stronger patient rela- tionships, and an overall healthier organization. We realized the immediate need to get in front of our patients, sooner than later, with a point-of-service model that was both customer friendly and financially sound for Trinity Health 200 14th Ave E, Sartell MN 56377 1.800.692.7374 www.alltran.com Copyright 2016, all rights reserved NEW
28. 28. Turning the Corner from Volume to Value Like it or not, the Center for Medicare and Medicaid Services (CMS) has turned from Fee- for -Service (FFS) to Pay-for Performance(PFP)ora ValueBasedPurchasing(VBP)model. The question is not whether or not providers, hospitals and systems are ready to let go of those margins, but rather what can they do to mitigate risk today and protect the Revenue Cycle of tomorrow? In the largest industry in America, healthcare providers are facing yet another perfect storm of Federal regulation and legislation. Today, were going to discuss three recent factors that if left unchecked, may negatively impact the Revenue Cycle in the near future. The Elimination of FFS and other volume-based reimbursements models by CMS CMS growing reliance on the Consumer Assessment of Healthcare Providers and Systems (CAHPS ) The Patient Protection & Affordable Care Act (PPACA,) with now nationally required pricing transparency and patient engagement Value Based Healthcare In late January 2015, CMS identified the benchmark of 30% of 2016 claims that must be value based, this target increases to 50% in 2018. CMS announced exactly the types of value based healthcare that participating providers, hospitals and clinics need to be adopting: FFS with a link of payment to quality, which includes hospital value-based purchasing, Physician Value-Based Modifier, the Readmissions/ Hospital Acquired Condition Reduction Program. For these models, a portion of payments vary based on the delivery of quality & efficient healthcare. Alternative payment models built on FFS architecture: Accountable Care Organizations (ACOs,) Patient Centered Medical Homes (PCMHs,) Medicare-Medicaid Financial Alignment Initiative FFS Model. For these types of reimbursement models, some of the payment is linked to effective population management and coordinated care. Population-based Payments, Pioneer ACOs (now in years 3-5 since inception) may participate in this reimbursement model. Payment is not directly triggered by service delivery, so volume is not linked to payment. Providers, Hospitals and Clinics are responsible for the coordinated care of the beneficiary for one year or more. CAHPS Although CMS has been using patient survey tools for decades, recently these tools have been increasingly linked to Prospective Payment System (PPS) reimbursement. The
29. 29. 200 14th Ave East | Sartell, MN 56377 | 888-340-7243 | www.alltran.com goal of these surveys is to standardize, track and gauge the propensity of desired behaviors within the care continuum. H-CAHPS (Hospital) were first on the scene. They track: Communication with Doctors and Nurses, Staff Responsiveness,PainManagement,MedicationandDischarge Instructions, and the Cleanliness/ Quietness of the Facility. Hospitals are required to complete approximately three hundred surveys (per year) within 6 weeks of discharge (e.g., medical, surgical, labor and delivery patients.) Hospitals are well served in establishing propensity baselines within their facilities, then working in small incremental steps toward top- box scores. Many successful models incorporate patient feedback and committees in go-forward improvements and efficiencies. CG-CAHPS (Clinician Groups) track 5 domains: Overall Provider Rating, Access to Care, Discharge & Follow-Up, How well the Doctor Communicates, and the Courtesy & Helpfulness of the Staff. As Providers are working to educate and engage their growing patient base; their payment from the largest payer in America is also increasingly dependent on soft skills. Consumers seek compassionate, competent care in a convenient setting that save(s) them time, money and effort. The PPACA Providers, Hospitals and Systems are now flooded with newly minted, nationally mandated patients who either require an incredible amount of financial & health literacy education; or have become truly savvy healthcare consumers with the loss of their first dollar coverage and increasing pricing transparency. This consumerism dictates that providers meet patients when and how they want to be treated-or they willleavetheprovider,practiceandfacilityandtaketheirdollar to another network-possibly for the rest of their lifetime. As CMS continues to forge the journey towards Value Based Purchasing (VBP) providers, hospitals and systems seek to attain, and then sustain the triple aim in Healthcare (Population Health Management, Decrease Per Capita Cost, and Improve the Experience of Care.) CMS has determined and released a timeline for conversion from Fee- for- Service (FFS) to Pay -for -Performance (PFP). Currently 20% of Medicare services are value-based, by 2016-30% of claims need to be PFP and in 2018, a solid 50% will be required. This means a large percentage of Medicare beneficiarieswillbetransitionedtothesenewmodels. Further complicating this charted course is the looming large and yet pending, national conversion to ICD-10 which has been delayed more than once to date. Models Are Changing The move from FFS means that Medicare patients will soon become part of a VBP model (e.g., ACOs, Patient Centered Medical Homes {PCMHs,}) these outcome based, reimbursementmodelsnecessitateanewlevelofcoordinated care and communication within the continuum. The
30. 30. In late January 2015, CMS identified the benchmark of 30% of 2016 claims that must be value based, this target increases to 50% in 2018. Copyright 2015, all rights reserved NEW 204A 200 14th Ave East | Sartell, MN 56377 | 888-340-7243 | www.alltran.com from their smartphones while they wait in your lobby, or at their house, or anywhere else the internet may reach. Inconclusionproviders,hospitalsandsystemsshouldresolve to enhance their current models to meet the consumer in the newhealthcaremarketplace-whichchampionsconsumerism and all that entails. Many areas of the country are finding that their consumers now want telehealth/ virtual appointments & walk-in or minute clinic convenience options.Providers, hospitals and systems have started to incorporate departments devoted to tracking patient outcomes; a similar model focused on patient engagement and education will mitigate risks today and protect the revenue cycle into the future. reimbursement stakes are raised by increasing percentages being based on the patients experience of care (surveyed through CAHPS .) Now that CMS readmission penalties are becoming more than a nuisance (up to 3% may be at risk,) and in 2014, 2,610 hospitals have incurred said penalties; some providers and facilities are looking to coordinate care with pharmacies that can help reconcile and mange (facilitate & report back) medication compliance, track and share population health data, and take care of the follow-up phone calls -made to the patient at Day 1, 3, 10 and 30. Providers tend to agree consumers are usually more compliant with prescriptions if they have them upon discharge- or can get them onsite. With an enhanced focus on appropriate access and utilization, healthcare service providers are squarely in the hot seat of delivering coordinated care across multiple platforms; while educating and engaging their growing patient base with less time and fewer resources. All this, while consumers demand a higher level of compassionate care delivered how, when and where they want to be treated. Education and Engagement Manyoftodayshealthcareconsumersdontunderstandcore concepts of their healthcare coverage, and their newfound coverage doesnt guarantee appropriate access. For many consumers that do understand the financial responsibilities of a $6,000.00 family deductible- they may delay seeking treatment, until emergent care is needed-therefore receiving high resource intensive care in an inappropriate treatment setting (e.g., chronic &/or comorbid conditions such as diabetes and heart disease being treated in the ED.) The key for providers, hospitals and systems is to jumpstart their patient facing education and engagement today, many times by extending the continuum of care into the front of the office. For many revenue cycles, battles are won and lost at the front line (i.e., Pre Access Staff.) They can also ensure their patient accounts representatives have the communication skills needed to work with peoples two biggest triggers: their health and their money. Many times, simple tools like roleplaying, sample scripting options, and incentivized collection contests empower employees to ask for that co- pay, co-insurance (coin) and deductibles. Patient Portals are good for more than taking payments and scheduling appointments; they can also effectively and efficiently educate patients about their condition or disease, define commonly misunderstood health and financial literacy terms and generally engage consumers
31. 31. Case Studies
32. 32. COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. Improving Accounts Receivable Strategies Through an External Partnership During the last several years, the number of mergers and acquisitions deals has increased within the health- care industry, rising to 328 in Q3 2015 according to Modern Healthcare. These expansions can help organi- zations achieve economies of scale, cost reductions, or increased market share and patient volumes; however, they may also prompt organizations to re-evaluate or revise current rev- enue cycle processes to enhance financial performance. HealthPartners, the largest con- sumer-governed non-profit health- care organization in the nation, has experienced a similar situa- tion in light of its continued growth through acquisitions and combina- tions of healthcare systems within its family of care organizations. These changes not only expanded the number of physicians and specialties, but also increased outstanding accounts receivable (A/R). HealthPartners Medical Group (HPMG) is part of HealthPartners, an integrated health care organization with 22,500 colleagues serving more than 1 million patients and 1.4 million health plan members annually. The aforementioned A/R trend prompted HPMG to revise its A/R model, reorganize its internal billing team, and more effectively leverage its collabora- tive 10-year partnership with ProSource Billing, resulting in a reduction in aged receivables. Challenges As HPMG expanded its services and volume base, revenue cycle leaders observed A/R over 90 days increase to 18%, in comparison to its 1012% best practice benchmark. This raised concerns surrounding claim timeli- ness and revenue capture for growing or high-dollar producing areas, par- ticularly specialty business lines such as chiropractic and neurosurgery. In addition, HPMG recognized an opportunity to improve its A/R model. Previously, HPMG and ProSource, which operate an internal and exter- nal billing team, respectively, used traditional methods to divide claims Rise in % A/R > 90 at HPMG Amidst System Growth As the number of physicians and specialties grew, so did A/Rprompting HPMG to re-evalu- ate its approach. 1012% 18% Historic Benchmark A/R > 90 During Expansion Highlights Profile HealthPartners Bloomington, Minnesota Employees: 22,500+ Affiliated Physicians: 1,700+ NPR: $679 million Challenge With HealthPartners continued growth, leadership observed an increase in A/R over 90 days Increasing A/R raised concerns about the timeliness of working receivables postclaim submission HPMGs internal billing team and ProSources external team were split by payer type, preventing staff from working accounts across payer lines or based on denial trends Solution HPMG implemented a new A/R model that assigned claims by specialty busi- ness lines and adjusted workflows to improve efficiency Dashboards were created within the practice management system so lead- ership at HPMG and ProSource could monitor performance and identify trends Training helped familiarize select staff with their assigned service line as well as its applicable codes and trends Results Multiple specialty areas reported improvement such as lower A/R days and % of A/R days over 90 The dashboard provides leaders at HPMG and ProSource added trans- parency and insights regarding finan- cial performance The universal biller model increased staff knowledge and added greater fluidity to the billing process Adjusting Biller Specialization Working with ProSource to enhance the model for billing teams helped HPMG improve its A/R management. A payer-line split made it difficult for billers to work across denial trends leading HPMG to move to assigning billers claims by clinical specialty
33. 33. Improving Accounts Receivable Strategies Through an External Partnership COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. between the two teams including financial class, special billing programs, andultimatelya payer line split. Leadership recog- nized that under this current model, billers were unable to work outstanding receivables across payer lines or based on identified denial trends, which may span across multiple payers. To more strategically optimize A/R and its partnership with ProSource, HPMG began investigating other A/R models that would allow greater fluidity of work between billers and focus on service lines that generate the most revenue. Solution HPMG selected a solution that invests in and capitalizes on its most valuable resource: people. To maximize in-house staff per- formance and leverage the external billers knowledge of all payer lines, HPMG decided to assign claims according to specialties, creating a universal biller model built upon many staff members pre-existing skill sets. HealthPartners historically worked in silos by working accounts on a payer split whereas ProSource was well-versed in all payer lines, says Jerry Hammock, Operations Manager of Patient Accounting at HealthPartners. We wanted to leverage that knowl- edge on the team to more effectively cycle through existing A/R as well as new A/R from recent growth. HPMG used a multifaceted strategy to determine which specialty service lines would be worked under the new model. Several spe- cialties were chosen based on level of aging receivables, high- dollar nature, or pre-existing challenges. Other specialties, like cardiology and behavioral health, were selected since their charge capture is managed at the hospital level rather than at the cen- tral revenue cycle. The model aimed to provide leaders in these areas a cleaner snapshot of their financial performance. This new strategy also built upon the strong, 10-year partnership shared by HPMG and ProSource. HPMGs close relationship with ProSource helped smooth the transition to this new model since both billing teams worked directly in HPMGs practice management system. Therefore, lead- ership restructured and reassigned certain billers to unique, spe- cialty-focused work queues within the system, and billers worked accounts consistently by following the same workflows, policies, and scripting. The process was relatively quick and seamless because the foundation was already there and the teams had good synergy, states Hammock. With the in-house and external billers both working in the same practice management system, we updated the rules and logic to shift how the accounts were divided between the billers and adjusted the filters to create the most efficient workflow. To gauge the effectiveness of this new strategy, HPMG ini- tially implemented the A/R model in a pilot form for specialties accounting for approximately 14% of their total A/R. Leadership was transparent about the logic behind the pilot program and engaged billers who were willing to learn new rules and payer lines. Training was provided to familiarize billers with their assigned specialty, its corresponding codes, and past trends. In addition, leadership captured baseline metrics and created sepa- rate dashboards within the system to subsequently monitor the performance of each specialty segment in terms of denials, edits, and age of receivables. This process, despite initial productivity losses due to training, helped validate the effectiveness of the strategy and obtain leadership buy-in following preliminary results that showed a prominent reduction in the age of receivables. Since the initial pilot project, the number of specialties included in this A/R strategy has expanded to 26% of total A/R with contin- ued positive results. Results More than a year after the new model began, HPMG and ProSource have used the systems dashboard to record improve- ment within a variety of the specialties, including decreased A/R days and percentage of A/R over 90 days, among other metrics. In particular, neurosurgery reported a 34-day reduction in A/R days and a 16 percentage point decrease in A/R over 90 days, while chiropractic services recorded a 19-day improvement in A/R days and a 13 percentage point decrease in A/R over 90 days. Overall, we have a very collaborative working relationship with ProSource and truly consider them to be an extension of our in-house team. We have strong communication and weekly interaction with their leadership to perform vendor manage- ment and oversight functions. Deanne Loehr Senior Director Revenue Cycle HealthPartners HPMGs A/R Metrics Pre- and Post-Solution February 2014 April 2015 A/R Days A/R > 90 Days Burn Chiro Neuro 129 100 54 35 68 34 Burn Chiro Neuro 40% 26% 18% 5% 36% 20%
34. 34. Improving Accounts Receivable Strategies Through an External Partnership COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. These types of metric snapshots have proved beneficial due to their added level of transparency and insights surrounding HPMGs financial performance, especially for growing service lines. The success of this initiative was driven in part by the fact that HPMG and ProSource directly worked accounts in the same system. Working in the same system and viewing the same internal dash- boards not only helps quickly identify and resolve negative trends, but it also allows us to leverage a partner that can provide valuable advice and recommendations, says Tammy Hughes, Operations Manager at ProSource. Through checks and balances during daily communication, we can pinpoint easier processes, learn why one team experienced greater success, or identify educa- tional gaps. It is a beneficial partnership. With the dynamic nature of the healthcare industry, HPMG and ProSource have also found the universal biller model beneficial since it challenges staff professionally, making them more well- rounded and knowledgeable. This has added greater fluidity to the billing process since staff are more comfortable working across payer types and shifting their work based upon changes within the industry or organization. The billers are also encouraged to use their experience and deductive reasoning to prompt further improvements in the A/R model. Throughout this entire process, we have realized areas of improvement within the revenue cycle and developed specific strategies to attain new goals, says Kelly Heyn, Senior Manager of Revenue Cycle at HealthPartners. Despite challenges that have arisen, we have stayed on course and consistently tried to work smarter, be proactive, enhance the patient experience, and lever- age our system capabilities so staff can develop professionally and work effectively. About ProSource Billing ProSource offers a full range of revenue cycle management ser- vices that are designed to seamlessly support and enhance the operations of any size organization. Our programs offer solutions for your outsourcing needs in the areas of billing, claims, payment receipt, and more. We are an extension of your organization, representing your mission and values, and treating your customers in a manner that aligns closely with your mission. All programs are tailored to your specifications. For more information, please visit: arraysg.com/prosource With specialty service lines accounting for 14% of HPMGs total A/R, improvements in these areas were particularly impactful. Specialty Business Lines (e.g., Chiropractic Care and Neurosurgery) as % of HPMGs A/R 14%
35. 35. COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. Leveraging Presumptive Charity Care to Improve Collection Efforts and Increase Revenue With patients accepting more responsibility for their healthcare costs, hospitals and health systems must find a way to collect as many self-pay dollars as possible. HBI research shows that healthcare organizations continue to write off more than 14% of net patient revenue to uncompensated care, which includes charity care and bad debt. Determining which accounts to write off, when to do so, and how to classify write-offsas bad debt or charity carecan affect different aspects of business. Not only do write-offs impact an organizations A/R, but they also impact collection efforts, vendor relations, and staffing. HBI research also shows that organizations have increased charity care levels, which cor- responds with a revision in charity care policies. To improve the allocation of charity care, some organizations are planning to implement a number of strategies including using vendors, technology, or internal criteria to classify accounts as charity care if patients are unable or unwilling to complete charity care applications. This process is called pre- sumptive charity care and has been implemented by a growing number of healthcare organizations. Rolene Lampi, Director of Business Services at St. Lukes Health Care System, shared her organizations experience with implementing a presumptive charity care process. The Challenge St. Lukes Health System is comprised of two hospitals, two pharmacies, 14 pri- mary care clinics, and 24 specialty care clinics located in Duluth, Minnesota. Leaders decided to reorganize the way they handled charity care due to the Minnesota Attorney General Hospital Agreement, which is a list of provisions that outline approved methods hospitals can use to collect a patients financial responsibility. St. Lukes must continue to follow those regulations to maintain its non-profit status and continue to reap the benefits. Furthermore, St. Lukes was driven to appropri- ately identify charity care after receiving only a 50% response rate on charity care applica- tions. In 2009, St. Lukes began researching options to help patients with the applications. The Solution Lampi researched presumptive charity care and decided this was an effective process since it could potentially improve collection efforts. St. Lukes partnered with a first-party self-pay vendor in 2009, and since then it has been using the vendors technology to segment accounts that are eligible for presumptive charity care. The vendor uses both proprietary and publicly available patient population data and then applies St. Lukes pre- sumptive charity care rules. Next, the vendor sends a file recommending accounts that should be sent to bad debt and accounts that should receive the charity care discount. St. Lukes uses the vendors findings to appropriately classify the percentage or amount of charity care to allocate on each account. Its very important to us that we dont apply two types of charity care to one account, says Lampi. If a patient received another type of discount during the revenue cycle, Highlights Profile St. Lukes Health Care System Duluth, Minnesota Beds: 292 NPR: $844 million Challenges St. Lukes has to work within the Minnesota Attorney General Hospital Agreement, which regulates the meth- ods state hospitals use to collect from patients The health system was only receiv- ing a 50% response rate from char- ity care applications, which increased bad debt The business office needed to research for additional ways to get patients to respond to charity care offerings Solution St. Lukes implemented a presumptive charity process with a first-party ven- dor, which allowed the health system to further segment its A/R Each account was allocated the appropriate percentage or amount of charity care, based on the vendors findings The health system also centralized collection efforts by signing an exclu- sive agreement with JCC Results In 2009, JCC was receiving $9.8 mil- lion in placements and the aver- age amount collected monthly was $86,350; by 2014, this increased to $6.8 million in placements and $149,000 in average amount col- lected monthly JCCs performance increased yearly, from collecting $1 million in 2009 to $1.78 million in 2014 St. Lukes staff has developed an excellent working relationship with JCC J.C. Christensen is a leader in collection services, and they also work with the Min- nesota Attorney General to ensure that their collection practices are compliant. Based on those factors and the excellent service they have provided us, we decided to enter into an exclusive relationship with JCC. Rolene Lampi Director of Business Services St. Lukes Health Care System
36. 36. Leveraging Presumptive Charity Care to Improve Collection Efforts and Increase Revenue COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. before we send the account to bad debt, we make sure that the appropriate adjustment is on that accountwhichever dis- count is more generous. Although St. Lukes does not notify patients when presumptive charity care is applied to their accounts, they have not received any complaints for administer- ing the discount. In fact, the community and patient population has become familiar with the process. Initially, St. Lukes worked with two bad debt agencies, but their 25-year, longstanding relationship with J.C. Christensen & Associates, Inc. (JCC) presented the opportunity to centralize col- lection efforts. J.C. Christensen is a leader in collection services, and they also work with the Minnesota Attorney General to ensure that their col- lection practices are compliant, says Lampi. Based on those fac- tors and the excellent service they have provided us, we decided to enter into an exclusive relationship with JCC. When JCC receives an account, they go through an extensive questionnaire to ensure they understand the patients financial position. This process verifies the patients insurance status and checks if any type of financial assistance has already been applied. If JCC is not successful in collecting from the patient usually around six months from placementbehavior and rank scores are utilized to determine which accounts should be referred to a law firm of St. Lukes choosing. The Results After implementing presumptive charity care, St. Lukes recorded an increase in the amount of collectible dollars from accounts being sent to JCC. In 2009, JCC received $9.8 million in placements and the average amount collected monthly was $86,350. This improved dramatically by 2014, when JCC received $6.9 million total place- ments and the average amount collected monthly increased to $149,000. In comparing 2009 (pre-presumptive charity care) to 2014 (post-presumptive charity care), the number of dollars col- lected increased by $750,000 annually. In addition to increased collectible dollars, St. Lukes staff has developed strong communication with JCC. Our staff has an excellent working relationship with JCC, says Lampi. They feel comfortable calling JCC with any questions, and frequently com- municate with them on a daily or weekly basis. To improve or implement presumptive charity care, it was impor- tant for St. Lukesand any healthcare organizationto under- stand their scope of work. Then they can enter into a beneficial business partnership with confidence. Any healthcare business office leader who is looking to improve their processes must define their goals and understand how that relates to their vendors capabilities, explains Lampi. St. Lukes was an early adopter of presumptive charity care, and through our partnership with JCC, we firmly believe our process has become the gold standard. About JCC JCC has helped hundreds of healthcare clients improve debt recovery rates and optimize cash flow while reducing costs with its successful accounts receivable management programs. JCCs programs are designed to give clients a voice in account management, full access to account reviews at any time, and ample opportunities to ask questions and make suggestions to improve performance. JCC is a privately owned subsidiary of Array Services Group, Inc. For more information, please visit: arraysg.com While placements have decreased from 2009 to 2014, the aver- age amount collected monthly increased from $86,350 in 2009 to $149,000 in 2014. St. Lukes Total Placements by Year J.C. Christensen & Associates $9.8M 2009 2010 2011 2012 2013 2014 $6.7M $6.3M $6.3M $7.1M $6.9M In comparing 2009 (pre-presumptive charity care) to 2014 (post- presumptive charity care), the number of dollars collected increased by $750,000 annually. St. Lukes Total Collections by Year J.C. Christensen & Associates $1M 2009 2010 2011 2012 2013 2014 $1.2M $1.2M $1.5M $1.6M $1.8M
37. 37. COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. Effectively Analyzing Self-Pay Accounts to Improve Revenue Cycle Performance Due to higher out-of-pocket costsco-insurance, co-pays, deductibles, more non-cov- ered servicesand a lack of insurance, patients have higher liabilities when paying for their healthcare services. Given that circumstance, the financial well-being of hospitals and health systems can be strongly tied to the collections of self-pay receivables. The self- pay class is generally the most difficult to collect from, and a lack of systematic collection processes often leads to bad debt write-offs and increased A/R days. Academy research shows that 21% of all self-pay collections (including residuals) are made at point-of-service (POS) for Emergency Department (ED) and outpatient accounts. The longer a patient balance remains unresolved, the less likely it is that a hospital or health system will be able to collect itso effective follow-up strategies are critical. In order to abide by Affordable Care Act requirements and increase collection rates, better-perform- ing organizations use the 120-day mark to pursue residual balances. To learn about one organizations experience with improving revenue cycle functions through the analysis of self-pay accounts, The Academy spoke with Jackie Hinderks, Director of Revenue Cycle at Rice Memorial Hospital. The Challenge Leaders in Rices revenue cycle department had a growing concern about residual balances and decided it would be best to focus on strategies to improve collection rates. The orga- nization struggled with pinpointing the root causes of their collection issues, and at the same time staff were adjusting to a recent conversion from the legacy system, which changed the 18-month write-off. From a front-end perspective, Rice had to examine how its customer ser- vice staff worked with patients to com- municate balances and how to obtain correct contact information to be able to reach patients more frequently. Not only did the staff need more educa- tion about how bad debt affects back- end revenue cycle functions, but the organization also needed to maintain a high level of customer satisfaction. Rice therefore sought a solution that would assist in improving col- lection rates, decreasing bad debt write-offs, and enhancing customer service. The Solution To better manage residual self-pay collection, Rice employed J.C. Christensen & Associates, Inc. (JCC) for accounts receivable management and debt recovery services. Weve been working with JCC for over six years, and trust that their services are going to be data-driven and pertinent in making improvements to revenue cycle functions, Hinderks says. Highlights Profile Rice Memorial Hospital Willmar, Minnesota 100 beds NPR: $106 million Challenges Rice Memorial Hospital had struggled historically to pinpoint the root causes of its collection issues Rice customer service staff needed to better communicate balances to patients, and obtain correct con- tact information to be able to reach patients more frequently The organization sought a solution that would assist in improving its col- lection rates and decrease its bad debt write-offs Solution To better manage residual self-pay collection, Rice Memorial Hospital employed J.C. Christensen & Associates, Inc.s (JCC) accounts receivable management and debt recovery services During quarterly meetings, JCC pro- vides Rice with quality on data to improve front-end revenue cycle function JCCs revenue cycle consultant con- ducted customer service training seminars Results In 2014 alone, collections have increased by $10,000 per month Liquidation rate has increased from 21% in 2013 to 23% in 2014 Estimated total dollars collected in 2014 is $362.4K, compared to $250.8K total collected in 2013 Dynamic Scoring Inventory is scored using internal and exter- nal information The individual score is updated each day based on a variety of factors, which JCC refers to as dynamic scoring Dynamic scoring provides superior segmen- tation for work strategy optimization much more than the age and balance of account Historical performance data is leveraged, patient behavioral patterns are taken into account, including: -- If the patient has resolved previous obligations -- If the patient has been referred to legal in the past -- If the patient has qualified for financial assistance in the past
38. 38. Effectively Analyzing Self-Pay Accounts to Improve Revenue Cycle Performance COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. Rice uses JCCs solution following its internal 120-day collection phase, during which a patient receives several statements and phone calls. When an account is flagged in the system, it goes into collections and the next day that account is sent to JCC. Rice is given a seven-day grace period to account for a patients late pay- ment. Also, if Rice makes a mistake by flagging an account, JCC sends the account back. JCC then works on accounts as far as they can take them. If collection effortsincluding legal actionare not successful after 18 months, the debt is ultimately written off. The established relationship between JCC and Rice has created an environment in which in-depth analytics are used to work the organizations self-pay accounts effectively. Using Rice patients historical payment data, JCC creates an automated dynamic scoring system that updates as new information is obtained. Dynamic scoring provides superior segmentation for work strat- egy optimization. JCC shares an alpha-split caseload with another vendor, and also works on Rices durable medical equipment accounts. Rice ensures that both agencies remain on track with the organizations very high performance standards utilizing comparison reports. We dont actively disclose the comparison reports, but I person- ally make sure that both agencies stay within the same range and let them know if there is an issue, Hinderks explains. Rice is also able to monitor performance by tracking if JCC does presumptive eligibility or charity scans before they start working accounts which might result in