isolutions iq innovation

UCB and Self Pay CompanyPartnering to Improve Self Pay CollectionsFebruary 2009Proprietary and ConfidentialThis information is not to be copied or otherwise utilized without the written consent of UCB, Inc.

Above and Beyond the Call

Question?

Do you have an automated charity care qualification process in place?

Is your charity care policy administered consistently or subjectively by your staff?

Do you validate every charity case with

Are you attempting to collect form patients who could qualify for your charity policy?


Are you maximizing your charity care and collecting what you should from your self pay patient population?

Introduction iSolutions

Provides financial assessment and account decisioning platform

Streamlines and automates charity care identification and processing

Accurately predicts patient maximum payment threshold

Benchmarks third party collection vendor performance

Validates registration demographics

Improves ROI on internal collection activity by focusing financial and human capital on accounts which have the greatest return

Automates current manual processes allowing workforce to “do more with less”


Hosted by Self Pay Company in partnership with UCB

Breakthrough technology reinvents Charity Care and Self Pay account processes

Market Drivers – Self PayAbove and Beyond the Call

National unemployment: September 2008 6.2% - January 2009 7.6% Highest in a decade (Source: Department of Labor)

State of Indiana: December 2007 4.5% - December 2008 7.8 (Source Bureau of Labor Statistics)

Increasing uninsured & underinsured population

Fewer employer-paid insurance plans

Higher deductibles and co-pays

Consumer directed healthcare plans increasing

Continued regulatory mandates and increased scrutiny

Market TrendsBreakthrough Strategies

Source: Department of Labor

Market Trends

154,616 Million in Civilian Labor Force

10,331 Million Unemployed

If Unemployment Increases to 10.6%

Source: Department of Labor


Increase of 7.5 Million New Self Pay Patients

Market TrendsAbove and Beyond the Call

iSolutions PlatformAbove and Beyond the Call

Address Validation

iSolutions Module

Validates correct address

against most current data available

Description of Module

Automate Charity

Propensity of Payment

Maximum Payment

Fraud Alert Detection

Charity identification - income and number ofdependents/validates against financial profile

Segments accounts into high, medium, low and bad debt payment probability groups

Identifies maximum amount a patient

can pay without hardship and financial duress

Provides systematic process

for protecting data – supports Red Flag Rule

QA – Missing DataIdentifies and validates all

missing data associated with patient account

Address validation Provides most current address, phone number, employer Updated data returned to hospital eliminating repetitive mail

returns Experian database updated in real time 24/7/365

Presumptive charity care Consistent system takes the subjectivity out of the process Ensures charity care is provided to worthy patients Customized to meet hospital’s charity guidelines Reduces FTE administrative costs by over 50%

Propensity of payment Segmentation of accounts by predictability of payment Payment predictor based on patient’s financial profile Empirical collectability benchmarks for each segment based on

workflow modifications

iSolutions PlatformAbove and Beyond the Call

Maximum payment recommendation Analyzes patient’s financial profile providing recommended

threshold for payment Accurate estimate of what the patient “really” can afford Eliminates guesswork of high/low balance collection strategy

Fraud alert protection Immediately identifies fraudulent use of PHI Provides systematic process supporting compliance of “Red

Flag Rule”

QA – Missing data Identifies accounts with missing critical demographic data Provides trending data for registration processes Highlights accounts which need additional demographic detail


iSolutions Platform

IRS may issue updated Form 990 to address a lack of standards in current policy

The IRS concerned over "lack of consistency or uniformity in classifying and reporting uncompensated care."

Senators Grassley, Bingaman push for new charity-care standards (proposed amendment to Economic Stimulus Bill - February 2009)

A second amendment would force the IRS to scrutinize “for profit” hospitals

Charity Legislation UpdateAbove and Beyond the Call

Charity Care PredictionAbove and Beyond the Call

iSolutions Platform utilizes the number of dependents and annual income to determine Charity Validation per the FPG

Income verification factors include:

monthly obligations, mortgage amount, average rent, available credit, credit card balances, auto loans, revolving credit

Stated patient Income is validated to ensure accuracy

Proprietary income estimator validates census & credit data

1

2

3

4

Tested algorithm ensures accurate charity prediction

All income estimations verified through Experian credit

iSolutions Database

Mortgage

Credit Cards

Auto Loans

Revolving Credit

Def

init i

on

Monthly Obligation

Number of Dependents

Greater than $1,361

1

Greater than $1,825

2

Charity Validation

Additional Attributes

Home Equity Value great than $5,000

Credit Available greater than

$2,500

Charity Care Qualification Methodology

The iSolutions Calculation engine uses the number of dependents and annual income to determine Charity Validation

*follows strict federal poverty guidelines for qualifications

Proprietary and ConfidentialThis information is not to be copied or otherwise utilized without the written consent of UCB, Inc.

**Example based on the federal poverty guidelines

Data gathered from Experian

(credit)

=

Estimated Household Income

Less than $20,420

Less than $27,380

Charity DeterminationAbove and Beyond the Call

Consistent Charity Qualification

Ensure Accurate Financial Analysis

Reduce Charity Fraud

Charity Care ValidationAbove and Beyond the Call

Consistent & Accurate Validation

Provides a single data sheet which validates charity per your hospital’s guideline

Utilizes stated or estimated income based on demographics

Estimated income is based on Block Census data plus validation factoring against the patients credit file

*Reduce the risk of collecting from qualified indigent patients

Charity Care Risk MitigationAbove and Beyond the Call

Presumptive Charity Policy

Mitigates risk from administering inconsistent charity policy

Reduces risk of inconsistent and subjective collection practices

Address potential legal issues

Class action lawsuit filed in December 2008 (Andresillo vs. Audit & Adjustment Company). Litigation initiated because charity qualified patients were pursued for collections

Charity Care Risk MitigationAbove and Beyond the Call

Law Firm Sues Collection Agency for Allegedly Violating Charity Care Law

January 2, 2009 Inside ARM

A medical collection agency in Washington is being sued by a local law firm over practices that the suit say run afoul of the state's charity care provisions. by Cynthia Wilson A Washington healthcare collection agency is being sued by a law firm seeking class action status for allegedly violating the state’s charity care law.

In a lawsuit filed on December 8, Seattle-based Phillips Law Group claims that Audit & Adjustment Company, Inc., based in the Seattle suburb of Lynnwood, has systematically engaged in “the unfair, deceptive and misleading practice of telling patients that they owe the full charges shown on hospital billing statements, without informing them that they may be entitled to charity care that reduces the hospital debt or eliminates it entirely depending on a patient’s income level.”

Lead attorneys John Phillips and Matthew Geyman are seeking class action status for the lawsuit filed in King County Superior Court. In addition to statutory damages on behalf of the plaintiffs for allegedly violating the state’s charity care law, Consumer Protection Act and Fair Debt Collection Practices Act (FDCPA), Phillips and Geyman want the agency to stop pursuing collections from charity care- eligible patients.

They are also asking the court to make the agency establish procedures to allow patients to qualify for charity care that it collects on behalf of Washington hospitals, and notify current and former patients the agency has collected from in past four years that they may be eligible for charity care that may reduce their obligation. Under Washington statute RCW 70.170.060, individuals and families with annual incomes below 100 percent of the federal poverty level -- $10,400 for a single person and $42,400 for a family of four living in Washington -- are deemed charity care patients for the full amount of hospital charges, provided that they are not eligible for other public or private health coverage sponsorship. The law also requires various levels of discounts for patients’ whose annual incomes range from 100 percent and 300 percent of the federal poverty level. The law entitles charity care-eligible patients to who have paid all or portions of their hospital bills to a refund, according to the lawsuit.

Self Pay StratificationAbove and Beyond the Call

Breakdown for XXX Healthcare Revenue by Percentage

High, 14%

Medium, 9%

Low, 4%

Charity, 2%Bad Debt, 55%

Needs More Data, 1%

No Data, 15% High

Medium

Low

Charity

Bad Debt

Needs More Data

No Data

Breakdown by RevenuePPI Amount

High $83,545.89Medium $55,296.18Low $22,687.62Charity $11,458.25Bad Debt $342,128.17Needs More Data $8,503.46No Data $92,213.56

Total: $615,833.13

Understand which accounts have the highest propensity for collection

Allocate resources on the accounts which offer the greatest ROI

Work Flow OptimizationAbove and Beyond the Call

91

86

81

73

65

43

High

Medium

Low

Bad Debt

Need Data

No Data 1% to 3%

3% to 10%

.5% to 1%

10% to 15%

25% to 35%

50% to 65%

Projected Liquidation by Segment

Work Flow OptimizationAbove and Beyond the Call

2006 2002

Total Charges Payments Percentage Total Charges Payments Percentage

High $217,017.82 $86,042.03 39.65% $235,506.34 $10,684.67 4.54%

Medium $153,286.05 $18,762.35 12.24% $117,089.43 $5,617.85 4.80%

Low $55,151.53 $2,493.36 4.52% $45,515.50 $1,130.32 2.48%

Charity $260,521.06 $6,498.28 2.49% $174,841.31 $1,617.43 0.93%

Bad Debt $1,183,922.13 $13,881.67 1.17% $520,329.68 $4,869.36 0.94%Needs More Data $85,433.16 $2,263.35 2.65% $53,804.80 $1,134.66 2.11%

No Data $103,264.75 $965.36 0.93% $60,236.93 $736.00 1.22%

Total: $2,058,596.50 $130,906.40 6.36% $1,207,323.99 $25,790.29 2.14%

2006 2002

Total Charges Payments Percentage Total Charges Payments Percentage

High $217,017.82 $86,042.03 39.65% $235,506.34 $10,684.67 4.54%

Medium $153,286.05 $18,762.35 12.24% $117,089.43 $5,617.85 4.80%

Low $55,151.53 $2,493.36 4.52% $45,515.50 $1,130.32 2.48%

Charity $260,521.06 $6,498.28 2.49% $174,841.31 $1,617.43 0.93%

Bad Debt $1,183,922.13 $13,881.67 1.17% $520,329.68 $4,869.36 0.94%Needs More Data $85,433.16 $2,263.35 2.65% $53,804.80 $1,134.66 2.11%

No Data $103,264.75 $965.36 0.93% $60,236.93 $736.00 1.22%

Total: $2,058,596.50 $130,906.40 6.36% $1,207,323.99 $25,790.29 2.14%

Analysis with Benchmarks and Targets

Maximum Payment EstimatorAbove and Beyond the Call

Validate Stated Income via Credit Report

Estimated Income Baseline from Block Census Bureau Report and Validated via Credit Report

Income Estimation

Estimation of Assets via Credit History

Open Lines of Credit Available

Estimated Cost of Living in Geo-Demographic Area

Financial Profile

Amount the Patient Can Pay Without Dire Financial Duress

Maximum Payment

Data ValidationAbove and Beyond the Call

Validation of Accounts

Sample of Patient Data

Platform AlgorithmAbove and Beyond the Call

Patient Demographic

DataCredit Report

Financial Assessment

Algorithm

Estimated Income

Charity Recommendation

History from 15 million accounts

Client specific payment history

Maximum Payment Recommendation

Payment Propensity

Work-Flow Management

Key Attribute

Platform Deliverables


Measurable Results from Presumptive Charity Policy and Self

Pay Stratification

Reduced placements of self pay accounts to collection agencies by nearly 50% within first six months

Reduced FTE allocation for follow up on self pay accounts by 25%

1

2

3

Increased cash receipts on self pay accounts by over 22% during first 90 days

Case Study

Reallocated 60% of FTE staff previously assigned to charity care application processing4

Return On InvestmentAbove and Beyond the Call

Reduce internal cost by eliminating a minimum of 2 statements on bad debt segmented accounts thereby improving agency performance on least collectable accounts

Reduce charity administration costs by over 80%. (Industry trends indicate the average cost to compile a charity application is approximately $40)

Improve internal/external liquidation of self pay accounts by 25% to 40%

Capture uncollectible dollars sooner by accelerating Medicaid cost reporting on bad debt segmented accounts while allowing higher collectable accounts to remain at collection agency longer

Secure Accurate Platform

Annual recalibration of cost of living index

Research any anomalies and validate

Quality control by dedicated IS staff

Secure server with redundant backups – 100% HIPAA compliant

Detailed reporting of non-matching data

Detailed reporting of missing data elements

Trends of registration performance are captured


Platform Delivery

Platform may be applied in real time at registration or in batch mode at any point in the revenue cycle

Integrated mode – assessment delivered through Nebo/Passport’s AMP real time platform (HL7 connection)

Batch mode data transferred via a secure FTP site (48 to 72 hours turnaround)

Batch data can be downloaded into internal patient account system


Notable FeaturesAbove and Beyond the Call

Charity methodology has been reviewed by states and passed general audit testing

Address verification can be bundled with charity model or applied as a stand alone

Competitive pricing

Low implementation costs

Rapid deployment of solution

Thank YouAbove and Beyond the Call

Phil C. SolomonChief Client Officer UCB, [email protected]

Do You Have Any Questions?

isolutions iq innovation

Documents