Access departments lack collection tools
Up to 5% of net patient revenue is at stake
After implementing a price estimation tool, patient access leaders at Ochsner Medical Center — North Shore, Slidell, LA, were able to increase monthly point-of-service collections by $22,000.
"It could have even been a greater growth, but we were in end-of-year status where deductibles and coinsurances have been met," says Tammy Flair, patient access manager. "We plan to see more opportunity with the new year."
The patient payment estimator tool (ClearQuote, manufactured by Chicago-based TransUnion Healthcare) gives registrars with an accurate estimate based off of the CPT code and level of care for emergency department patients. "We can include diagnosis codes, CPT or descriptions, surgeries, anesthesia charges, and professional charges," says Flair. "This tool allows us to inform the patients days in advance so that they can prepare for this financial obligation."
The department has seen a decrease in inquiries about patient responsibility, fewer billing follow-up calls, and less bad debt. Patients seem to have more peace of mind after they're given an accurate and timely estimation of their responsibility, adds Flair.
"The financial requirements for healthcare are a large stressor for our patients," she says. "To be able to communicate this in advance, and offer front end financing arrangements, has been a large satisfier for our community."
If upfront collections aren't done effectively due to lack of the right technology, 2% to 5% of net patient revenue can be lost, says Paul Shorrosh, MSW, MBA, CHAM, founder & CEO of AccuReg Patient Access Solutions, a Mobile, AL-based provider of front-end revenue cycle technology. "The trick is to collect prior to service," he says. "A dollar collected before service is worth more than a dollar collected after service, because after service the cost to collect goes up and the likelihood of collecting goes down."
It is generally accepted that the likelihood of collecting prior to service is about 70%, compared to 30% after service. "This ratio improves or declines with technology that automatically calculates patient liabilities, alerts employees to the collection opportunity, and enforces collection of those liabilities through escalation to supervisors and individual performance visibility," says Shorrosh.
Estimation tool is vital
Because it is impossible for anyone to collect an unknown quantity, having a patient liability estimation technology is vital, says Shorrosh.
It is simply too complex and time-consuming to look up a procedure in a chargemaster, identify the allowable from the payer contract, and then pull the copay, remaining deductible, or co-insurance from patient benefit information. All of this information is found in disparate systems, files, contracts, payer sites, and/or spreadsheets.
Additional vital technologies to improve collections are propensity to pay, payment processing, and financial screening tools, Shorrosh says. Many patient access departments don't have the capability of reporting what dollar amounts they have collected over a time period.
"Reporting is a must-have, to track performance," Shorrosh says. "In many facilities, front-end staff do not have goals, training, or scripting for effective collections." Shorrosh says patient access managers should do the following:
- Know what their baseline collections have been.
- Have minimum and "stretch" goals, with incentives in place for reaching them.
Run estimation tools automatically for every patient, regardless of payer status, during pre-registration and/or registration.
"If the employee has to initiate the estimate, they will miss many collection opportunities," he says.
- Alert employees about a collection opportunity with a message or alert in real-time.
- Report collection performance ratios by employee, department, facility, and/or region. "One important key performance indicator is the collection opportunity rate; dollars collected divided by dollars estimated," says Shorrosh.
- Escalate any failures to collect over a certain threshold amount to supervisors for last-chance intervention prior to service delivery.
Move the timing of collecting further upstream.
"Estimate and collect liabilities as early as possible, meaning prior to a patient's arrival," says Shorrosh. "Pre-registration is the best possible place to get this done, and you have more time to get it done." (See related story on how a department doubled its collection goal for 2014, below.)
- For more information about improving upfront collections, contact:
- Tammy Flair, Patient Access Manager, Ochsner Medical Center — North Shore, Slidell, LA. Email: email@example.com.
- Christopher Lah, Senior Director, Patient Access, Cincinnati (OH) Children's Hospital Medical Center. Phone: (513) 636-8904. Email: Chris.Lah@cchmc.org.