New tool may mean 25% more collected

Accuracy will be much greater

Registrars at Sarasota (FL) Memorial Health Care System have gotten very good at calculating estimates manually, but the department is implementing a price estimation tool to make the job much easier, says Diane C. Settle, CPA, CHFP, executive director of revenue cycle.

"I expect this will really make our numbers go up. I'm really hoping our next fiscal year is going to be awesome," she says. "We will be able to show the deductible and the coinsurance in a written letter. It's going to be much more formal."

Performance bonuses for registrars will be based on a 15% increase in collections, the same as for the previous five years, but Settle is hopeful that the tool might increase collections by up to 25%.

Staff members now have frequent conversations with the physician's office staff about the actual procedures being done, and they consult with coders to be sure that the right code is used. "Some staff think we've gotten so good with manual processes that there isn't much more opportunity out there, but I'm optimistic," Settle says. "We're currently collecting close to 2% of net revenue on an annualized basis."

More accuracy

With the new tool, registrars will be able to explain to patients exactly how an estimate was calculated.

"Right now, we can see the deductible through our eligibility system, but staff don't necessarily know what the contracted rate is," says Settle. If a patient with a $5,000 deductible is having major surgery, the entire deductible will be collected, but if it's a minor surgery, staff will estimate a lower amount to be sure they're not overcharging the patient.

"We are estimating on the low side," Settle says. "But if we ask for $1,500 and the patient ends up owing $2,200, we sometimes never get paid the remainder." Estimates now will be closer to what the patient actually will owe, she says.

"Staff right now go to multiple payer websites and, even then, sometimes can't find the answers they need," she says. "We have a lot of patients who travel here from all over the country. If they have a smaller insurance plan, it's a real challenge to determine what's going to be owed."