GeBBS Healthcare RCM Blog

Best Practices for Identifying Patients Who Have the Propensity to Pay Before and During POS

Posted on Wed, Jul 13, 2016 @ 05:00 AM

With cash flows declining, margins shrinking, and bad debt on the rise, it's more important than ever for healthcare providers to maintain a steady stream of income. If your organization has not implemented an end-to-end, comprehensive best practices revenue cycle management (RCM) solution, it is time to do it! You don’t have to add staff; just call on an experienced outsourcing firm with 10+ years of RCM experience with expertise in multi-specialty collections and billing. They will be able to deliver an all-inclusive RCM solution that follows industry-standard key performance metrics to measure success and integrate best practices, so that you get the value of their proven experience and expertise.

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Hospital systems are beginning to screen patients in high-deductible plans for their propensity to pay, and many are developing systems to collect in advance of care. The reason is the rise in high-deductible health insurance policies that are challenging hospitals and physicians across the country to change the way they prepare for and collect payments from people who are getting hit with large out-of-pocket costs for care. Hundreds of patients, many of them newly insured, are causing some hospitals to “drown in debt” from these high deductibles not covered by their plans.

Here are just a few of the best practices an experienced outsourcing company will bring to your RCM and help you identify, at the POS, patients who have the propensity to pay for their services. Collections at the point-of-service are of ever-growing importance. Collecting payment at or before the POS reflects the industry's experience that as more time passes after care is delivered, a patient's propensity to pay decreases substantially. By requesting payment before services are rendered -- or by making agreed-to- payment arrangements have the potential to substantially reduce uncompensated care and the resultant bad debt.

The revenue cycle starts at registration, so capturing accurate patient information during registration is critical. Documenting accurate patient demographics at the first point of contact lays the groundwork for efficient, effective payment collections.

Conduct thorough eligibility checks. When you overlook potential care coverage during the pre-authorization process, you may be inadvertently leaving revenue on the table, while driving-up potential bad debt and charity care costs. A thorough eligibility and pre-authorization process ensures providers will receive the highest possible reimbursement from a patient's health plan while reducing a patient's financial burden.

Shift your focus from denial management to denial avoidance. A high clean claims rate not only keeps cash flowing, but also it can save thousands of dollars per year in paperwork costs and unnecessary time spent interacting with insurers and reworking claims. 

Keep a vigilant eye on your claims metrics. Providers who can spot inefficiencies in their claims processing will have critical insights into their revenue cycle health. They will be able to resolve problems quickly and efficiently by monitoring claims data and establishing benchmarks for claim rejections, denials and the days to final billing.

An experience end-to-end RCM outsourcing firm can offer these best practices and many more than are identified here to help your facility overcome the challenges of declining cash flows, shrinking margins and bad debt.

Tags: Accounts Receivable (A/R), Offshore Medical Billing, Self-Pay Collections, Medical Billing BPO

Sobering Statistics about Growing Patient Self-Pay Amounts

Posted on Mon, Dec 14, 2015 @ 10:00 AM

With the growing number of high deductible insurance plans and the Affordable Care Act (ACA), patients are now responsible for up to 35 percent of their healthcare delivery costs. Here are some staggering facts from MGMA and McKinsey & Company:

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 - Patient A/R growing to $660 billion in 2015
 - $65 billion in bad debt projected
 - Annual family deductibles average now up to $5,000
 - Some ACA plans can approach $12,000
 - 30% of patients walk out the door without paying anything
 - 3.3 billing statements will be sent before a patient’s balance is paid in full
 - Only $15.77 of every $100 owed is recovered once turned over to collections

With patient self-pay amounts growing, are you prepared to collect these large deductible amounts at the point of care?

This new A/R environment requires new procedures and new thinking to deal with this new world of large self-pay amounts. You must be prepared to implement new technologies, and an end-to-end, outsourced, comprehensive revenue cycle management solution that includes complete billing and collections services with call center follow-up support which includes compassionate collection methods used by highly trained professionals.

Make sure your outsourcing partner has expertise in multi-specialty collections and billing, and is well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. It is also important that your outsource partner has a staff that is highly trained in compassionate collection techniques that do not employ “strong arm” tactics which can upset your patients.

In the high deductible insurance world, insurance policy and eligibility amount verifications are absolutely critical. Identifying the patient’s responsibility upfront, prior to delivery of services, is critical in managing your receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, nonpayment and bad debt.

An outsourced, end-to-end, back office solution can provide the services you need to help you survive in this new world of high deductible insurance plans.

Tags: Business Process Outsourcing (BPO), Accounts Receivable (A/R), Knowledge Process Outsourcing (KPO), Best Practices, Offshore Medical Billing, Self-Pay Collections

The New World of High Insurance Deductibles Requires New Solutions

Posted on Mon, Dec 07, 2015 @ 11:00 AM

The amounts for insurance deductibles continue to grow each year and there is no end in sight to these increases. With more and more patients opting for high deductible, low premium commercial health insurance policies, and the growing usage from the Affordable Care Act (ACA), providers must seek ways to collect these large deductible amounts at the point of care, using an integrated approach that includes call centers and comprehensive end-to-end revenue cycle management, coupled with compassionate collection training.

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As patient financial obligation rise, so does bad debt.

The surge in these high-deductible health plans has also highlighted the fact that as financial obligations increase, the propensity for patients to pay any portion of that obligation decreases -- for all patients, at all income levels. One report from McKinsey states that 30 percent of patients walk out of treatment facilities without paying anything. How can you be prepared to deal with these high deductible patient insurance plans?

You and your team must adjust your procedures and your thinking to deal with this new world of large self-pay amounts. Even patients are uncertain about how much they owe for their care. By updating your point of care collections procedures and investing in technology that allows your staff to openly engage with patients about their financial obligation, you can be equipped to minimize your bad debt levels.

The next step is to implement an end-to-end, comprehensive revenue cycle management solution that includes complete billing and collections services with professional call center follow-up support. Make sure your outsourcing partner has expertise in multi-specialty collections and billing, and is well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. It is also important that your outsource partner has a staff that is trained in compassionate collection techniques that do not employ “strong arm” tactics which can upset your patients.

With high deductible commercial insurance claims and the ACA, insurance and eligibility verification are absolutely critical. Identifying the patient’s responsibility upfront, prior to the visit is critical in managing your receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, nonpayment and bad debt. An end-to-end, outsourced back office solution can provide the answers you need, and help you survive in this new world of high deductibles.

Tags: Business Process Outsourcing (BPO), Accounts Receivable (A/R), Knowledge Process Outsourcing (KPO), Best Practices, Offshore Medical Billing, Self-Pay Collections

With the Start of ICD-10, It's Now About Reducing the Denial Rate

Posted on Fri, Oct 23, 2015 @ 07:00 AM

gebbs denial managementThe world did not come to an end on October 1, 2015. With the start of ICD-10, healthcare professionals anticipated an overall reduction in productivity of their billing staff. In a pre-October 1 survey, 94% of respondents indicated that they expected increased denials, but only 30% had done any work toward solving the problem. 

If you are one of these, you are suggested to begin immediately to improve your denial management processes and your ICD-10 coding. Most providers, payers, and even CMS expect there will be a noticeable increase in the coding denial ratios, which currently range between 15-20%, and may actually double. Though, by design, ICD-10 is expected to reduce the denial rates; in the short term there is bound to be reduced collections, higher denial ratios, and lower productivity.

If you have been less than diligent in your preparations, two things can help you rescue your revenue cycle from disaster:

EXPERT ICD-10 CODING

Medical coding is the lifeblood of your revenue cycle. Accurate and efficient ICD-10 coding is crucial to meet your financial and compliance goals. You need reliable medical coders who are accurate, productive, and experts in all types of inpatient and outpatient ICD-10 coding. This kind of coding support is available immediately from an experienced outsourcing provider.

When you partner with an outsourcing company for coding services, you add immediate value to your coding and revenue cycle operations. You will have immediate access to highly-trained ICD-10 coders who will improve your coding accuracy and production and eliminate staffing shortages and backlogs, while reducing your overall costs for coding.

DENIAL MANAGEMENT

The second thing you need is denial management support. A revenue cycle outsourcing company can provide access to a large pool of qualified denial management resources that can work in any practice management system or hospital financial environment and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.  These analysts are adept at trending denials and looking for patterns of deficiency that will increase cash flow and reduce aging A/R.

Even prior to October, GeBBS has been dual and direct ICD-10 coding for several clients using iCode, a proprietary computer-assisted coding software. They have also helped clients with CDI projects to ensure charting and documentation will adequately support the greater specificity required for ICD-10 diagnoses.

If you feel the “hammer may still drop” on your revenue cycle, there is a solution: obtain outsourced coding assistance and denial management support. There is still time to rescue your revenue cycle.

Tags: ICD-10, Accounts Receivable (A/R), Best Practices, Insurance Billing Solutions

Compliance with Credit Balance Resolution Rules Does Not Have to Be Difficult

Posted on Wed, Jun 17, 2015 @ 05:00 AM

Credit balances are unavoidable and time-consuming. However, by law, they must be resolved. This activity does not have to be difficult even for already over-worked billing staffs. Professional outsourcing services are available to help with this growing challenge.

These services can be customized to fit into your specific workflow and increase your staff’s productivity, allowing you to increase the volume of accounts resolved on a daily basis, without hiring extra FTEs.

There are professional outsource companies that specialize in enhancing the financial performance of your revenue cycle management and related processes. They act as your partner to work within your legacy billing systems to research accounts in credit status, determine the root causes of the credit, and take appropriate corrective actions to resolve your credit balances. They leverage their healthcare expertise, technology, and qualified personnel resources. There is no capital outlay required.

Incorrect adjustments, erroneous credits, and misuse of debit codes make the credit balance task challenging without precision. 

In contrast, professional outsource analysts are diligent and well-trained to ensure outstanding credit balances are accurately resolved in an expeditious manner. Their services are highly client-centric. They understand a professional and cooperative environment is the key to resolving credit balances, many of which become account corrections, as opposed to actual refunds.

A professional credit balance outsource company will:credit_balance_img-resized-215

   ● Analyze accounts along with EOBs
   ● Work all assigned accounts - big and small-balances
   ● Resolve all accounts - inspect for patient liability or other adjustment issues
   ● Determine if double payments were made - if so, refund as required:
        -- By patient and insurance carrier
        -- By two insurance carriers (both acting as primary)
   ● Check for duplicate payments made for the same account
   ● Provide credit balance analysts who are certified Patient Account Technician (CPAT) from AAHAM
   ● Offer the highest levels of security, with a SAS 70 Type II internal-controls audit, and HIPAA compliance

By allowing a professional outsource company to take charge of your credit balances, you can expeditiously decipher, process and post refunds, and/or handle account corrections to consistently ensure the overall integrity of your revenue cycle.

Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Credit Balance Resolution

Six Benefits and Results of Having a Good Credit Balance Resolution Program

Posted on Wed, May 20, 2015 @ 09:00 AM

In today’s healthcare environment, credit balances are commonplace. The healthcare industry has a high incidence of credit balances due to multiple parties paying claims. The way that various information technology (IT) systems operate also creates credit balances.

Each provider must determine its credit balance strategy -- implement an internal program, which usually requires adding staff; outsourcing this work; or ignoring it. This last option is not optimal or realistic, given penalties for failure to comply with regulations on both the state and federal levels can be significant.

The common result is that healthcare providers do not want to add staff, if it can be avoided, and credit balance resolution provides a substantive distraction from the staff’s primary billing and collection focus. Among the reasons for this, is the provider belief that it’s painful to pay staff members to “give money away.” And, once behind in their credit balance resolution work, it is very difficult to catch up.

This leaves as the best alternative for handling credit balance resolutions – outsourcing! Following are the six top benefits and results for outsourcing your credit balance work:

Six Credit Balance Benefits:

1.   Significantly reduces staff time spent on credit balancescredit_balance_img-resized-215

2.   Allows staff to focus on billing and collection activities

3.   You can accurately quantify your cash exposure

4.   Reduces interest costs for patient refunds

5.   Provides regulatory and Sarbanes-Oxley compliance

6.   Cost-effective to implement and use

 

Six Credit Balance Solution Benefits:

1.   Significantly reduces overall credit balances

2.   Increases staff productivity

3.   Resolves more credit balances with same number of staff

4.   Fewer payer and patient inquiries

5.   Better compliance with payer contract terms

6.   Escheat (uncashed payment checks) compliance

 

 

Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Credit Balance Resolution

10 Best Practices for Credit Balance Resolution

Posted on Tue, Apr 28, 2015 @ 07:00 AM

Credit balances are simply a part of everyday life in the delivery of healthcare services. Unresolved credit balance accounts can distort the profitability of a healthcare facility and foster financial risks. Researching and correcting posting errors, duplicate payments, overpayments, and misapplied credits are not only time consuming, but also expensive. However, failure to address these credit balances in a timely manner may result in missed billing opportunities, and when associated with government payers, may also bring compliance risks and penalties. Following are 10 best practices to help you with your credit balance resolutions:

1.   Identify true overpaymentscredit_balance_img-resized-215

2.   Work balances oldest to newest

3.   Analyze credit balances using:

Patient admissions forms
 Payer remittance advices
 Patient accounts receivable details
 Other hospital records

4.   Identify whether the patient is an eligible Medicare beneficiary

5.   Adhere to applicable Medicare payment rules

 Medicare recommends identification of credit balances on a daily basis with immediate resolution

6.   Identify primary payer and other liable insurers

7.   Verify validity that all credit balances are due and refundable

8.   Monitor staff compliance with policies/procedures

9.   Identify preventable causes of credit balances

10. Seek professional outsourcing assistance if your staff cannot handle credit balance resolutions in a timely manner

Credit balance accounts are a natural part of today's complex reimbursement environment, and resolving these credits puts a burden on already limited business office resources. However, ignoring credit balances can lead to bigger problems.

 

Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Credit Balance Resolution

ERAs Are a Win-Win over Paper EOBs

Posted on Thu, Feb 12, 2015 @ 08:52 AM

The introduction several years ago of the ERA (Electronic Remittance Advice) created a quantum leap in the healthcare billing arena by providing an improvement to the traditional, paper-based EOBs. Astonishingly, many providers have not taken advantage of this revolutionary change. It has been estimated that even today only 46 percent of the claims are processed electronically, while the remaining 54% claims are processed in the traditional paper-based method. However, the Affordable Care Act (ACA) mandated that all healthcare plans adopt and support ERA operating rules before January 1, 2014. 

Here are just a few reasons why you should adopt ERAs:

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Significantly Reduce Processing Time: The major benefit of implementing ERAs is that they significantly bring down the medical claims billing processing time. When payment postings are done electronically, cash flow is accelerated. Also, since everything is electronic, the length of time a paper check or EOB spends in the traditional ‘snail mail’ system is avoided.

Reduce Manual Workflows: By adopting ERAs, providers and healthcare billing companies can reduce manual workflows significantly. Also, the number of employees can be reduced who have been assigned to post payments, or these employees can be reassigned to other medical claims billing functions.

Electronic Posting Efficiency: ERAs allow the use of electronic auto posting features, which enable posting of payments on to the system automatically. The error rate of the automated posting method is much less than that of manual postings, and the time spent correcting manual errors is also lessened.

Cost-Effective: Healthcare providers and medical billing companies can save significant dollars by implementing ERAs. The cost involved in recruiting new employees and training current employees is saved. Huge savings in terms of paper costs, printing costs and mailing costs can be realized. Electronic payment posting is not only time efficient, but also cost-effective.

It’s “Green”: The adoption of ERAs has encouraged several healthcare billing companies and providers to “Go Green.” Approximately, 2.5 billion pieces of paper can be saved by using eco-friendly electronic payment processing.

If you want to immediately achieve these benefits, your practice, hospital or billing company can implement a full-service outsourced payment posting solution that will allow you to instantly convert your paper EOBs to ERAs. Your outsourcing partner will use a technology solution that will import 837 claim data and convert your paper EOB's into ANSI 835/ERAs. The data will easily integrate with your document management system. By outsourcing this work, you can immediately treat every remittance as an ERA.

if you would like more information about the blog topic or how GeBBS can help you:

 

Contact GeBBS Now

 

Tags: Data Analytics, Revenue Cycle Management (RCM), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs), Accounts Receivable (A/R), Insurance Billing Solutions

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:59 AM

Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcingHealthcare Financials healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

Most hospital CFOs and group practice managers have no choice but to look for next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased self-pay volumes have driven many marginally performing healthcare organizations to the brink.

In 2014, it is predicted that changes, such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions and increased self-pay collection costs will all contribute to overall declining margins. The increase in self-pay accounts will be significant, driven the Affordable Care Act (ACA) which is going to send a huge number of newly insured patients into the healthcare delivery system. Under ACA, every U.S. citizen is required to have some form of medical insurance, or pay an opt-out fine.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a January 2014 article in Kaiser Health News, out-of-pocket payment amounts under the ACA will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Revenue Cycle Management (RCM), Healthcare Revenue Billing, Accounts Receivable (A/R), Accountable Care Organizations (ACOs), Affordable Care Act

Strategies for Managing the Increased Self-pay Revenue Stream

Posted on Wed, Mar 05, 2014 @ 06:52 AM

web icon medical checklistIn an earlier blog, we admonished healthcare providers not to let their revenue cycles be swamped by the rising number of new self-pay patients entering the healthcare delivery stream. Under the Affordable Care Act (ACA), the self-pay portion of a healthcare provider’s receivables is going to increase significantly. According to a recent Healthcare Financial Management Association (HFMA) study, the current self-pay average is 20 percent of a healthcare provider’s receivables, but that is only going to increase over the next few years. How to manage the accounts of patients who must pay a significant percentage of their bill out of pocket will be a key strategy to achieve or maintain profitability during the new rollout of federal reform mandates.

Big changes are taking place in healthcare in 2014. Thirty to forty million new people will be covered by insurance; however, that doesn’t mean they won’t have to pay anything out of pocket. Patients who have been covered by Medicaid or charity care in the past will now be covered by high-deductible insurance plans. Everyone will be expected to pay something.

How can healthcare providers cope with these changes? The HFMA reports 95 percent of hospitals are already seeing an increase in self-pays. Regardless of a hospital’s payer mix, collection costs are going to increase. It costs seven times more to collect from an individual than from an insurer or the government.

The first step providers need to take is to ascertain how large this issue will be for them – what will be the size of their self-pay portfolio? For example, how much of a loss can you allow on the back end when you do collections? Many hospitals fail to do a good job of segmenting and identifying the likelihood that any given patient will or won’t pay.

Hospitals should also employ technology both to decrease their costs and to increase the convenience for the patient. The HFMA says only 42 percent of hospitals have an online portal where patients can pay their bills online. Automatic dialers can increase the volume of calls you make, and interactive voice response systems can let patients pay their bills by phone without having to wait for a human. And, there are analytical solutions that can help you identify which accounts are most worth pursuing.

Many hospitals make the mistake of throwing more bodies at the problem without the right tools to help them. This only increases their cost of collection. Having analytics that support self-pay collections can have a dramatic impact on your overall collection efforts. And it doesn’t have to be expensive; with the popularity of the software-as-service model, you can be up and running with very little capital investment.

Having patients pay their share, or some part of their share, up front is a good idea, but not very realistic for many patients. We’re going to need a cultural shift where patients are expected to pay for care before they receive it. Hospital admitting professionals need to alert patients to the fact that they will owe something. This type of preparation will create the expectation of payment; if the healthcare providers don’t create the expectation, it will not happen.

Can healthcare providers learn from other industries? It’s about 75 percent less expensive for collection agencies to collect bills than for hospitals, because that’s the only thing they do. They have the right analytics, the right technology, they are not afraid to ask for money, and they are persistent. It makes sense for hospitals to outsource self-pay receivables collection to agencies early in the revenue cycle, because they’re good at it. It’s a different tactic from using an agency after the charge-off -- it’s not punitive to the patient; it simply takes advantage of the agency’s skills and resources.

Another thing healthcare providers might want to consider is paying incentives to their collectors. If an agency can make more money by hitting their numbers, that can be a powerful incentive. Another self-pay lesson can come from the financial services industry, because of the way these companies do portfolio management. Healthcare providers will need to look at their increased self-pay receivables as a financial portfolio that needs to be properly managed.

 

Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Affordable Care Act