GeBBS Healthcare Blog

Be Prepared for "Surprise" Medical Billing

Posted on Wed, Feb 08, 2017 @ 12:45 PM

A recent article on the Radiology Business Management Association (RBMA) web site discussed consumer’s frustration with the cost of medical care as being at an all-time high as many purchasers of narrow-network, high-deductible and high-co-pay health plans are finding out that the benefits they get from their monthly insurance premiums are much more limited than they thought. One target of their frustration is “surprise” medical bills for services such as radiology, as well as other medical specialty services that a patient may receive from an out-of-network (OON) physician, while either receiving emergency care or a planned treatment at an in-network facility. It is an issue that has been covered by the likes of Consumer Reports and numerous other publications in recent years.  In response, state legislators in nearly two dozen states are either considering or have already passed laws to protect patients from such unexpected/surprise bills.

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Both California and New York have passed “Surprise” Medical Billing laws. The California Law applies to plans and insurance policies issued in California, amended, or renewed after July 1, 2017.

It is important for providers, health plans, and insurers in California to quickly create a plan to successfully navigate this new law. It is also important to note that these new California and New York regulations may be harbingers of laws elsewhere as it represents the next step in the evolution of state legislative efforts to address the tricky issues that arise when beneficiaries receiving OON services without a reasonable opportunity to consent to them.

This is precisely the time to engage with a partner who brings a deep understanding of the revenue cycle and provides tailored insurance billing solutions that cut through the complexity with expertise, operational excellence, and a sophisticated approach. An expert outsourced billing partner can deliver solutions specific to each client’s need, while working with a client’s host system and using its tools to build efficient workflow processes with higher output through the use of a hybrid of automated and manual solutions.

The healthcare environment is changing with these new “surprise” medical billing laws, The Affordable Care Act and whatever evolution may follow, and the transition to ICD-10 all put added layers of expense and complexity on our already burdened billing systems.  Patient volumes are on the rise with the newly-insured population, and high-deductible plans putting added pressures on revenue cycle operations and the drive to collect payments. 

The key to success is access to a large pool of outsourced, qualified denial management experts who can work in any healthcare environment and that understand the new compliance laws, such as “surprise billing,” and how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.  Outsourced RCM analysts adept at trending denials and looking for patterns of deficiency will increase cash flow and reduce aging A/R.

Tags: Revenue Cycle Management (RCM), RCM Solutions, Patient Access Management, Medical Billing BPO, Offshore Medical Billing, outsourced medical billing

High Deductible Self-Pay Accounts Can Be a Major Threat to Revenue Cycle Management

Posted on Thu, Jan 26, 2017 @ 05:00 AM

According to data from the latest quarterly Crowe RCA Benchmarking Analysis: "Patient Financial Responsibility on the Rise,” healthcare providers could be facing a major threat to their revenue cycles. The analysis found that in the past year, insured patient financial responsibility has grown from 23.3 percent to 26.9 percent for outpatients and 10.2 percent to 12.1 percent for inpatients.

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This new revenue cycle threat comes from the fact that patients continue to take on more financial responsibility for their care due to participating in high-deductible health plans, especially those of the Affordable Care Act, (ACA). In 2017, the out-of-pocket maximum for ACA can range from $7,150 for an individual plan to $14,300 for a family plan before marketplace subsidies kick in. Healthcare providers are struggling with collection rates as they try to adapt to increasing patient responsibility amounts for insured self-pay co-pays and deductibles, according to the Crowe benchmarking data.

This trend is expected to grow over the next few years. As a result, both patient liability and bad debt are on the rise and healthcare providers are experiencing unprecedented revenue and margin pressure. Hospitals and clinics have become like retail organizations, which need to provide their consumers with access to payment capabilities at point of service, via the web, through payment plans, and more. The answer for healthcare providers is to take advantage of professional outsourcing companies who have expertise in patient access management solutions that can improve patient satisfaction, while lowering your collection costs and increasing revenue.  These necessary outsourcing services include:

- Scheduling, Eligibility Verification, and Pre-Authorization
- Patient Call Center
- Self-Pay Collections

Self-pay collection is the most critical of these services. A recent McKinsey study found that 74 percent of insured consumers indicated that they are both able and willing to pay their out-of-pocket medical expenses up to $1,000 per year and 90 percent would pay for medical expenses up to $500 per year.

Reasons for a rise in self-pay bad debts are due in part to inefficient and ineffective collection practices followed by most billing companies and physician practices. An expert self-pay collections team uses technology-enabled practices to maximize patient contact with:

  • - Easy to understand patient statements
  • - Automated dialers
  • - Digital messaging campaigns
  • - Mobile technology to drive text messaging campaigns

The outsourced self-pay collections team leverages analytics to arrive at the best time to contact patients and their propensity to pay scores to create outbound campaigns that are patient experience-oriented, non-obtrusive, and drive higher patient connect ratios.

Don’t let high-deductible, self-pay insurance amounts wreck your revenue cycle. Work with an experienced outsourcing team that will provide your patients with flexible payment options and easy access to payment capabilities for web, phone, credit card, and e-check payments.

Tags: Revenue Cycle Management (RCM), RCM Solutions, Patient Access Management

Optimizing Patient Access Management in the New Healthcare Consumerism Environment

Posted on Mon, Jul 13, 2015 @ 06:00 AM

Healthcare consumerism is going to be an important factor in the new healthcare financial environment where a number of patients are going to be responsible for a portion of their healthcare costs. Empowering healthcare consumers to schedule appointments, receive online statements, and make electronic payments are just a few of the options that consumers are demanding.

How can today’s healthcare providers meet this increased demand for consumerism in their healthcare delivery? One solution is to employ a professional, outsourced, state-of-the-art call center that can exclusively handle your patient inquiries.  This center can offer the up-to-date infrastructure you need to handle heavy call traffic and manage call volume peaks and valleys with ease. Experienced healthcare billing professionals can provide quick resolutions to patient issues and queries. 

A healthcare-specific call center can:
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  • Provide a detailed study of your call patterns, including a “reason for call” analysis to identify automation opportunities
  • Implement an interactive voice response (IVR) to handle simple queries such as balance inquiry and statement requests
  • Furnish a patient portal to automate credit card payments
  • Offer flexible staffing to manage peaks and valleys in call volumes
  • Provide extended operating hours to manage all calls 24X7 with live operators and an after-hours voice mail system
  • Implement a real-time call management and reporting solution

With a professional call center, you can begin to manage your patients’ expectations prior to their arrival -- expected copayments, referrals and authorizations -- all before services are rendered. In today’s newly expanded self-pay environment, a professional call center will allow you to adopt a proactive approach for patient financial responsibilities, prior to delivering non-emergency services.

Optimal patient access management requires a robust preregistration program, combined with a redesigned registration process, to facilitate patient flow and produce more accurate financial patient data. A professional call center will provide a facilitated registration process for preregistered patients where their insurance coverage and their ability to handle self-pay amounts have already been determined, prior to their presenting at the hospital.

Best-performing healthcare providers have a stringent process in place for insurance verification within 24 hours of admission. A professional call center will allow you to scrutinize accounts registered as self-pay within 24 hours of admission seven days per week. They can also periodically re-evaluate patients with long hospital stays to make sure that eligibility is maintained.

The healthcare revenue cycle is just beginning to feel the effects of this consumerism as employers focus on containing healthcare costs. A professional call center will allow you to implement revenue cycle solutions that extend the capabilities of your information system, helping you improve patient access management, while accelerating cash collection and improving payer performance.

Tags: Business Process Outsourcing (BPO), Patient Access Management, Best Practices

Patient Access Management in your Organization

Posted on Thu, Dec 18, 2014 @ 11:36 AM

Where Should Patient Access Management be Located within the Organization?

Patient access management should be incorporated as an element of a hospital’s financial department because in today’s new financial environment, everything this department does ties into multiple areas of the revenue cycle.

Best practices hospitals use the approach where any and all information that affects the revenue cycle is disseminated among all members of the revenue cycle team. With new governmentally mandates sending thousands of patients with high-deductible insurance policies into the healthcare delivery system, it is critical that these patients and their ability to pay be identified at the very beginning of the revenue stream. 

The critical data collected by the patient access staff should be shared with all key players on the revenue cycle team, including patient financial services, HIM, managed care staff members, as well as the chargemaster manager and information technology. This data can then be used to create a list of potential issues related to the revenue cycle.  

 

Collection issues discovered early in the revenue cycle process can be assigned to the proper people in the revenue cycle so they can conduct the root-cause analyses needed to solve the issues. This early detection and problem resolution will minimize finger pointing and keep the discussions focused on resolving the issues.

A comprehensive revenue cycle approach also ensures that patient access management plays an integral part in the hospital's management of issues such as denials, bad debt, and, of course, patient bed placement. Best-performing hospitals aggressively track denials and zero payment accounts, and diligently seek ways to eliminate process deficiencies that lead to denials. Bad debt files should be reviewed regularly and high-dollar accounts should be scrutinized. Best-performing hospitals have a sign-off system in place so patient access and patient accounting managers and directors can work collaboratively on large dollar cases.

Patient access functions have traditionally been responsible for bed placement. There is some debate as to whether this function should remain with patient access or be transferred to nursing. Regardless of whether or not patient access determines bed placement, patient representatives have a critical role to play in the collection and dissemination of critical financial information. 

Tags: Patient Access Management, Revenue Cycle Management (RCM)

Optimized Patient Access Management

Posted on Tue, Dec 09, 2014 @ 09:46 AM

Patient access management department structures vary among hospitals, but in best-performing facilities, patient access management functions are typically structured with their patient access staff members divided into three areas: pre-service, time of service and post-service to handle the issues unique to these processes at each stage in the continuum of care.

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Pre-service: Hospitals are beginning to realize the importance of managing the patient's expectations prior to arrival - expected copayments, referrals and authorizations all must be completed before services are rendered. In today’s newly expanded self-pay environment, hospitals need to adopt aggressive philosophies for patient financial responsibilities prior to delivering non-emergency services.

Time-of-service. Optimum patient access management requires a robust preregistration program, combined with a redesigned registration process, to facilitate patient flow and produce more accurate financial patient data in every area but ED.  Best practices hospitals have established facilitated registration processes for preregistered patients where their insurance coverage and their ability to handle self-pay amounts have already been determined, prior to their presenting at the hospital.

Post-service. The nature of healthcare delivery is such that many services cannot be scheduled in advance. ED volumes have increased dramatically as a growing number of uninsured patients use the ED as their primary care source. It has been estimated that on average, more than half of inpatient admissions are derived from the ED in many hospitals.

Best-performing hospitals have a stringent process in place for insurance verification within 24 hours of admission. These hospitals also scrutinize accounts registered as self-pay within 24 hours of admission seven days per week. They also periodically re-evaluate patients with long hospital stays to make sure that eligibility is maintained.

ED patients who are treated and released pose a greater challenge, especially if they lack insurance. Best-performing hospitals ensure that a high percentage of ED patients are financially screened prior to discharge. The right patient access management department structure can reduce uncollected revenue for many hospitals.

Tags: Best Practices, Patient Access Management

Patient Access Management: The New Vanguard in Healthcare

Posted on Thu, Nov 20, 2014 @ 03:37 PM

With all of the changes in healthcare reimbursement policies and the influx of high-deductible patients, healthcare providers need to shift their patient access management strategies to meet these new challengesNo longer can the registration process be looked upon as a simplistic completing of forms patient_billingand getting the patient into a bed. Today's patient access professional must be capable of highly skilled worksuch as reviewing referrals, obtaining authorizations, verifying eligibility, determining the patients’ willingness and ability to pay, requesting payment at time of service and arranging sophisticated payment schedules to ensure collection of revenue for services rendered.

Today’s patient access representatives have much broader responsibilities than did traditional registrars in the past. Hospital information systems use insurance plan codes to identify the various products offered by each insurance carrier. Patient representatives are expected to quickly decipher which plan the patient belongs to from the patient's ID card. The patient representative's choice affects the manner in which the claim is sent to the carrier, and an incorrect choice can delay claim submissions and often result in rejected claims and delayed payments.

Managed care agreements have added another level of complexity. Patient access representatives must know when to obtain preauthorization and referrals, and to verify the appropriateness of the place of service. Even the most sophisticated "managed care matrix" cannot address every scenario for every plan. Within a specific carrier, the rules can differ down to the level of a particular employer. 

Healthcare providers must become highly creative in implementing best practices for patient access management to address today’s patient registration challenges. 

Tags: Patient Access Management, Insurance Billing Solutions, Revenue Cycle Management (RCM)

Healthcare Consumerism and Patient Access Management

Posted on Tue, Oct 21, 2014 @ 11:59 AM

Healthcare consumerism is going to be an important factor in the new healthcare financial environment where many patients are going to be responsible for a large portion of their healthcare costs. Consumer self-service is already becoming common place in healthcare today. Access to healthcare kiosks and patient portals will become an expectation in patients’ healthcare delivery processes. Allowing healthcare consumers to research costs, schedule appointments, receive online statements and make electronic payments are just some of the options consumers are demanding.

The healthcare revenue cycle is just beginning to feel the effects of this consumerism as employers focus on containing healthcare costs. Revenue cycle solutions that extend the capabilities of a healthcare organization’s hospital information system are the key to improving access management, responding to healthcare consumerism, accelerating cash collection and improving payer performance.

Patient Access Management

The expanding role of patient access professionals in the revenue cycle is the next step in responding to healthcare consumerism. In the future, these professional will become the “face” of many healthcare providers to the general public. Patient access representatives, used early in the healthcare delivery process, can help providers not only determine insurance eligibility, but also the consumers’ ability and willingness to pay for their healthcare costs. Including medical necessity checking during registration, scheduling and ordering can also help reduce Medicare denials and increase reimbursement by providing medically necessary services or by issuing an ABN for non-covered services.

With the growing financial pressures on healthcare organizations, due to the influx of high-deductible consumer/patients, providers need to seek innovative strategies to improve their revenue cycle performance. The use of patient access management early in the revenue cycle may be a way to avoid financial disaster downstream.

Tags: Revenue Cycle Management (RCM), Revenue Cycle Management (RCM), Patient Access Management, Insurance Billing Solutions