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