1. Information Request for Revenue Cycle and Accounts
Receivable Management Services
2. 1 Professional Contact Center, Accounts Receivable and
Revenue Cycle Management Solutions 2016Copyright AllRightsReserved
Revenue Cycle and Accounts Receivable Management Revenue Cycle and
Accounts Receivable Management For over 39 years we have been one
of the most trusted business partners in the healthcare Revenue
Cycle and Accounts Receivable Management industry. We have
partnered with over 127 healthcare facilities nationwide providing
increase patient satisfaction. Our facilities manage over $500
million in bad debt annually, $65 million in new monthly self pay
placements, provide Medicaid eligibility services in 15 states, and
offer a host of consulting and extended office billings services
for our clients. Our innovative approach is designed to offer
clients and patients a patient-centric experience while maintaining
the highest levels of compliance standards and patient lifetime
value. Extended Business Office o Preservice coverage and cleanup o
Full physician billing o Charge entry o Insurance coverage and
benefits determination Insurance Billing and Follow Up o Insurance
billing and rebilling primary and secondary o All payors government
and commercial o Denial and no response follow up o Denial
management and trending Federally Qualified Healthcare Facilities o
Custom cleanup projects o Remittance integration and analysis o
Medicaid Eligibility and Self Pay collection o Managed Care
enrollment Self Pay o Self Pay follow up o Early out programs for
Self Pay of all ages, customized to each client including: Self Pay
resolution/payment monitoring and follow up Insurance
identification, verification and filing Self Pay Plus o
Point-of-Service Training o Operations assessment and
recommendations on process improvement o Ongoing staff training for
those involved with patient management Medicaid Eligibility &
Verification o Eligibility assistance provided to patients o
Ongoing support and education for patients o Appeal and Fair
Hearing support
3. 2 Professional Contact Center, Accounts Receivable and
Revenue Cycle Management Solutions 2016Copyright AllRightsReserved
o Medicaid Eligibility determination and claim submission Bad Debt
o Primary, Secondary, Tertiary o Late Stage o Probate Contact
Services o Health Risk Assessments o Inbound and Outbound member
support services o Wellness Outreach o Provider support
4. Services
5. Copyright 2016, all rights reserved NEW105A By utilizing our
expertise, healthcare facilities can focus on thier patients.
Multi-system proficiency provides a seamless transition for our
clients. KPI and trend analysis reporting, and continuous process
improvement. We offer a broad portfolio of customizable solutions.
Revenue Cycle & Accounts Receivable Management At Alltran, we
passionately believe theres a better way to help people resolve
their financial challenges. For over 38 years we have been a
transformational force in the healthcare revenue cycle management
industry. We have built a diverse portfolio of clients including:
Healthcare Systems Medical Centers Public and Private Hospitals
Specialty Clinics Services We assist our clients in managing their
accounts receivables so they can provide greater access to
healthcare. With customized strategies and best-in-class technology
systems, and we offer services that are specifically aligned with
our clients revenue cycle and accounts receivable management goals.
Ares of specialization include: Billing and Insurance Follow Up
Self Pay Eligibility Services Extended Business Office Managed Care
Bad Debt Collections Compliance Alltran staff includes experts in
regulatory requirements across the healthcare industry. We believe
in adherence to the letter and spirit of the law, and proactively
educate our clients as changes occur. With 100% commitment to treat
every client and patients with respect and professionalism, we
offer: Dedication to Compliance and Regulatory Management
Professional Strategy Experienced Staff and Veteran Management Team
Extensive Training Cutting-Edge Technology 200 14th Ave East |
Sartell, MN 56377 | 877-5197446 | www.alltran.com
6. 200 14th Ave East | Sartell, MN 56377 | 877-5197446 |
www.alltran.com Extended Business Office Copyright 2016, all rights
reserved NEW103A By utilizing our expertise, healthcare facilities
can focus on their patients. We offer a broad portfolio of
customizable solutions. Multi-system proficiency provides a
seamless transition for our clients. KPI and trend analysis
reporting, and continuous process improvement. At Alltran Health,
we passionately believe theres a better way to help people resolve
thier financial challenges. For over 39 years we have been a
transformational force in the healthcare revenue cyce and accounts
recieveable management industry. We have built a diverse profolio
of clients including: Healthcare Systems Medical Centers Public and
Private Hospitals Specialty Clinics The Need for a Solution With
the changing face of healthcare, facilities and providers must
expend added resources and attention to the billing and collection
efforts. Decreasing financial capabilities and the continuously
evolving regulatory and technological landscape, further impede
facilities and providers from focusing on the entire revenue cycle,
including patient satisfaction. We offer a tested and proven
extended business office solution that spans the spectrum of
services from initial billing, rebilling and appeals to
credentialing and reporting. Our Program Includes: Preservice
coverage and cleanup Preservice financial counseling for newly
insured patients Insurance coverage and benefits determination
Insurance billing and followup services Ability to work on your
system or provide services through our system Customer-focused
services by experienced professionals Custom cleanup projects
Compliance Focused Alltran Healths staff includes experts in
regulatory requirements across the Healthcare industry. We believe
in adherence to the letter and spirit of the law, and proactively
educate our clients as changes occur. With our 100% commitment to
treat every client and account holder with respect and
professionalism, we offer: Experience staff and veteran management
team Professional strategy Extensive training
7. FQHC ExtendedBusinessOffice Copyright 2016, all rights
reserved NEW103A By utilizing our expertise, healthcare facilities
can focus on thier patients. We offer a broad portfolio of
customizable solutions. Multi-system proficiency provides a
seamless transition for our clients. KPI and trend analysis
reporting, and continuous process improvement. At Alltran Health,
we passionately believe theres a better way to help people resolve
thier financial challenges. For over 38 years we have been a
transformational force in healthcare revenue cycle and accounts
receivable management industry. We have built a portfolio of
clients including: Healthcare Systems Medical Centers Public and
Private Hospitals Specialty Clinics The Need for a Solution With
the increasing demand for community-based health care services, it
is imperative that Federally Qualified Health Centers (FQHC) have
the necessary resources and tools to minimize administrative and
billing challenges, allowing them to focus on clinical and patient
care issues. We offer a tested and proven FQHC extended business
office (EBO) solution that spans the spectrum of services from
initial billing, rebilling and appeals to credentialing and
reporting. Our Program Includes: Seamless, timely and collaborative
implementation processes Experienced and knowledgeable FQHC
representatives Custom clean-up project and consulting services
Initial billing, rebilling, and appeals; remittance integration and
analysis; customize business intelligence reports; medicaid
eligibility and self pay collection; benefit determination; managed
care enrollment; and patient statement production Compliance
Focused Alltran Healths staff includes experts in regulatory
requirements across the Healthcare industry. We believe in
adherence to the letter and spirit of the law, and proactively
educate our clients as changes occur. With our 100% commitment to
treat every client and account holder with respect and
professionalism, we offer: Experience staff and veteran management
team Professional strategy Extensive training 200 14th Ave East |
Sartell, MN 56377 | 877-5197446 | www.alltran.com
8. Copyright 2016, all rights reserved NEW107A By utilizing our
expertise, healthcare facilities can focus on thier patients. We
offer a broad portfolio of customizable solutions. Multi-system
proficiency provides a seamless transition for our clients. KPI and
trend analysis reporting, and continuous process improvement.
Insurance Billing and Follow Up At Alltran, we passionately believe
theres a better way to help people resolve thier financial
challenges. For over 38 years we have been a transformational force
in healthcare revenue cycle and accounts receivable management
industry. We have built a portfolio of clients including:
Healthcare Systems Medical Centers Public and Private Hospitals
Specialty Clinics The Need for a Solution The implementation of the
Affordable Care Act (ACA) has further complicated insurance
billing. Effectively collecting outstanding insurance payments,
requires healthcare facilities to maintain a fully functional and
extensively trained billing and collections staff that can
efficiently manage the full spectrum of insurance billing, claims
management, and collection services. Our proven insurance billing
and follow up process can be customized to meet the unique needs of
our clients. Our Program Includes: Accounts Receivable services
such as: - Primary and secondary claim submission (including
Coordination of Benefits) - Claim edits - Denial management
including trending and reporting Self Pay Billing Services such as:
- Self pay statements and follow-up - Engagement notice generation
and mailing - Bad debt determination and write-off Compliance
Focused Alltrans staff includes experts in regulatory requirements
across the Healthcare industry. We believe in adherence to the
letter and spirit of the law, and proactively educate our clients
as changes occur. With our 100% commitment to treat every client
and account holder with respect and professionalism, we offer:
Experience staff and veteran management team Professional strategy
Extensive training 200 14th Ave East | Sartell, MN 56377 |
877-5197446 | www.alltran.com
9. At Alltran, we passionately believe theres a better way to
help people resolve thier financial challenges. For over 38 years
we have been a transformational force in the healthcare revenue
cyce and accounts recieveable management industry. We have built a
diverse profolio of clients including: Healthcare Systems Medical
Centers Public and Private Hospitals Specialty Clinics The Need for
a Solution A growing portion of healthcare facility and provider
office payments are now generated through direct payments by
patients. Given the myriad of other financial commitments that
patients may have, collecting on these financial responsibilities
is increasingly challenging, resulting in the need for bad debt
collection. Using a well-defined, predictive reporting process and
highly experienced and trained collection agents, our bad debt
collection process has demonstrated significant increases in
overall collection and reduced accounts receivable days. This
results in higher collection rates for clients. Our Program
Includes: Use of sophisticated predictive reporting process that
identifies patients at high risk of bad debt Active outreach to
collect on bad debt, using customer-focused processes Ability to
manage a wide range of payment plan options Operational excellence
100% call monitoring and call transparency professionals Compliance
Focused Alltrans staff includes experts in regulatory requirements
across the Healthcare industry. We believe in adherence to the
letter and spirit of the law, and proactively educate our clients
as changes occur. With our 100% commitment to treat every client
and account holder with respect and professionalism, we offer:
Experience staff and veteran management team Professional strategy
Extensive training Copyright 2015, all rights reserved NEW103A
Healthcare Collections By utilizing our expertise, healthcare
facilities can focus on thier patients. We offer a broad portfolio
of customizable solutions. Multi-system proficiency provides a
seamless transition for our clients. KPI and trend analysis
reporting, and continuous process improvement. 200 14th Ave East |
Sartell, MN 56377 | 888-340-7243 | www.alltran.com
10. By utilizing our expertise, healthcare facilities can focus
on thier patients. We offer a broad portfolio of customizable
solutions. Multi-system proficiency provides a seamless transition
for our clients. KPI and trend analysis reporting, and continuous
process improvement. Copyright 2016, all rights reserved NEW104A
Medicaid Eligibility Program At Alltran, we passionately believe
theres a better way to help people resolve thier financial
challenges. For over 39 years we have been a transformational force
in the healthcare revenue cyce and accounts recieveable management
industry. We have built a diverse portfolio of clients including:
Healthcare Systems Medical Centers Public and Private Hospitals
Specialty Clinics The Need for a Solution The increasing number of
Medicaid patients, eligibility determination complexities, and
Medicaid billing challenges have adversely impacted the ability of
healthcare facilities to receive appropriate reimbursement for
services. The introduction of the Affordable Care Act (ACA) in 2010
further complicated an already daunting process. Our program will
increase patient satisfaction, decrease unpaid bills or charity
care referrals, increase hospital cash flow and net revenue, and
reduce business office A/R management expenses. Our Program
Includes: Decrease days in accounts receivable with nationally
certified Medicaid CACs Hands-on, onsite eligibility assistance to
patients on behalf of your facility Assistance completing the
Medicaid application and obtaining needed supporting documents,
often converting self pay to Medicaid Establish working
relationships with Social Security Disability Insurance (SSDI) and
Medicaid offices, increase of follow up to ensure timely
eligibility determination Supporting patients in cases of Appeals
and Fair Hearings Compliance Focused Alltranss staff includes
experts in regulatory requirements across the Healthcare industry.
We believe in adherence to the letter and spirit of the law, and
proactively educate our clients as changes occur. With our 100%
commitment to treat every client and account holder with respect
and professionalism, we offer: Experience staff and veteran
management team Professional strategy Extensive training 200 14th
Ave East | Sartell, MN 56377 | 877-519-7446 | www.alltran.com
11. Copyright 2016, all rights reserved NEW105A By utilizing
our expertise, healthcare facilities can focus on thier patients.
Multi-system proficiency provides a seamless transition for our
clients. KPI and trend analysis reporting, and continuous process
improvement. We offer a broad portfolio of customizable solutions.
Out-of-State Medicaid Provider Enrollment and Claims Management 200
14th Ave East | Sartell, MN 56377 | 877-5197446 | www.alltran.com
At Alltran, we passionately believe theres a better way to help
people resolve their financial challenges. For over 39 years we
have been a transformational force in the healthcare revenue cycle
and accounts receivable management industry. We have built a
diverse portfolio of clients including: Healthcare Systems Medical
Centers Public and Private Hospitals Specialty Clinics The Need for
a Solution The increasing number of Medicaid patients and Medicaid
billing challenges has made it difficult for healthcare facilities
to receive appropriate reimbursement for services, particularly
when a patient is out of state. We provide the lifeblood every
healthcare system needs to thrive payment for servicesand our
approach results in higher re- turns for our clients. Our Program
Includes: Follow up on inventory accounts until payment is secured
Billing of out-of-state Medicaid primary accounts Researching state
filing requirements and verifying claims meet the requirements
Editing and submitting all claims to appropriate out-of-state payer
Completing Medicaid participation agreements or enrollment forms
Researching and providing information needed for posting
out-of-state payments Compliance Focused Alltran staffs experts in
regulatory requirements across the Healthcare industry. We believe
in adherence to the letter and spirit of the law, and proactively
educating our clients as changes occur. With our 100% commitment to
treat every client and account holder with respect and
professionalism, we offer: Experience staff and a veteran
management team Professional strategy Extensive training
12. Self Pay Copyright 2015, all rights reserved NEW107A By
utilizing our expertise, healthcare facilities can focus on thier
patients. We offer a broad portfolio of customizable solutions.
Multi-system proficiency provides a seamless transition for our
clients. KPI and trend analysis reporting, and continuous process
improvement. At Alltran, we passionately believe theres a better
way to help people resolve their financial challenges. For over 38
years we have been a transformational force in the healthcare
revenue cycle and accounts receivable management industry. We have
built a diverse portfolio of clients including: Healthcare Systems
Medical Centers Public and Private Hospitals Specialty Clinics The
Need for a Solution With increasing healthcare costs, patients are
taking on greater self-pay responsibilities in the form of higher
premiums, deductibles, and co-payments. A growing portion of
healthcare facility and provider office payments are now generated
through direct payments by patients. Using highly experienced and
trained service representatives, our self pay process has
demonstrated significant increase in overall collection, reduced
accounts receivable days, and improved financial assistance
capture, resulting in higher collection rates for clients. Our
Program Includes: An ability to work on your system or provide
services through our system A sophisticated autodialer technology
outreach to patients Preservice financial counseling for newly
insured patients Well-defined business intelligence modeling
Compliance Focused Alltrans staff includes experts in regulatory
requirements across the Healthcare industry. We believe in
adherence to the letter and spirit of the law, and proactively
educate our clients as changes occur. With our 100% commitment to
treat every client and account holder with respect and
professionalism, we offer: Experience staff and veteran management
team Professional strategy Extensive training 200 14th Ave East |
Sartell, MN 56377 | 877-5197446 | www.alltran.com
13. Self Pay Plus An innovative approach to maximize Self Pay
revenue Copyright 2015, all rights reserved NEW100A By utilizing
our expertise, healthcare facilities can focus on thier patients.
We offer a broad portfolio of customizable solutions. Multi-system
proficiency provides a seamless transition for our clients. KPI and
trend analysis reporting, and continuous process improvement. At
Alltran, we passionately believe theres a better way to help people
resolve their financial challenges. For over 38 years we have been
a transformational force in the healthcare revenue cycle and
accounts receivable management industry. We have built a diverse
portfolio of clients including: Healthcare Systems Medical Centers
Public and Private Hospitals Specialty Clinics The Need for a
Solution Most hospitals have recognized the impact high deductibles
and co-payments have on healthcare receivables. Our goal is to
teach healthcare organizations how to maximize point-of-service
collections and self pay revenue so they meet their financial
goals. Our proven self pay process can be customized to meet the
unique needs our clients and is designed to reduce accounts
receivable days, and improve financial assistance capture,
resulting in higher collection rates. Our Program Includes:
Implementation of an effective point-of-service process Assessment
and recommendations on process improvements in facility-based
point-of-service collections process Initial and ongoing staff
training for those involved with patient management,
point-of-service, and billing services Full responsibility for Day
One self pay follow up and collection Identifying and rebilling new
insurance coverage and increasing quick pay dollars Compliance
Focused Alltrans staff includes experts in regulatory requirements
across the Healthcare industry. We believe in adherence to the
letter and spirit of the law, and proactively educate our clients
as changes occur. With our 100% commitment to treat every client
and account holder with respect and professionalism, we offer:
Experience staff and veteran management team Professional strategy
Extensive training 200 14th Ave East | Sartell, MN 56377 |
877-5197446 | www.alltran.com
14. Whitepapers
15. Healthcare Compliance: Affordable Care Act 501(r) and IRS
Final Rule When Section 501(r) was added to the Internal Revenue
Code in 2010, focus on the Affordable Care Act (ACA) regulatory
changes shifted to non-profit hospitals, namely imposing
requirements to maintain tax-exempt status. The amended ACA affects
organizations with one or more hospitals, which are reviewed on a
facility-by-facility basis. Final IRS ACA 501(r) regulations apply
to taxable years beginning after December 29, 2015. These
regulations will affect patient transactions from financial
assistance to collections. Hospitals must: Establish and widely
publicize a Financial Assistance Plan (FAP) and emergency care
policies. Limit amounts charged for emergency or other medically
necessary care to patients eligible under a FAP. Make reasonable
efforts to determine whether an individual qualifies for a FAP
before engaging in extraordinary collection actions. Conduct and
publish the results of a community health needs assessment at least
once every three years. One of the biggest issues under 501(r) is
how your collection partner will contact patients regarding
outstanding bills. Hospitals need policies that describe how and
when theyand their third-party collection partnerscontact patients.
To that end, the content in this document Financial Assistance Plan
and Extraordinary Collection Activities provides an overview of ACA
501(r) and highlights specific requirements in each section that
pertain to medical billing and collections. It also maps how
Alltran can help you plan for compliance with this complex
regulation. We partner with clients to create and monitor
collection procedures that meet tax-exempt requirements and
strengthen your position as a provider of compassionate, quality
care. The final 501(r) regulations require hospitals to offer a
plain language summary of the organizations established FAP during
the intake or discharge of patients. In addition, billing
statements must include a conspicuous written notice that informs
patients of your established FAP and its availability. Beginning on
the date of their first post-discharge billing statement, patients
are granted a notification period of up to 120 days to determine
whether they would like to apply for financial assistance and start
the application process. The patient then receives an additional
120-day application period to submit the application forms. An
important aspect of FAP is that absolutely no extraordinary
collection activities (ECAs) may occur during the combined 240-day
notification and application periods, unless reasonable efforts
have been satisfied by the healthcare facility. Moreover, hospitals
are required to process applications submitted within this window
of time. What Constitutes an ECA? The regulations define ECAs to
include the following: Employing legal or judicial process to
obtain payment for a bill covered under FAP Selling debt to a third
party Reporting adverse information to credit agencies Deferring or
denying medical care based on non-payment for previously
FAP-covered care Requiring payment before providing medically
necessary care
16. Securing Your ACA 501(r) Compliance Financial assistance
policy (FAP) and emergency medical care policy A plain language
summary of the FAP A FAP application form and instructions hfma
National Institute ECA Protocol and Reasonable Efforts ECAs may
only commence when the hospital, its third-party collection vendor,
or its legal partner has made a reasonable effort to determine a
patients FAP eligibility, and that patient is deemed ineligible.
Should a hospital intend to proceed with an ECA, it must make a
reasonable effort to determine whether the patient is eligible for
FAP assistance. While the finer requirements of reasonable effort
remain unclear under the ACA 501(r), it appears, at a minimum the
following steps are neces- sary to complete this requirement:
Include plain language summary with all (and at least 3) billing
statements and written communications about the bill during the
notification Inform patients about FAP in all oral communications
about their bill during the notification process of FAP assistance
Provide the patient with at least a 30 day notification of the
intent to perform ECAs and listing out the specific ECAs that may
be completed The most critical aspect of this regulation is that
all ECAs are suspended between the completed FAP application
submission and In addition to implementing processes and procedures
that reflect the language of ACA 501(r), hospitals can turn to a
third-party to collect patient debt. Your tax-exempt status is
critical and has implications that extend beyond business
practicalities. It is one factor that allows you to provide the
utmost service to your patients and community. The complexities of
new regulations and what is at stake make it ever more critical to
select a vendor that is 100% compliance-ready. Alltran views ACA
501(r) as an opportunity to protect your tax-exempt status while
solidifying your positive standing with the patients and
communities you serve. Your patients likely reside in your area and
should feel comfortable to turn to you again for future needs. Our
experience has shown that account resolution, when handled
appropriately, improves the overall patient- provider relationship.
Through innovation, education, and support, we can assist your
patients in resolving their accounts in a manner that protects you
and your patients. Compliance-Ready Resources and Training
Important Decisions: What ECAs will your facility allow Alltran to
perform? How will your facility ensure that reasonable efforts have
been completed for each date of service? What dates are you able to
supply to Alltran to identify the notification and application
period? How should Alltran direct your patients to apply for FAP? a
formal determination of eligibility. ** Note - that if your
facility never intends to pursue any ECAs you do not need to prove
reasonable efforts.
17. How will your facility communicate any new and ongoing FAP
applications to Alltran? A partnership with Alltran means that
patients expressing financial hardship will receive professional
assistance that reflects your values. When you provide us with your
toll-free number and/or website address, our collection agents are
able to act seamlessly on your behalf, helping patients resolve
their debt. Alltran collection agent, supervisor, and management
training and continuing education programs are essential to total
compliance. All new Collection Agents are required to attend our
comprehensive, in-house training. We track progress and conduct
annual tests to evaluate program completion and effectiveness.
Curriculum topics include: What is 501(r)? How does 501(r) affect
non-profit hospitals? How does 501(r) affect Alltran?
Client-Specific Handling FAP Handling Extraordinary Collection
Activities 501(r) Timelines Alltran managers regularly complete the
same training tests as their team members to stay current on
industry changes and be optimally prepared to field employee
questions. Our Collection Agents assigned to your accounts will be
prepared to use your provided, plain-language FAP summary. Our
initial written communication with a patient will include this
language: The Healthcare Services Provider(s) listed above may
provide financial assistance for eligible persons who cannot afford
to pay for medical care. Financial assistance eligibility is based
upon documented family circumstances and family size. If you need
assistance in contacting the Healthcare Services Provider regarding
their financial assistance policy, please contact us at and we will
provide contact information for the appropriate Healthcare
Provider(s). Collection agents will also be equipped with carefully
written and approved scripts. Any changes or special alerts appear
instantly on the agents screen.
18. Make Alltran Your Partner in ACA 501(r) Compliance When we
assist you with 501(r) compliance, our people, processes, and
technologies minimize your administrative and resource burdens. Let
us partner with you so that you are free to focus on what you do
best. About Alltran Alltran provides highly effective and
Compliance-Ready Inventory Management with Artiva Alltran leverages
the Artiva collection system from Ontario Systems to design and
automate workflows for optimal compliance within a changing
regulatory landscape. The technology allows us to record and
monitor calls and substantiate the delivery of alerts and/or
scripts. The results of monitored calls are maintained in a
Complaint and Dispute Management Application (CDMA), which provides
360-degree complaint and dispute resolution. Account numbers can be
individually loaded such that reporting is delivered to you based
on individual episodes of care. Importantly, data fields can be
designated 200 14th Ave E, Sartell MN 56377 1.800.692.7374
[email protected] Copyright 2016, all rights reserved NEW Alltran
leverages the Artiva collection system from Ontario Systems to
design and automate workflows for optimal compliance within a
changing regulatory landscape. The technology allows us to record
and monitor calls and substantiate the delivery of alerts and/or
scripts. professional third-party debt collection services. Since
its onset in 1977, Alltran has excelled in the healthcare market.
Our sensitivity to patient satisfaction and dedication to sound
business practices are evident in the results we deliver to our
loyal clients. We want to partner with your healthcare organization
so that you can focus on what you do best. Your success is our
mission.
19. Compliance Management Systems: a Process, Not a Product
From conferences to sales pitches to webinars -- its likely that at
some point youve seen the phrase Compliance Management System or
its acronym CMS. This is not to be confused with a Contact
Management System or a Complaint Management System which also share
this acronym. Compliance Management Systems are required by the
Consumer Financial Protection Bureau (CFPB) for collection agencies
of all sizes. In fact, the CFPB has been very clear that
organizations can build and scale a CMS that matches the size and
complexity of their organization, while addressing the unique risks
inherent to the companys collections or services. A small companys
CMS does not have to be identical to that of a large-market
participant. The goal is to get to the same end- point which is to
maintain compliance with regulations and treat consumers fairly and
with respect. An important clarification is necessary in that a CMS
does not describe a software program which is simply purchased and
installed within the organization. Its not that easy, reputable CMS
vendors will not only supply you software but also engage your
organization in using that system to develop an effective CMS
program. CMS software will help you manage your compliance
procedures, but it is not the most important element of a
successful CMS. A CMS describes a complement of policies,
procedures, and, in some cases, software components. As stated in
the title of this article: a CMS is a process, not a product. The
CFPBs Supervisory and Examination Manual spells out four
interdependent control components for a CMS: Implementing board and
management oversight Implementing a compliance program Consumer
complaint handling Conducting compliance audits Well take a quick
look at these components, and offer some tips. Implementing Board
and Management Oversight This doesnt necessarily mean you have to
have a board of directors, especially if youre a small collection
agency. The expectation of the CFPB is that there is an established
governing body that holds regular meetings where compliance and
operational oversight are topics. The governing body should have
the authority to make operational decisions for the organization.
Your compliance officer or committee representative will report any
information about nonconformities, requirements for policy and
procedure updates, a review of complaint analytics, and litigation
information involving the organization. The Board of directors or
governing body is expected to adopt and approve the policies and
procedures regarding consumer compliance. The CFPB expects the
governing body to drive compliance and to allocate resources to
support the size and complexity of the organization so that it can
comply with the consumer financial laws and avoid consumer harm.
Implementing a Compliance Program Your compliance program should
include documented policies, procedures and processes which are
true representations of what your organization believes and how it
conducts business. The organization should be able to demonstrate
that the policies, procedures, and processes are followed on a
daily basis. If audited, it will be more damaging to your
organization if the policies and procedures are not in compliance
than if no documentation existed. The lack of compliance to your
own beliefs will call your entire documentation suite into
question. Consumer Compliant Handling The CFPB broadly defines
complaints as a consumers expression of dissatisfaction with a
product or service. As a first step it is important to define the
difference between a complaint and a dispute and document how your
organization disseminates and tracks each. Your CMS processes
should also have a policies and procedures which call for a review
of any complaint received and outline your communication schedule
to consumers when a complaint is logged.
20. Conducting Compliance Audits The CFPB expects that
collection agencies will perform internal (in-house) and external
(3rd party assessment) compliance audits. This will likely will be
a time consuming process but one that will provide useful insight
into your organization and will expose the gap between what is
written down and what is actually happening. Where possible,
leverage your host recovery system to provide you with an analysis
of your accounts against the expected outcomes. Investments in
systematic alerts and a reports are well worth money to ensure that
you are in compliance. A Compliance Management System describes the
processes your agency is engaging with in pursuit of compliance and
consumer protection. There is no simple way to launch and manage an
effective Compliance Management System. It is a lengthy and
expensive endeavor to engage in but one that is well worth it when
done well. Complaint tracking and trend analysis is an important
element of your CMS and should be included in your analysis and
procedure management. Part of your regular board meetings should
include a review of consumer complaints and the efforts/actions
that went into resolving them. 200 14th Ave E, Sartell MN 56377
1.800.692.7374 [email protected] Copyright 2016, all rights reserved
NEW Derek Scheskie Director of Operations Derek has more than 20
years of Accounts Receivable Management (ARM) experience. Since
joining JCC in 2004, his aptitude for collections systems
technology, strategic planning and management, and client relations
has resulted in significant growth within Alltrans financial
collection division and consistent performance among our scored
portfolios.
21. Medicaid Eligibility: The High Price of Free Healthcare The
four saddest words in todays healthcare industry: Put it in
writing. Healthcare has become a sea of paper and supporting
documentation (or e-records). In spite of efforts to the contrary,
ink bleeds into every corner of the industry, both on the clinical
and revenue cycle side. It will come as no surprise to anyone in
healthcare that the difference between getting paid or writing off
an account to bad debt can be as little as a signature on a single
form or providing appropriate documentation. When it comes to
government healthcare programs--especially the subject of this
article, Medicaid--bureaucracy has and continues to drive the
financial engine. While some healthcare providers became adept on
the mechanics of the process, patients were overwhelmed. From its
inception in 1965, Medicaid has required that patients and/or their
families fill out an application and provide financial and medical
information, depending upon what aegis of the program they fell
under. If the boxes were not checked, the fields not filled out,
the signature not made, documentation not provided, outstanding
treatment dollars for Medicaid patients slid into bad debt and
patients did not receive the ongoing coverage for care they
desperately needed. Over time, providers lost significant Medicaid
reimbursements because of misunderstanding changing regulations,
missing patient information,
lackofpatientengagementandconsent.Acottage industry of patient
advocacy firms grew up to better connect the dots between provider,
patient and the government. Now, along comes the Patient Protection
and Affordable Care Act, which included the opportunity for the
states to expand Medicaid along with offering healthcare insurance
coverage. Thirty-two states and the District of Columbia agreed to
some version of expansion, and take up the federal government on
its offer. One of the purported benefits, in addition to greater
federal reimbursement (at least initially) was that the application
process would go online, and, in theory at least, become more
streamlined. TheprocessofmovingMedicaidapplicationsonline has
mirrored the health insurance exchanges/ marketplaces. Some states
have elected to create their own portals, some operate portals
jointly with the federal government, and others have opted to
havethefedsruntheportalaltogether.Wearenow two years into Medicaid
expansion and our clients in those states that accepted it are
seeing some measurable improvement in the level and quality of care
for certain low income populations. While moving the application
process online has been an improvement, the need for patient
advocacy has not disappeared. Many Medicaid- qualified patients
still fail to properly fill out forms or continue to submit
incomplete or inaccurate financial and medical information. Many
times the data accessed electronically is inaccurate or simply
doesnt exist.
22. While the application process has been
streamlined,thechallengesfacedbypatientswho potentially qualify for
Medicaid have not entirely changed, among them: Lack of access or
understanding of the technology. Despite the omnipresence of the
internet, several Medicaid eligibles dont have access to it or,
what is probably more common, an aversion to using it due to
confusion about the process. Cultural bias. There are those who may
be qualified Medicaid patients whom are immigrants and potentially
considered (depending upon the program and status) qualified
aliens. However, they may originate from countries where they have
learned from an early age not to trust the government, a belief to
have matters handled within their own family or community as well
as language barriers. Higher priorities elsewhere. Several Medicaid
eligibles have to make difficult choices about utilizing their
limited resources and time. Do I go to work or complete a financial
assistance application? Do I spend money for food or on a taxi to
get a birth certificate? Do I pay a medical bill or keep the lights
on for another month? Medical conditions limiting patients ability
to comply with the application process. Many times qualified
Medicaid eligibles have a medical condition (physical or
behavioral) which hinders their ability to complete the process to
obtain coverage. This in essence, can be the difference between
getting healthy and dealing with a much more serious health dilemma
that can be fatal. If therearenofamilymembersorguardianswhocan be
the voice of these patients, they continue to be at risk. As
healthcare providers have learned, the need for patient
intervention is not going away with expanded Medicaid. If anything,
it has become more nuanced and in some cases more difficult due to
the misconception of ease. At the same time the stakes have grown
much higher since reimbursements from other revenue sources are
shrinking dramatically. In the next article, well look at ways that
providers can fine-tune their patient championing efforts to get
the most from their limited resources. The Challenge for Healthcare
Providers The challenge for healthcare providers is not Medicaid
eligibility; the challenge is making sure 200 14th Ave East |
Sartell, MN 56377 | 888-340-7243 | www.alltran.com
23. those that are eligible for Medicaid get enrolled
correctly. I outlined some of the obstacles healthcare providers
face enrolling Medicaid eligibles. Despite the advances that
resulted from the Patient Protection and Affordable Care Act,
specifically by moving the application process online, many
qualified Medicaid patients continue to slip between the cracks and
from there slide into bad debt. For healthcare providers, the ACA
is mostly good news with relation to Medicaid, at least in the 32
states and District of Columbia that consented to some version of
expanding the program. By increasing the income range under which
patients qualify a greater number of low income individuals can get
the level of care they require and better clinical outcomes.
Healthcare providers are still required to work with patients to
assist with the financial assistance process. Even though more
people qualify for Medicaid, they still are required to complete
applications and have some level of income verification and,
depending upon the program, supporting evidence of qualifying
medical conditions. While providers understood that the number of
Medicaid eligible patients under the ACA would increase, there also
was a perception by many that the new streamlined application
process would absorb the need for any additional resources to
manage the growing volume.
Thisresultedinmanyproviderstakingthefollowing steps: Some reduced
staff and resources to those departments or individuals responsible
for patient application intervention with the expectation that the
new streamlined process will result in fewer Medicaid eligibles
getting away. Others relied on Navigators or in-person assisters
provided by the state or federal
governmenttobeavailabletopatientswhohave questions or dont
understand the process. Still others maintained or even increased
budgets for patient advocacy efforts, but found that despite the
increased resources the number of Medicaid eligibles slipping into
bad debt has increased. At least in our experience, many healthcare
providers are coming to the realization they underestimated
potential website, data, and application limitations and the sheer
volume of potentially qualified applicants. They found that the new
online application process, though more efficient, has not
eliminated the need for patient intervention to help complete
applications, obtain supporting documentation, and correct
application errors. There is still a need to track the states
progress on making timely and correct decisions due to increased
volume. Many have observed that this has not been an entirely
smooth transition and
unfortunatelythereisstillaneedtofilefairhearings and appeals. The
challenge for healthcare providers is not Medicaid Eligibility; the
challenge is making sure those that are eligible for Medicaid get
Copyright 2015, all rights reserved NEW 203A Author: Sherry Dobbs
Manager, Medicaid Eligibility Operations 200 14th Ave East |
Sartell, MN 56377 | 888-340-7243 | www.arlltran.com
25. Systemic changes in how healthcare is deliv- ered and paid
for have increased the volume and complexity of transactionshigh
deductibles, co-in- surance, and co-paysand shifted payment respon-
sibility to the patient. The resulting business issues have left
many hospitals grappling with decreased patient-portion
collections, high collection costs, and bad debt. Many are also
observing coinciding, troubling drops in patient satisfaction.
Trinity Health was perhaps especially impacted by the changes due
to its largely transient patient pop- ulation. The sheer volume of
patients coming and going made patient-portion collection
difficult. Fur- thermore, thoroughly educating patients about their
financial responsibilities in the transitioning environ- ment was
near impossible. The processes they had in place did not match the
updated payment climate, causing an unpredictable revenue stream
and ebbing patient satisfaction. These circumstances did not al-
low for optimal organizational health. Leadership at Trinity Health
recognized that to con- tinue delivering the best care, its
operations must be healthy, too. Cash flow is a strong indicator of
organi- zational health, and management knew they faced a critical
challenge to align the consistently high quality of patient care
for which they are known with basic operational imperatives. We
realized the immediate need to get in front of our patients, sooner
than later, with a point-of-service
modelthatwasbothcustomerfriendlyandfinancially sound for Trinity
Health, explained Trent Chastain, vice president, Revenue Cycle.
After careful vender analysis, Chastain and his team selected
Alltran Health as their partner to design and implement a patient
access model that would improve outcomes and decrease costs
26. of payment collections. Alltrans consulting groupled by
Chuck Seviour, Vice President of Consulting
waschosenduetotheirexperiencewith identifying the most urgent
challenges, creating integrated plans that address issues
systemically, and implementing long-term solutions with innovative
policies, processes, and tools that exactly match the defined
business needs. The two enti- ties initiated the patient access
engagement with these guiding principles: Maximize cash collections
at patient access Identify community care opportunities early in
the billing process Improve patient satisfaction through
communication and education Solution Design Staff Identification
and Buy-In For the patient access engagement to be a success,
Seviour and his consulting team needed participa- tion and buy-in
from the key Trin- ity Health managers and staff of relevant
patient access areas. This included department leaders with spe-
cific responsibilities related to self-pay and patient access
opportunities from these areas: Case Management Support Services
Physician Services Patient Access Pre-Certification Nursing
Critical Care ETC They then analyzed areas with poten- tial for
cash collections and further detailed the staff involvement list to
include team members and managers from: Clinic Registration Clinic
Scheduling Outpatient Surgery Emergency Department Admitting
Financial Counselors Once key players were identified, the
AlltranHealthteamexplainedthevision for the project, the potential
changes, and how each group would be affected by these changes.
They also detailed how the successful adaptation of these
changeswouldmakewayforsubstantial improvement in day-to-day and
overall operations. Setting Parameters for New Policies and
Procedures Critical to the patient access engage- ments success was
working with each department to ensure that any pro- posed changes
would be absolutely necessary and create the intended outcome.
Setting parameters began with an audit of current procedures to
assess what needed to change versus what was currently working
well. The consulting team examined and pri- oritized the previously
identified areas for potential cash collection while also
soliciting feedback from those whose roles would be most impacted
by the changes. Below is a sampling of the ini- tial, agreed-upon
adjustments for staff within clinics as well as the hospitals
Emergency and Same-Day Surgery De- partments. Leveraging the Role
of Financial Counselors Trinity Health has long recognized the
significant role financial counselors play in day-to-day self-pay
operations. In the quest for increased cash flow and improved
patient satisfaction, the responsibilities of financial counselors
willbecomeevenmoreimportantatev- ery point of contact along the
payment continuum. One integral aspect moving forward is that
financial counselors will take on tasks typically shared between
coun- selors and call center representatives. For example,
counselors will make calls to all scheduled patients regarding up-
cominginpatientandoutpatientproce- dures. They will discuss fiscal
responsi- bility and request that the payment be made at the time
of service. They will also follow up with Clinical or Surgery
Department patients who did not pay their co-pay amount at the time
of the visit. This approach is intended to en- hance relationships
by offering a single- point-of-contact for concerns about self-pay
responsibility and payment ability or options.
27. Department Alignment Midway through the Trinity Health-
Alltran Health engagement, the teams arranged an onsite visit to
confirm continuity with clinics, hospital ar- easincluding prior
authorization and pre-certifications staff that compiles
out-of-cost potentialand financial counselors. Alignment activities
were centered on communication and training. Communication Staff
members were interviewed to determine their awareness and
understanding of the pending changes. When it was clear that the
initiative to increase patient access collections was fully
understood, the consultants and Trinity team leaders solicited
feed- back to identify and address potential impediments to a
smooth acceptance and implementation of these chang- es. They also
highlighted the positive impact increased cash flow would bring for
each specific area. Training Alltran Health designed the train- ing
according to the needs and func- tions of staff in each department
and role. In addition, all staff re- ceived uniform training
regarding the compassionate, courteous, and digni-
fiedtreatmentofTrinityHealthsvalued patients. Training will be
ongoing, yet it has already been an advantageous op- portunity for
further communica- tion, as well as a trial run to determine
whether additional changes or tweaks to the new procedures will be
neces- sary. For example, the Support Ser- vices group represented
the largest re-alignment of responsibilities and was considered to
have the most impact on Trinity operations, its finan- cial
counselors, and its patients. The comprehensive training included
instruction, Q&As, videotaped sessions, and role-playing with
pre- written patient-interaction scripts. Whats Next? Not long ago,
Trinity Health went live with the revamped patient access
procedures. Trinity Health and All- tran Health agreed that a
reason- able period of time must be al- lowed for patient education
to strengthen and take hold before data collection will accurately
reflect the impact of the changes on patient ac- cess cash
collection. Still, Trinity Health and its patients are already
benefit- ting from the initial effects of these changes. The two
entities mutually embrace the philosophy that true and lasting
organizational change relies on the consistency of effort toward
matching strategies with the overarching vision and clearly defined
goals. Trinity Health management monitors day-to-day activities to
ensure that policies are followed and patient interac- tions are
conducted accord- ing to the previously agreed-upon scripts. The
Alltran Health team remains in regular contact to support the
implementation, flag opportunities for additional training, and
field ques- tions or thwart possible roadblocks to progress. Future
plans for the project include tracking and quantifying data to
analyze the programs efficacy and leveraging data toward its
long-term success. Leadership will also create incentives for
current and new staff members to reach their individual,
departmental, and organization-wide goals. As more areas within
Trinity Health are working to collect self-pay dollars from
patients at point-of-service, the organization is already
demonstrat- ing that its unbending commitment to patients is
compatible with operational efficiency and efficacy. Collecting
self-pay patient requirements will increase cash flow. Educating
patients about their financial responsibilities will help patients
better understand their out-of-pocket costs and obligations. The
results so far point to improved processes, stronger patient rela-
tionships, and an overall healthier organization. We realized the
immediate need to get in front of our patients, sooner than later,
with a point-of-service model that was both customer friendly and
financially sound for Trinity Health 200 14th Ave E, Sartell MN
56377 1.800.692.7374 www.alltran.com Copyright 2016, all rights
reserved NEW
28. Turning the Corner from Volume to Value Like it or not, the
Center for Medicare and Medicaid Services (CMS) has turned from
Fee- for -Service (FFS) to Pay-for Performance(PFP)ora
ValueBasedPurchasing(VBP)model. The question is not whether or not
providers, hospitals and systems are ready to let go of those
margins, but rather what can they do to mitigate risk today and
protect the Revenue Cycle of tomorrow? In the largest industry in
America, healthcare providers are facing yet another perfect storm
of Federal regulation and legislation. Today, were going to discuss
three recent factors that if left unchecked, may negatively impact
the Revenue Cycle in the near future. The Elimination of FFS and
other volume-based reimbursements models by CMS CMS growing
reliance on the Consumer Assessment of Healthcare Providers and
Systems (CAHPS ) The Patient Protection & Affordable Care Act
(PPACA,) with now nationally required pricing transparency and
patient engagement Value Based Healthcare In late January 2015, CMS
identified the benchmark of 30% of 2016 claims that must be value
based, this target increases to 50% in 2018. CMS announced exactly
the types of value based healthcare that participating providers,
hospitals and clinics need to be adopting: FFS with a link of
payment to quality, which includes hospital value-based purchasing,
Physician Value-Based Modifier, the Readmissions/ Hospital Acquired
Condition Reduction Program. For these models, a portion of
payments vary based on the delivery of quality & efficient
healthcare. Alternative payment models built on FFS architecture:
Accountable Care Organizations (ACOs,) Patient Centered Medical
Homes (PCMHs,) Medicare-Medicaid Financial Alignment Initiative FFS
Model. For these types of reimbursement models, some of the payment
is linked to effective population management and coordinated care.
Population-based Payments, Pioneer ACOs (now in years 3-5 since
inception) may participate in this reimbursement model. Payment is
not directly triggered by service delivery, so volume is not linked
to payment. Providers, Hospitals and Clinics are responsible for
the coordinated care of the beneficiary for one year or more. CAHPS
Although CMS has been using patient survey tools for decades,
recently these tools have been increasingly linked to Prospective
Payment System (PPS) reimbursement. The
29. 200 14th Ave East | Sartell, MN 56377 | 888-340-7243 |
www.alltran.com goal of these surveys is to standardize, track and
gauge the propensity of desired behaviors within the care
continuum. H-CAHPS (Hospital) were first on the scene. They track:
Communication with Doctors and Nurses, Staff
Responsiveness,PainManagement,MedicationandDischarge Instructions,
and the Cleanliness/ Quietness of the Facility. Hospitals are
required to complete approximately three hundred surveys (per year)
within 6 weeks of discharge (e.g., medical, surgical, labor and
delivery patients.) Hospitals are well served in establishing
propensity baselines within their facilities, then working in small
incremental steps toward top- box scores. Many successful models
incorporate patient feedback and committees in go-forward
improvements and efficiencies. CG-CAHPS (Clinician Groups) track 5
domains: Overall Provider Rating, Access to Care, Discharge &
Follow-Up, How well the Doctor Communicates, and the Courtesy &
Helpfulness of the Staff. As Providers are working to educate and
engage their growing patient base; their payment from the largest
payer in America is also increasingly dependent on soft skills.
Consumers seek compassionate, competent care in a convenient
setting that save(s) them time, money and effort. The PPACA
Providers, Hospitals and Systems are now flooded with newly minted,
nationally mandated patients who either require an incredible
amount of financial & health literacy education; or have become
truly savvy healthcare consumers with the loss of their first
dollar coverage and increasing pricing transparency. This
consumerism dictates that providers meet patients when and how they
want to be treated-or they
willleavetheprovider,practiceandfacilityandtaketheirdollar to
another network-possibly for the rest of their lifetime. As CMS
continues to forge the journey towards Value Based Purchasing (VBP)
providers, hospitals and systems seek to attain, and then sustain
the triple aim in Healthcare (Population Health Management,
Decrease Per Capita Cost, and Improve the Experience of Care.) CMS
has determined and released a timeline for conversion from Fee-
for- Service (FFS) to Pay -for -Performance (PFP). Currently 20% of
Medicare services are value-based, by 2016-30% of claims need to be
PFP and in 2018, a solid 50% will be required. This means a large
percentage of Medicare
beneficiarieswillbetransitionedtothesenewmodels. Further
complicating this charted course is the looming large and yet
pending, national conversion to ICD-10 which has been delayed more
than once to date. Models Are Changing The move from FFS means that
Medicare patients will soon become part of a VBP model (e.g., ACOs,
Patient Centered Medical Homes {PCMHs,}) these outcome based,
reimbursementmodelsnecessitateanewlevelofcoordinated care and
communication within the continuum. The
30. In late January 2015, CMS identified the benchmark of 30%
of 2016 claims that must be value based, this target increases to
50% in 2018. Copyright 2015, all rights reserved NEW 204A 200 14th
Ave East | Sartell, MN 56377 | 888-340-7243 | www.alltran.com from
their smartphones while they wait in your lobby, or at their house,
or anywhere else the internet may reach.
Inconclusionproviders,hospitalsandsystemsshouldresolve to enhance
their current models to meet the consumer in the
newhealthcaremarketplace-whichchampionsconsumerism and all that
entails. Many areas of the country are finding that their consumers
now want telehealth/ virtual appointments & walk-in or minute
clinic convenience options.Providers, hospitals and systems have
started to incorporate departments devoted to tracking patient
outcomes; a similar model focused on patient engagement and
education will mitigate risks today and protect the revenue cycle
into the future. reimbursement stakes are raised by increasing
percentages being based on the patients experience of care
(surveyed through CAHPS .) Now that CMS readmission penalties are
becoming more than a nuisance (up to 3% may be at risk,) and in
2014, 2,610 hospitals have incurred said penalties; some providers
and facilities are looking to coordinate care with pharmacies that
can help reconcile and mange (facilitate & report back)
medication compliance, track and share population health data, and
take care of the follow-up phone calls -made to the patient at Day
1, 3, 10 and 30. Providers tend to agree consumers are usually more
compliant with prescriptions if they have them upon discharge- or
can get them onsite. With an enhanced focus on appropriate access
and utilization, healthcare service providers are squarely in the
hot seat of delivering coordinated care across multiple platforms;
while educating and engaging their growing patient base with less
time and fewer resources. All this, while consumers demand a higher
level of compassionate care delivered how, when and where they want
to be treated. Education and Engagement
Manyoftodayshealthcareconsumersdontunderstandcore concepts of their
healthcare coverage, and their newfound coverage doesnt guarantee
appropriate access. For many consumers that do understand the
financial responsibilities of a $6,000.00 family deductible- they
may delay seeking treatment, until emergent care is
needed-therefore receiving high resource intensive care in an
inappropriate treatment setting (e.g., chronic &/or comorbid
conditions such as diabetes and heart disease being treated in the
ED.) The key for providers, hospitals and systems is to jumpstart
their patient facing education and engagement today, many times by
extending the continuum of care into the front of the office. For
many revenue cycles, battles are won and lost at the front line
(i.e., Pre Access Staff.) They can also ensure their patient
accounts representatives have the communication skills needed to
work with peoples two biggest triggers: their health and their
money. Many times, simple tools like roleplaying, sample scripting
options, and incentivized collection contests empower employees to
ask for that co- pay, co-insurance (coin) and deductibles. Patient
Portals are good for more than taking payments and scheduling
appointments; they can also effectively and efficiently educate
patients about their condition or disease, define commonly
misunderstood health and financial literacy terms and generally
engage consumers
31. Case Studies
32. COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED.
Improving Accounts Receivable Strategies Through an External
Partnership During the last several years, the number of mergers
and acquisitions deals has increased within the health- care
industry, rising to 328 in Q3 2015 according to Modern Healthcare.
These expansions can help organi- zations achieve economies of
scale, cost reductions, or increased market share and patient
volumes; however, they may also prompt organizations to re-evaluate
or revise current rev- enue cycle processes to enhance financial
performance. HealthPartners, the largest con- sumer-governed
non-profit health- care organization in the nation, has experienced
a similar situa- tion in light of its continued growth through
acquisitions and combina- tions of healthcare systems within its
family of care organizations. These changes not only expanded the
number of physicians and specialties, but also increased
outstanding accounts receivable (A/R). HealthPartners Medical Group
(HPMG) is part of HealthPartners, an integrated health care
organization with 22,500 colleagues serving more than 1 million
patients and 1.4 million health plan members annually. The
aforementioned A/R trend prompted HPMG to revise its A/R model,
reorganize its internal billing team, and more effectively leverage
its collabora- tive 10-year partnership with ProSource Billing,
resulting in a reduction in aged receivables. Challenges As HPMG
expanded its services and volume base, revenue cycle leaders
observed A/R over 90 days increase to 18%, in comparison to its
1012% best practice benchmark. This raised concerns surrounding
claim timeli- ness and revenue capture for growing or high-dollar
producing areas, par- ticularly specialty business lines such as
chiropractic and neurosurgery. In addition, HPMG recognized an
opportunity to improve its A/R model. Previously, HPMG and
ProSource, which operate an internal and exter- nal billing team,
respectively, used traditional methods to divide claims Rise in %
A/R > 90 at HPMG Amidst System Growth As the number of
physicians and specialties grew, so did A/Rprompting HPMG to
re-evalu- ate its approach. 1012% 18% Historic Benchmark A/R >
90 During Expansion Highlights Profile HealthPartners Bloomington,
Minnesota Employees: 22,500+ Affiliated Physicians: 1,700+ NPR:
$679 million Challenge With HealthPartners continued growth,
leadership observed an increase in A/R over 90 days Increasing A/R
raised concerns about the timeliness of working receivables
postclaim submission HPMGs internal billing team and ProSources
external team were split by payer type, preventing staff from
working accounts across payer lines or based on denial trends
Solution HPMG implemented a new A/R model that assigned claims by
specialty busi- ness lines and adjusted workflows to improve
efficiency Dashboards were created within the practice management
system so lead- ership at HPMG and ProSource could monitor
performance and identify trends Training helped familiarize select
staff with their assigned service line as well as its applicable
codes and trends Results Multiple specialty areas reported
improvement such as lower A/R days and % of A/R days over 90 The
dashboard provides leaders at HPMG and ProSource added trans-
parency and insights regarding finan- cial performance The
universal biller model increased staff knowledge and added greater
fluidity to the billing process Adjusting Biller Specialization
Working with ProSource to enhance the model for billing teams
helped HPMG improve its A/R management. A payer-line split made it
difficult for billers to work across denial trends leading HPMG to
move to assigning billers claims by clinical specialty
33. Improving Accounts Receivable Strategies Through an
External Partnership
COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. between the
two teams including financial class, special billing programs,
andultimatelya payer line split. Leadership recog- nized that under
this current model, billers were unable to work outstanding
receivables across payer lines or based on identified denial
trends, which may span across multiple payers. To more
strategically optimize A/R and its partnership with ProSource, HPMG
began investigating other A/R models that would allow greater
fluidity of work between billers and focus on service lines that
generate the most revenue. Solution HPMG selected a solution that
invests in and capitalizes on its most valuable resource: people.
To maximize in-house staff per- formance and leverage the external
billers knowledge of all payer lines, HPMG decided to assign claims
according to specialties, creating a universal biller model built
upon many staff members pre-existing skill sets. HealthPartners
historically worked in silos by working accounts on a payer split
whereas ProSource was well-versed in all payer lines, says Jerry
Hammock, Operations Manager of Patient Accounting at
HealthPartners. We wanted to leverage that knowl- edge on the team
to more effectively cycle through existing A/R as well as new A/R
from recent growth. HPMG used a multifaceted strategy to determine
which specialty service lines would be worked under the new model.
Several spe- cialties were chosen based on level of aging
receivables, high- dollar nature, or pre-existing challenges. Other
specialties, like cardiology and behavioral health, were selected
since their charge capture is managed at the hospital level rather
than at the cen- tral revenue cycle. The model aimed to provide
leaders in these areas a cleaner snapshot of their financial
performance. This new strategy also built upon the strong, 10-year
partnership shared by HPMG and ProSource. HPMGs close relationship
with ProSource helped smooth the transition to this new model since
both billing teams worked directly in HPMGs practice management
system. Therefore, lead- ership restructured and reassigned certain
billers to unique, spe- cialty-focused work queues within the
system, and billers worked accounts consistently by following the
same workflows, policies, and scripting. The process was relatively
quick and seamless because the foundation was already there and the
teams had good synergy, states Hammock. With the in-house and
external billers both working in the same practice management
system, we updated the rules and logic to shift how the accounts
were divided between the billers and adjusted the filters to create
the most efficient workflow. To gauge the effectiveness of this new
strategy, HPMG ini- tially implemented the A/R model in a pilot
form for specialties accounting for approximately 14% of their
total A/R. Leadership was transparent about the logic behind the
pilot program and engaged billers who were willing to learn new
rules and payer lines. Training was provided to familiarize billers
with their assigned specialty, its corresponding codes, and past
trends. In addition, leadership captured baseline metrics and
created sepa- rate dashboards within the system to subsequently
monitor the performance of each specialty segment in terms of
denials, edits, and age of receivables. This process, despite
initial productivity losses due to training, helped validate the
effectiveness of the strategy and obtain leadership buy-in
following preliminary results that showed a prominent reduction in
the age of receivables. Since the initial pilot project, the number
of specialties included in this A/R strategy has expanded to 26% of
total A/R with contin- ued positive results. Results More than a
year after the new model began, HPMG and ProSource have used the
systems dashboard to record improve- ment within a variety of the
specialties, including decreased A/R days and percentage of A/R
over 90 days, among other metrics. In particular, neurosurgery
reported a 34-day reduction in A/R days and a 16 percentage point
decrease in A/R over 90 days, while chiropractic services recorded
a 19-day improvement in A/R days and a 13 percentage point decrease
in A/R over 90 days. Overall, we have a very collaborative working
relationship with ProSource and truly consider them to be an
extension of our in-house team. We have strong communication and
weekly interaction with their leadership to perform vendor manage-
ment and oversight functions. Deanne Loehr Senior Director Revenue
Cycle HealthPartners HPMGs A/R Metrics Pre- and Post-Solution
February 2014 April 2015 A/R Days A/R > 90 Days Burn Chiro Neuro
129 100 54 35 68 34 Burn Chiro Neuro 40% 26% 18% 5% 36% 20%
34. Improving Accounts Receivable Strategies Through an
External Partnership
COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. These types
of metric snapshots have proved beneficial due to their added level
of transparency and insights surrounding HPMGs financial
performance, especially for growing service lines. The success of
this initiative was driven in part by the fact that HPMG and
ProSource directly worked accounts in the same system. Working in
the same system and viewing the same internal dash- boards not only
helps quickly identify and resolve negative trends, but it also
allows us to leverage a partner that can provide valuable advice
and recommendations, says Tammy Hughes, Operations Manager at
ProSource. Through checks and balances during daily communication,
we can pinpoint easier processes, learn why one team experienced
greater success, or identify educa- tional gaps. It is a beneficial
partnership. With the dynamic nature of the healthcare industry,
HPMG and ProSource have also found the universal biller model
beneficial since it challenges staff professionally, making them
more well- rounded and knowledgeable. This has added greater
fluidity to the billing process since staff are more comfortable
working across payer types and shifting their work based upon
changes within the industry or organization. The billers are also
encouraged to use their experience and deductive reasoning to
prompt further improvements in the A/R model. Throughout this
entire process, we have realized areas of improvement within the
revenue cycle and developed specific strategies to attain new
goals, says Kelly Heyn, Senior Manager of Revenue Cycle at
HealthPartners. Despite challenges that have arisen, we have stayed
on course and consistently tried to work smarter, be proactive,
enhance the patient experience, and lever- age our system
capabilities so staff can develop professionally and work
effectively. About ProSource Billing ProSource offers a full range
of revenue cycle management ser- vices that are designed to
seamlessly support and enhance the operations of any size
organization. Our programs offer solutions for your outsourcing
needs in the areas of billing, claims, payment receipt, and more.
We are an extension of your organization, representing your mission
and values, and treating your customers in a manner that aligns
closely with your mission. All programs are tailored to your
specifications. For more information, please visit:
arraysg.com/prosource With specialty service lines accounting for
14% of HPMGs total A/R, improvements in these areas were
particularly impactful. Specialty Business Lines (e.g.,
Chiropractic Care and Neurosurgery) as % of HPMGs A/R 14%
35. COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED.
Leveraging Presumptive Charity Care to Improve Collection Efforts
and Increase Revenue With patients accepting more responsibility
for their healthcare costs, hospitals and health systems must find
a way to collect as many self-pay dollars as possible. HBI research
shows that healthcare organizations continue to write off more than
14% of net patient revenue to uncompensated care, which includes
charity care and bad debt. Determining which accounts to write off,
when to do so, and how to classify write-offsas bad debt or charity
carecan affect different aspects of business. Not only do
write-offs impact an organizations A/R, but they also impact
collection efforts, vendor relations, and staffing. HBI research
also shows that organizations have increased charity care levels,
which cor- responds with a revision in charity care policies. To
improve the allocation of charity care, some organizations are
planning to implement a number of strategies including using
vendors, technology, or internal criteria to classify accounts as
charity care if patients are unable or unwilling to complete
charity care applications. This process is called pre- sumptive
charity care and has been implemented by a growing number of
healthcare organizations. Rolene Lampi, Director of Business
Services at St. Lukes Health Care System, shared her organizations
experience with implementing a presumptive charity care process.
The Challenge St. Lukes Health System is comprised of two
hospitals, two pharmacies, 14 pri- mary care clinics, and 24
specialty care clinics located in Duluth, Minnesota. Leaders
decided to reorganize the way they handled charity care due to the
Minnesota Attorney General Hospital Agreement, which is a list of
provisions that outline approved methods hospitals can use to
collect a patients financial responsibility. St. Lukes must
continue to follow those regulations to maintain its non-profit
status and continue to reap the benefits. Furthermore, St. Lukes
was driven to appropri- ately identify charity care after receiving
only a 50% response rate on charity care applica- tions. In 2009,
St. Lukes began researching options to help patients with the
applications. The Solution Lampi researched presumptive charity
care and decided this was an effective process since it could
potentially improve collection efforts. St. Lukes partnered with a
first-party self-pay vendor in 2009, and since then it has been
using the vendors technology to segment accounts that are eligible
for presumptive charity care. The vendor uses both proprietary and
publicly available patient population data and then applies St.
Lukes pre- sumptive charity care rules. Next, the vendor sends a
file recommending accounts that should be sent to bad debt and
accounts that should receive the charity care discount. St. Lukes
uses the vendors findings to appropriately classify the percentage
or amount of charity care to allocate on each account. Its very
important to us that we dont apply two types of charity care to one
account, says Lampi. If a patient received another type of discount
during the revenue cycle, Highlights Profile St. Lukes Health Care
System Duluth, Minnesota Beds: 292 NPR: $844 million Challenges St.
Lukes has to work within the Minnesota Attorney General Hospital
Agreement, which regulates the meth- ods state hospitals use to
collect from patients The health system was only receiv- ing a 50%
response rate from char- ity care applications, which increased bad
debt The business office needed to research for additional ways to
get patients to respond to charity care offerings Solution St.
Lukes implemented a presumptive charity process with a first-party
ven- dor, which allowed the health system to further segment its
A/R Each account was allocated the appropriate percentage or amount
of charity care, based on the vendors findings The health system
also centralized collection efforts by signing an exclu- sive
agreement with JCC Results In 2009, JCC was receiving $9.8 mil-
lion in placements and the aver- age amount collected monthly was
$86,350; by 2014, this increased to $6.8 million in placements and
$149,000 in average amount col- lected monthly JCCs performance
increased yearly, from collecting $1 million in 2009 to $1.78
million in 2014 St. Lukes staff has developed an excellent working
relationship with JCC J.C. Christensen is a leader in collection
services, and they also work with the Min- nesota Attorney General
to ensure that their collection practices are compliant. Based on
those factors and the excellent service they have provided us, we
decided to enter into an exclusive relationship with JCC. Rolene
Lampi Director of Business Services St. Lukes Health Care
System
36. Leveraging Presumptive Charity Care to Improve Collection
Efforts and Increase Revenue
COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. before we
send the account to bad debt, we make sure that the appropriate
adjustment is on that accountwhichever dis- count is more generous.
Although St. Lukes does not notify patients when presumptive
charity care is applied to their accounts, they have not received
any complaints for administer- ing the discount. In fact, the
community and patient population has become familiar with the
process. Initially, St. Lukes worked with two bad debt agencies,
but their 25-year, longstanding relationship with J.C. Christensen
& Associates, Inc. (JCC) presented the opportunity to
centralize col- lection efforts. J.C. Christensen is a leader in
collection services, and they also work with the Minnesota Attorney
General to ensure that their col- lection practices are compliant,
says Lampi. Based on those fac- tors and the excellent service they
have provided us, we decided to enter into an exclusive
relationship with JCC. When JCC receives an account, they go
through an extensive questionnaire to ensure they understand the
patients financial position. This process verifies the patients
insurance status and checks if any type of financial assistance has
already been applied. If JCC is not successful in collecting from
the patient usually around six months from placementbehavior and
rank scores are utilized to determine which accounts should be
referred to a law firm of St. Lukes choosing. The Results After
implementing presumptive charity care, St. Lukes recorded an
increase in the amount of collectible dollars from accounts being
sent to JCC. In 2009, JCC received $9.8 million in placements and
the average amount collected monthly was $86,350. This improved
dramatically by 2014, when JCC received $6.9 million total place-
ments and the average amount collected monthly increased to
$149,000. In comparing 2009 (pre-presumptive charity care) to 2014
(post-presumptive charity care), the number of dollars col- lected
increased by $750,000 annually. In addition to increased
collectible dollars, St. Lukes staff has developed strong
communication with JCC. Our staff has an excellent working
relationship with JCC, says Lampi. They feel comfortable calling
JCC with any questions, and frequently com- municate with them on a
daily or weekly basis. To improve or implement presumptive charity
care, it was impor- tant for St. Lukesand any healthcare
organizationto under- stand their scope of work. Then they can
enter into a beneficial business partnership with confidence. Any
healthcare business office leader who is looking to improve their
processes must define their goals and understand how that relates
to their vendors capabilities, explains Lampi. St. Lukes was an
early adopter of presumptive charity care, and through our
partnership with JCC, we firmly believe our process has become the
gold standard. About JCC JCC has helped hundreds of healthcare
clients improve debt recovery rates and optimize cash flow while
reducing costs with its successful accounts receivable management
programs. JCCs programs are designed to give clients a voice in
account management, full access to account reviews at any time, and
ample opportunities to ask questions and make suggestions to
improve performance. JCC is a privately owned subsidiary of Array
Services Group, Inc. For more information, please visit:
arraysg.com While placements have decreased from 2009 to 2014, the
aver- age amount collected monthly increased from $86,350 in 2009
to $149,000 in 2014. St. Lukes Total Placements by Year J.C.
Christensen & Associates $9.8M 2009 2010 2011 2012 2013 2014
$6.7M $6.3M $6.3M $7.1M $6.9M In comparing 2009 (pre-presumptive
charity care) to 2014 (post- presumptive charity care), the number
of dollars collected increased by $750,000 annually. St. Lukes
Total Collections by Year J.C. Christensen & Associates $1M
2009 2010 2011 2012 2013 2014 $1.2M $1.2M $1.5M $1.6M $1.8M
37. COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED.
Effectively Analyzing Self-Pay Accounts to Improve Revenue Cycle
Performance Due to higher out-of-pocket costsco-insurance, co-pays,
deductibles, more non-cov- ered servicesand a lack of insurance,
patients have higher liabilities when paying for their healthcare
services. Given that circumstance, the financial well-being of
hospitals and health systems can be strongly tied to the
collections of self-pay receivables. The self- pay class is
generally the most difficult to collect from, and a lack of
systematic collection processes often leads to bad debt write-offs
and increased A/R days. Academy research shows that 21% of all
self-pay collections (including residuals) are made at
point-of-service (POS) for Emergency Department (ED) and outpatient
accounts. The longer a patient balance remains unresolved, the less
likely it is that a hospital or health system will be able to
collect itso effective follow-up strategies are critical. In order
to abide by Affordable Care Act requirements and increase
collection rates, better-perform- ing organizations use the 120-day
mark to pursue residual balances. To learn about one organizations
experience with improving revenue cycle functions through the
analysis of self-pay accounts, The Academy spoke with Jackie
Hinderks, Director of Revenue Cycle at Rice Memorial Hospital. The
Challenge Leaders in Rices revenue cycle department had a growing
concern about residual balances and decided it would be best to
focus on strategies to improve collection rates. The orga- nization
struggled with pinpointing the root causes of their collection
issues, and at the same time staff were adjusting to a recent
conversion from the legacy system, which changed the 18-month
write-off. From a front-end perspective, Rice had to examine how
its customer ser- vice staff worked with patients to com- municate
balances and how to obtain correct contact information to be able
to reach patients more frequently. Not only did the staff need more
educa- tion about how bad debt affects back- end revenue cycle
functions, but the organization also needed to maintain a high
level of customer satisfaction. Rice therefore sought a solution
that would assist in improving col- lection rates, decreasing bad
debt write-offs, and enhancing customer service. The Solution To
better manage residual self-pay collection, Rice employed J.C.
Christensen & Associates, Inc. (JCC) for accounts receivable
management and debt recovery services. Weve been working with JCC
for over six years, and trust that their services are going to be
data-driven and pertinent in making improvements to revenue cycle
functions, Hinderks says. Highlights Profile Rice Memorial Hospital
Willmar, Minnesota 100 beds NPR: $106 million Challenges Rice
Memorial Hospital had struggled historically to pinpoint the root
causes of its collection issues Rice customer service staff needed
to better communicate balances to patients, and obtain correct con-
tact information to be able to reach patients more frequently The
organization sought a solution that would assist in improving its
col- lection rates and decrease its bad debt write-offs Solution To
better manage residual self-pay collection, Rice Memorial Hospital
employed J.C. Christensen & Associates, Inc.s (JCC) accounts
receivable management and debt recovery services During quarterly
meetings, JCC pro- vides Rice with quality on data to improve
front-end revenue cycle function JCCs revenue cycle consultant con-
ducted customer service training seminars Results In 2014 alone,
collections have increased by $10,000 per month Liquidation rate
has increased from 21% in 2013 to 23% in 2014 Estimated total
dollars collected in 2014 is $362.4K, compared to $250.8K total
collected in 2013 Dynamic Scoring Inventory is scored using
internal and exter- nal information The individual score is updated
each day based on a variety of factors, which JCC refers to as
dynamic scoring Dynamic scoring provides superior segmen- tation
for work strategy optimization much more than the age and balance
of account Historical performance data is leveraged, patient
behavioral patterns are taken into account, including: -- If the
patient has resolved previous obligations -- If the patient has
been referred to legal in the past -- If the patient has qualified
for financial assistance in the past
38. Effectively Analyzing Self-Pay Accounts to Improve Revenue
Cycle Performance
COPYRIGHTHEALTHCAREBUSINESSINSIGHTS.ALLRIGHTSRESERVED. Rice uses
JCCs solution following its internal 120-day collection phase,
during which a patient receives several statements and phone calls.
When an account is flagged in the system, it goes into collections
and the next day that account is sent to JCC. Rice is given a
seven-day grace period to account for a patients late pay- ment.
Also, if Rice makes a mistake by flagging an account, JCC sends the
account back. JCC then works on accounts as far as they can take
them. If collection effortsincluding legal actionare not successful
after 18 months, the debt is ultimately written off. The
established relationship between JCC and Rice has created an
environment in which in-depth analytics are used to work the
organizations self-pay accounts effectively. Using Rice patients
historical payment data, JCC creates an automated dynamic scoring
system that updates as new information is obtained. Dynamic scoring
provides superior segmentation for work strat- egy optimization.
JCC shares an alpha-split caseload with another vendor, and also
works on Rices durable medical equipment accounts. Rice ensures
that both agencies remain on track with the organizations very high
performance standards utilizing comparison reports. We dont
actively disclose the comparison reports, but I person- ally make
sure that both agencies stay within the same range and let them
know if there is an issue, Hinderks explains. Rice is also able to
monitor performance by tracking if JCC does presumptive eligibility
or charity scans before they start working accounts which might
result in