Patient Collections - Optimizing Collections Before, During, and After the Visit

Presented by Aimee Heckman

July 13, 2017

Kareo Confidential

Agenda

2

Agenda

2

• Introductions

• Welcome to the Patient Collections Boot Camp

• Optimizing Collections Before the Visit

• Collecting at the Time of Service

• Reducing Days in A/R After the Visit

• Monitoring Your Ongoing Patient Collections Fitness

• How Kareo Can Help

• Your Questions

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Kareo Confidential 55

Discover Kareo’s Role

• PAHCOM has approved 1 CEU credit.

• You’ll be asked at the end of the webinar if

you want a CEU certificate.

• Certificates will be emailed within the next

few days.

• Attendees must be logged into the webinar

to receive credit.

“…Make Your Practice a Best Practice!”


Aimee Heckman CPPM, CPB

• Healthcare Business Consultant and President at Ease RCM Solutions.

• Certified Professional Biller (CPB) and Certified Physician Practice Manager (CPPM)

• More than 25 years experience in Medical Practice Management, Revenue Cycle Management, PM/EHR implementation, and business development.

Kareo Confidential

Agenda

7

Agenda

7

• Introductions







• Your Questions

Welcome to Boot CampWhat does patient collections have to do with a boot camp?


Welcome to Boot Camp

How to get the most out of this Boot Camp

• Set realistic expectations to avoid becoming discouraged part way

through the process and giving up.

• Pick what seems doable for you right now, give it your best effort and

keep moving forward, even if it’s baby steps.

• Take the amount of time you need to in order to complete all of the

“weeks” of Boot Camp.

• Follow a modified path that you can easily handle all the way through

and then repeat the Boot Camp again to implement additional items

that you weren’t quite ready for.


Why a Boot Camp?

39.1% 54% 90% 30%

Privately insured individuals under age 65

with HDHP

HDHPs

Increase in HDHPs since 2010

Increase

HDHP purchased on exchanges and the

open market

Bronze/Silver

Percent of revenue attributed to patients

Patient


The Patient Collections Journey

Bill Payer/Patient

Submit claims immediately, post

payments promptly and send statements

frequently

Validate and Collect

Confirm all financial information at each

visit and collect copay and any balances due

Gather Data

Collect all demographic info needed to verify insurance and patient

responsibility when scheduling the appointment

Effective patient collections begins long before the patient sets foot in the office. Each step in the process is

an opportunity for success and will directly impact your net collections.

Follow-Up

Stay on top of patient balances and be pro-

active before accounts reach 60 days

BeforeVisit

AtVisit

AfterVisit

FollowUp

Optimizing Collections

Before the VisitPre-Check-In, Re-Verify Eligibility, Appointment Reminders


Make the Most of Pre-Check-In

Workout Set 1



The patient collections cycle begins when the first appointment is scheduled. Create a checklist for staff scheduling new patient appointments that includes the following:

• Patient name, DOB, address, and phone number.

• Insurance information including policy and group number.

• If patient is not primary subscriber, also collect subscriber name, DOB, and relationship to patient.

• Explain the financial policy as it relates to collecting copay at time of service. Refer them to your website to download a copy prior to the visit.

• Remind them to bring their insurance card and photo ID to their appointment.



For patients without insurance, it is even more critical to set

expectations regarding what to expect from the very beginning. Be

sure to discuss the following when setting the initial appointment:

• Patient name, DOB, address, and phone number.

• Explain the aspects of the financial policy that relate to self-pay

responsibilities, including that payment is due at time of service.

• Provide an idea of what a new patient visit typically costs for self-pay

patients so they are prepared.

• If the caller asks about discounts or financial hardship policies, refer

them to your financial policy on your website or offer to send a copy.


Re-Verify Eligibility Prior to Appointment

Workout Set 2



Do I really need to check eligibility prior to every visit? If you have

ever heard or read the following statement you know the answer is

YES!

“A quote of benefits and/or authorization does not guarantee

payment or verify eligibility. Payment of benefits are subject to all

terms, conditions, limitations, and exclusions of the member’s

contract at time of service.”



Eligibility is the number one cause of rejections and denials. To give

your practice the best chance at collecting:

• Verify eligibility when a visit is scheduled.

• Verify eligibility just prior to the date of service.

• Ask patients about any changes to their insurance or benefits when

confirming appointments.

• Utilize features in your software to automate eligibility verification so

that you have the most up-to-date information at the date of service.

• Strive for 100% eligibility verification prior to visits.



Be sure your eligibility verification includes the following at a minimum:

• Effective date.

• Subscriber name.

• Patient name if different from subscriber.

• Copay as applies to your provider – primary care or specialty.

• Deductible amount – total and amount met or remaining.

• Is there a referral or authorization required?

• Is their premium payment current?


Use Appointment Reminder as Payment Notice

Workout Set 3



The appointment reminder is the perfect opportunity to also remind

patients of their payment responsibility. Your appointment reminder

should include:

• Appointment date and time

• Reminder to bring ID and insurance card

• Copay amount due at time of service

• Outstanding balance from previous visits

• Estimated amount due for the visit of self-pay patients

• Payment methods accepted including the option to sign up for credit

card on file



Automated reminders vs. personal calls

• Each has its own benefits

• Consider using a combination of the two

• Personal calls should be used for patients with outstanding or past due balances

• Whenever possible, be sure caller ID is your practice number that patients recognize

• Take advantage of automated email and text reminders for patients that prefer them

• Provide scripts for staff to use when making appointment reminder calls (See Sample Script: Collecting During the Appointment Reminder in Event Resources)


Set clear expectations for staff regarding:

• Verifying eligibility at time of scheduling and again prior to visit

• Collecting copays and balances due at time of service

• Offering to set up credit card on file for patients with past due

balances

Look for ways to “catch” staff successfully implementing these new

policies and offer positive reinforcement for taking initiative to adopt

new behaviors.

Collecting at the Time of ServiceReview Eligibility, Communicate Estimated Responsibility and

Amount Due, Confirm Payment Pathway, and Collect


Review Eligibility and Estimated Patient Responsibility

Workout Set 1



Having the following items in place each day will help you collect

successfully at the time of service:

• Verified eligibility for all patients scheduled for the day including an

estimate of what their responsibility will be based on deductibles,

copays, coinsurance and current balances.

• List of patients who have balances that were not collected during the

appointment reminder calls.

• Signs displayed prominently at check-in and check-out indicating that

copays and past due balances are due at time of service.



Let’s talk about Patient Responsibility Estimators

• Is collecting estimated responsibility allowed?

• Should you collect the full estimated responsibility?

• Should you use an online estimator or build your own?



With your tools in place, consider implementing a “Daily Huddle” to

ensure that all staff are on the same page and prepared to do their

part in collecting patient responsibility. Daily Huddle topics may

include:

• Brief walk through of the days schedule.

• Discussion of any balances to be collected.

• Special arrangements that have been made for patients based on

financial policy or hardship.

• Role play to practice effective communication when speaking about

patient payment responsibility and other options available.


Communicate Amount Due, Confirm Payment Pathway, and Collect

Workout Set 2



Tips for Effective Collections at Check-In:

• Confirm patient information, review photo ID and insurance card and

complete any forms or paperwork

• Collect copays and previously adjudicated balances at check-in

• Provide an estimate of patient’s responsibility from today’s visit

• Provide staff with training and scripts that will guide them through

the collections process at check-in (See Sample Script: Asking for

Patient Payment at Checkout in Event Resources)



Tips for Effective Collections at Check-Out:

• Review financial responsibility for the visit to determine if they were

collected at check-in.

• Review the estimate of patient’s responsibility from today’s visit to

determine if there are any changes to the pre-visit estimate.

• Present any remaining balance due to patient before informing them

of care instructions, scheduling follow-ups, etc.


Talk Openly with Staff:

• Discuss the difference between empathy and sympathy

• Remember that some of your staff may face similar challenges that your patients are facing in regards to finances

• Provide scripts and role play opportunities to make staff more comfortable talking about financial responsibilities

Goal for Week 3:

• Collect 100% of copays, outstanding balances and self-pay amounts at time of service

Reducing Days in A/R After the Visit

Review Past Due Accounts, Set Up Communication Channels Statement Best Practices, Last Chance Communications


Reducing Days in A/R After the Visit

Tips to Decrease A/R:

• Offer discounts for timely payment of self-pay balances. Be sure to

comply with payer contracts in regard to preferential pricing as well

as Stark Laws prohibiting incentives for patient enticement.

• Utilize credit card on file systems to allow processing of payments for

balances immediately after adjudication to reduce the number of

statements sent.

• Offer multiple two-way communication methods between your

practice and your patients.

• Use your patient portal to enhance your collections efforts.


Review Past Due Accounts and Set Up Communication Channels

Workout Set 1


Review Past Due Accounts and Set Up Communication Channels

Accuracy in patient statements is critical to post visit collections.

• Periodically review your billing software to make sure that payments are correctly posted and patient balances are accurate. Plan enrollment, coverage limits and other details can change and have in impact on patient balances.

• Finding errors on their account makes patients distrust future statements and gives them an excuse to delay payment.

• Be prepared to provide itemized statements to patients who are paying off a large balance so that they can see that their payments are being applied correctly.

• Use your patient portal to enhance your collections efforts. Providing multiple ways for patient to contact you about their responsibility increases chances of collection.


Patient Statement Best Practices

Workout Set 2



To increase effectiveness, statements should:

• Be easy to read with explanation of bill at-a-glance

• Be electronic, if possible

• Clearly show amount owed and payment options including online,

credit cards accepted, etc.

• Offer the patient alternative payment pathways such as payment

plans and credit card on file

• Provide contact information including phone and patient portal



The days of sending out statements once a month are over if you

want to maximize patient collections. Sending statements more

frequently provides the following benefits:

• Stabilizes cash flow

• Spreads out patient phone calls

• Presents patients with their responsibility with less time elapsed

Options for eStatements make it easier than ever to send statements

out more frequently. Outsourcing the task of printing statements

also decreases the workload of your staff, allowing them to spend

more time on actual collections.


Last Chance Communications

Workout Set 3



The success rate in collecting balances turned over to a collections

agency declines significantly. Before sending accounts to collections,

consider the following:

• The average recovery rate for accounts sent to collections is 16.5%.

• The impact of medical debt was downgraded by most credit

reporting agencies.

• Collecting for specialty practices tends to be more difficult because

often patients don’t have an ongoing relationship with the provider

once the course of treatment is complete.



Tips for implementing “soft collections” in your practice:

• Use appointment reminder calls as an opportunity for soft collections.

• Update your financial policy to include steps that will be taken to

resolve past due balances including termination from the practice and

being turned over to collections.

• Consider using a third party for “early out” collections and statement

processing.

• Be consistent in following your financial policy as it relates to past due

balances, rescheduling appointments, terminating from the practice

and turning accounts over to collections.

• What about offering discounts for prompt payment?



If a patient continues to be in violation of your financial policy and

you have exhausted all other measure, you may need to dismiss

them from the practice. Keep in mind:

• The process should be clearly spelled out in your financial policy and

patient should be notified in writing.

• Specify the amount of time that they have to find a new provider and

that your office will only provide care for urgent medical needs

during that time.

• Include resources for them to turn to for financial help as well as

locating a new provider, such as the provider directory on their

payers website.


Establish a Soft Collections Process:

• Reduce the number of accounts sent to external collections by creating a soft collections department internally

• Approach patients from the standpoint that lack of payment is an oversight rather than intentional

• Offer patients a payment plan as an alternative to turning over to collections

• Follow through on statements made to patients that they will be turned over to collections if they do not make an attempt to resolve past due balances

Goal for Week 4:

• Contact all patients who have received two or more statements with the offer of a payment plan. You may be surprised how many will take you up on the offer.


Monitor Your Ongoing Patient Collections Fitness

Keep up the progress you have made by monitoring these aspects of patient collections on a monthly, quarterly and yearly basis:

• Overall patient collections rate

• Percent of copays collected at time of service

• A/R days within 35 days and no more than 20% of accounts more than 90 days old

• Patient balances sent to collections less than 2%

• Eligibility rejection/denial rate

You made it through the Patient Collections Boot Camp. Keep working to improve a little each month and you will be on your way to patient collections success!

Kareo Confidential

Agenda

46

Agenda

46

• Introductions







• Your Questions


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If you missed Part 1 of the Patient Collections Boot

Camp or want to review it again, the recording

and event resources can be found HERE.

http://kareo.lookbookhq.com/webinar-patient-collections-boot-camp-part-1-preparing-your-technology-your-staff-and-your-financial-policy1



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