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Upfront Collections Training

Upfront Collections Training

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    Professor Cash Professor Cash Presentation Transcript

    • POS 101 Point of Service Cash Collections Training Frye Regional Medical Center Professor Cash
    • POS Objectives
      • Why collect at the time of service?
      • How to estimate patient responsible balances.
      • How to ask patient for payment.
      • Role Playing
      • Summary
    • Why collect at time of service
      • Patients responsible balances are increasing as employers increase out-of-pockets. Thus bad debt could increase if the hospital did attempt upfront collections.
      • Increasing number of patients who are uninsured. Failure to collect from these patients will result in an increase in bad debt.
    • Why collect at time of service
      • Collecting at the time of service can improve customer satisfaction because patients want to be informed about their financial responsibilities. Receiving a large bill months after service can cause many patients to think negatively about their experience.
      • It takes about 60 days from the time of discharge to receipt of payment from insurance. Without POS, the hospital is basically financing a service interest free for 60 days.
    • Why collect at time of service
      • If patient leaves without making a payment; chances of collection go down to 40%, collection costs increase, and cash flow to pay salaries and medical equipment may not be sufficient.
    • Estimating Patient Balances
      • Patients may owe the following if they have insurance:
      • Deductible -The initial portion of a covered expense (usually in indemnity or PPO plans) that must be paid by the insured person before the insurance policy pays its part of the expense. (For example, if the deductible is $100, then you must pay the first $100 of the covered medical costs before the insurance will pay anything at all.)
      • Copay - A fixed fee that subscribers to a medical plan must pay for their use of specific medical services covered by the plan.
      • Coinsurance - An insurance policy provision under which the insurer and the insured share costs incurred after the deductible is met, according to a specific formula. An example is an 80/20 policy with an out of pocket maximum of $2000. This means that insurance will pay at 80% until the patient has met the 20% limit of $2000. After the patient meets the $2000 limit, insurance will pay at 100%.
    • Estimating Patient Balances
      • Uninsured patients are patients who have no insurance.
      • Uninsured patients at Frye receive a discount similar to the managed care plans. Uninsured patients are responsible for 100% of the discounted amount.
    • Allowed Charges
      • In calculating the amount that the patient will owe it is important to understand that the calculation for Managed Care patients such as Blue Cross begins with determining the allowed charges.
      • Allowed Charges – Allowed Charges are the discounted charges that Frye has agreed to except for medical services based on an agreed contract.
    • Calculation of Allowed Charges
      • Scenario: Patient is having an MRI of the brain and their insurance is Blue Cross of North Carolina.
      • Step 1: Determine the charge for the MRI. By looking at the charge master the charge is $1956.00
      • Step 2: Determine the contract rate. In this case, the contract rate for Blue Cross outpatient services is a reimbursement of 28.4% of charges.
      • Step 3: Calculate the allowed charges based on information obtained in step 1 and 2.
    • Calculation of Allowed Charges
      • In this example the calculation of allowed charges would be:
      • MRI Charge $1956.00
      • Blue Cross Contract Rate 28.4%
      • Allowed Charges = 1 X 2
      • $1956.00 X 28.4% = $555.50 Allowed Charges
    • Calculation of Patient Liability
      • Now that we have calculated the allowed charges (total payment that the hospital will receive from insurance and patient ), we can calculate the estimated patient liability based on the insurance verification of benefits.
    • Patient Liability Calculation Example 1
      • Using the same test, MRI-Brain, we have verified insurance coverage as follows:
      • Deductible $500 none of which has been met.
      • Coinsurance 20% up to a maximum of $2000. None of the coinsurance has been met.
    • Patient Liability Calculation Example 1
      • Total Charge $1956.00 (1)
      • Contract Rate 28.4% (2)
      • Allowed Charges (1) X (2) $555.50
      • Patient Deductible $500.00(3)
      • Allowed Charges less Ded $55.50(4)
      • Patient Coinsurance % 20%(5)
      • Patient Coinsurance (4) X (5) $11.10(6)
      • Total Patient Liability (3) + (6) $511.10
    • Patient Liability Calculation Example 2
      • Using the same test, MRI-Brain, we have verified insurance coverage as follows:
      • Deductible $500 which $250.00 has been met.
      • Coinsurance 20% up to a maximum of $2000. $1000 of the coinsurance has been met.
    • Patient Liability Calculation Example 2
      • Total Charge $1956.00 (1)
      • Contract Rate 28.4% (2)
      • Allowed Charges (1) X (2) $555.50
      • Patient Deductible $250.00(3)
      • Allowed Charges less Ded $305.50(4)
      • Patient Coinsurance % 20%(5)
      • Patient Coinsurance (4) X (5) $61.10(6)
      • Total Patient Liability (3) + (6) $311.10
    • Patient Liability Calculation Example 3
      • Using the same test, MRI-Brain, we have verified insurance coverage as follows:
      • Deductible $500 which $500.00 has been met.
      • Coinsurance 20% up to a maximum of $2000. $1900.00 of the coinsurance has been met.
    • Patient Liability Calculation Example 3
      • Total Charge $1956.00 (1)
      • Contract Rate 28.4% (2)
      • Allowed Charges (1) X (2) $555.50
      • Patient Deductible $0(3)
      • Allowed Charges less Ded $555.50(4)
      • Patient Coinsurance % 20%(5)
      • Patient Coinsurance (4) X (5) $111.10(6)
      • Patient has met all Coinsurance except $100.00(7)
      • Total Patient Liability (7) $100.00
    • Patient Liability Calculation Example 4
      • The patient is uninsured and is having an MRI-Brain.
      • Step 1: Go to http://www.carepricer.imacs.com .
      • Step 2: Create an invoice.
      • Step 3: Enter description of service or CPT Code = 70552
      • Step 4: Uninsured price for MRI is $900.00
      • Step 5: Print invoice.
      • Step 6: Ask patient for $900.00
    • Collection Scripts
      • The concept behind a script is to develop statements that are said to patients in a consistent manner and allows staff to handle responses from the patient.
      • Remember when you talk to the patient always look the patient and the eyes and smile.
    • Collection Scripts
      • Never say to the patient “HOW” will you be paying your responsible balance.
      • By using “HOW” you would be giving the patient the right off the bat the chance to respond “I am not going to pay”. You lose control of the collection process by saying “HOW”.
    • Collection Scripts
      • Insurance Has Been Verified
      • Mr./Ms. (patient/responsible party’s name), our policy is to request payment of patient responsible balance at the time of service. We have verified your insurance and there is a deductible and coinsurance (or copay) of $_____ for this visit. Please note that this is only an estimate and can vary from the actual amount owed. Which method of payment will you be paying with, cash, check, we accept American Express, Discover, MasterCard, Visa or Debit Card.
    • Collection Scripts
      • Uninsured Patient
      • Mr./Ms. (patient/responsible party’s name), the estimated cost of your service today is $______. Please note that this is only an estimate and can vary from the final amount that you will owe. Which method of payment will you be making today, cash, check, we accept American Express, Discover, MasterCard, Visa or Debit Card.
    • Scripts for Patient Objections
      • Scenario 1: Patient states “Never had to pay at the time of service before.
      • Patient: I never had to pay at the time of service before.
      • Frye Registrar: Mr./Ms. (patient/responsible party’s name) I understand your concern, but changes in our policies were needed to contend with rising costs of health care. Paying at the time of service helps us to avoid additional administrative costs, which saves you money. Plus, it lets you take care of your payment now rather than worry about a bill later. Which method will you be paying with cash, check, we accept American Express, Discover, MasterCard, Visa or Debit Card.
    • Scripts for Patient Objections
      • Scenario 2: Insurance will pay.
      • Patient: My insurance will pay.
      • Frye Registrar: Mr./Ms.(patient/responsible party’s name) we verified your insurance coverage, and yes your insurance will pay but the hospital should not have to wait until insurance processes to receive your balance which we have estimated today. Which method will you be paying with today?
    • Scripts for Patient Objections
      • Scenario 3: Don’t have purse/wallet, checkbook etc.
      • Patient: I don’t have my purse/wallet.
      • Frye Registrar: Mr./Ms. which method were you going to pay if you had your purse/wallet?
      • If the patient replies by check, the Frye registrar could respond: “Will you be sending a check as soon as you get home? Here is a self-addressed stamped envelope for your convenience.
      • Patient: I didn’t bring my checkbook.
      • Frye Registrar: That’s okay Mr./Ms. we accept cash or credit cards.
      • Patient: I don’t have any money with me.
      • Frye Registrar: That’s okay Mr./Ms. We accept checks or credit cards.
      • Patient: I don’t have my credit cards with me.
      • Frye Registrar: That’s okay Mr./Ms. would you like to call home/spouse for your credit card number.
    • Scripts for Patient Objections
      • Scenario 4: I don’t want to put on credit card and pay high interest can I make payments?
      • Patient: I really do not want to make payment with my credit card because I would have to pay interest.
      • Frye Registrar: Mr./Ms. It really is better for you to make a payment today with your credit card. You can make monthly payments to your credit card and the hospital cannot afford to continue to accept monthly payments without interest.
    • Scripts for Patient Objections
      • Scenario 5: My ex-spouse is responsible.
      • Patient: My ex-spouse pays for all my medical bills.
      • Frye Registrar: I understand Mr./Ms. that you may have an agreement between your and your former husband/wife, but that is something you need to take up with your former spouse. I will give you a receipt to send to your former spouse showing the bill has been paid so you can be reimbursed. So, which method of payment will you be making today?
    • Scripts for Patient Objections
      • Scenario 6: Doctor told patient not to worry about bill
      • Patient: My doctor told me not to worry about a bill.
      • Frye Registrar: Mr./Ms. Your physician didn’t mean you would not have to pay the bill. Your physician expected payment from you and so does the hospital. We request you pay the amount in full by cash, check or credit card.
      • Patient: I can’t afford to pay, and the doctor knew that. I don’t understand why the doctor sent me in for tests knowing I couldn’t pay.
      • Frye Registrar: Mr./Ms. the tests were a necessary part of your treatment. If they had been elective procedures, we could have scheduled them at a later date when you would be in a better financial position. However, since the tests were required immediately, let’s work out a payment plan that falls within the hospital policy.
    • Scripts for Patient Objections
      • Scenario 7: More Concerned about payment than my care.
      • Patient: You seem more worried about the bill than my care.
      • Frye Registrar: Mr./Ms. we are concerned about your care first. And payment for that care ensures that we can continue to provide the quality treatment you and other patients expect.
      • Which method will you be paying with today, cash, check or credit card?
    • Scripts for Patient Objections
      • Scenario 8: Send a bill.
      • Patient: Just send me a bill.
      • Frye Registrar: Mr./Ms. our hospital policy is to collect payment at the time of service. Which method will you be paying with today, cash, check or credit card.
    • Role Playing
      • I need 2 volunteers to demonstrate the right and the wrong way to ask patients for money.
    • Applause for Role Players