iSolutions IQ Innovation
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iSolutions IQ Innovation






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    iSolutions IQ Innovation iSolutions IQ Innovation Presentation Transcript

    • UCB and Self Pay Company Partnering to Improve Self Pay Collections February 2009 Proprietary and Confidential This information is not to be copied or otherwise utilized without the written consent of UCB, Inc. Above and Beyond the Call Above and Beyond the Call
    • Question?
        • Do you have an automated charity care qualification process in place?
        • Is your charity care policy administered consistently or subjectively by your staff?
        • Do you validate every charity case with
        • Are you attempting to collect form patients who could qualify for your charity policy?
      Above and Beyond the Call Are you maximizing your charity care and collecting what you should from your self pay patient population?
    • Introduction iSolutions
        • Provides financial assessment and account decisioning platform
        • Streamlines and automates charity care identification and processing
        • Accurately predicts patient maximum payment threshold
        • Benchmarks third party collection vendor performance
        • Validates registration demographics
        • Improves ROI on internal collection activity by focusing financial and human capital on accounts which have the greatest return
        • Automates current manual processes allowing workforce to “do more with less”
      Above and Beyond the Call Hosted by Self Pay Company in partnership with UCB Breakthrough technology reinvents Charity Care and Self Pay account processes
    • Market Drivers – Self Pay Above and Beyond the Call
      • National unemployment: September 2008 6.2% - January 2009 7.6%
        • Highest in a decade (Source: Department of Labor)
      • State of Indiana: December 2007 4.5% - December 2008 7.8 (Source Bureau of Labor Statistics)
      • Increasing uninsured & underinsured population
      • Fewer employer-paid insurance plans
      • Higher deductibles and co-pays
      • Consumer directed healthcare plans increasing
      • Continued regulatory mandates and increased scrutiny
    • Market Trends Breakthrough Strategies
        • Source: Department of Labor
    • Market Trends 154,616 Million in Civilian Labor Force 10,331 Million Unemployed If Unemployment Increases to 10.6%
        • Source: Department of Labor
      Above and Beyond the Call Increase of 7.5 Million New Self Pay Patients
    • Market Trends Above and Beyond the Call
    • iSolutions Platform Above and Beyond the Call Address Validation iSolutions Module Validates correct address against most current data available Description of Module Automate Charity Propensity of Payment Maximum Payment Fraud Alert Detection Charity identification - income and number of dependents/validates against financial profile Segments accounts into high, medium, low and bad debt payment probability groups Identifies maximum amount a patient can pay without hardship and financial duress Provides systematic process for protecting data – supports Red Flag Rule QA – Missing Data Identifies and validates all missing data associated with patient account
    • iSolutions Platform
      • Address validation
        • Provides most current address, phone number, employer
        • Updated data returned to hospital eliminating repetitive mail returns
        • Experian database updated in real time 24/7/365
      • Presumptive charity care
        • Consistent system takes the subjectivity out of the process
        • Ensures charity care is provided to worthy patients
        • Customized to meet hospital’s charity guidelines
        • Reduces FTE administrative costs by over 50%
      • Propensity of payment
        • Segmentation of accounts by predictability of payment
        • Payment predictor based on patient’s financial profile
        • Empirical collectability benchmarks for each segment based on workflow modifications
      Above and Beyond the Call
    • iSolutions Platform
      • Maximum payment recommendation
        • Analyzes patient’s financial profile providing recommended threshold for payment
        • Accurate estimate of what the patient “really” can afford
        • Eliminates guesswork of high/low balance collection strategy
      • Fraud alert protection
        • Immediately identifies fraudulent use of PHI
        • Provides systematic process supporting compliance of “Red Flag Rule”
      • QA – Missing data
        • Identifies accounts with missing critical demographic data
        • Provides trending data for registration processes
        • Highlights accounts which need additional demographic detail
      Above and Beyond the Call
      • IRS may issue updated Form 990 to address a lack of standards in current policy
      • The IRS concerned over "lack of consistency or uniformity in classifying and reporting uncompensated care." 
      • Senators Grassley, Bingaman push for new charity-care standards (proposed amendment to Economic Stimulus Bill - February 2009)
        • A second amendment would force the IRS to scrutinize “for profit” hospitals
      Charity Legislation Update Above and Beyond the Call Are you ready for the increased scrutiny?
    • Charity Care Prediction Above and Beyond the Call S elf Pay Scoring R evenue Cycle Outsourcing E arly Out P ayer Search M edicaid Eligibility B ad Debt
      • iSolutions Platform utilizes the number of dependents and annual income to determine Charity Validation per the FPG
      • Income verification factors include:
        • monthly obligations, mortgage amount, average rent, available credit, credit card balances, auto loans, revolving credit
      Stated patient Income is validated to ensure accuracy Proprietary income estimator validates census & credit data 1 2 3 4 Tested algorithm ensures accurate charity prediction All income estimations verified through Experian credit
    • Charity Determination Above and Beyond the Call Consistent Charity Qualification Ensure Accurate Financial Analysis Reduce Charity Fraud
    • Charity Care Validation Above and Beyond the Call Consistent & Accurate Validation
      • Provides a single data sheet which validates charity per your hospital’s guideline
      • Utilizes stated or estimated income based on demographics
      • Estimated income is based on Block Census data plus validation factoring against the patients credit file
      • * Reduce the risk of collecting from qualified indigent patients
    • Charity Care Risk Mitigation Above and Beyond the Call Presumptive Charity Policy
      • Mitigates risk from administering inconsistent charity policy
      • Reduces risk of inconsistent and subjective collection practices
      • Address potential legal issues
        • Class action lawsuit filed in December 2008 (Andresillo vs. Audit & Adjustment Company). Litigation initiated because charity qualified patients were pursued for collections
    • Charity Care Risk Mitigation Above and Beyond the Call Law Firm Sues Collection Agency for Allegedly Violating Charity Care Law January 2, 2009 Inside ARM A medical collection agency in Washington is being sued by a local law firm over practices that the suit say run afoul of the state's charity care provisions. by Cynthia Wilson A Washington healthcare collection agency is being sued by a law firm seeking class action status for allegedly violating the state’s charity care law. In a lawsuit filed on December 8, Seattle-based Phillips Law Group claims that Audit & Adjustment Company, Inc., based in the Seattle suburb of Lynnwood, has systematically engaged in “the unfair, deceptive and misleading practice of telling patients that they owe the full charges shown on hospital billing statements, without informing them that they may be entitled to charity care that reduces the hospital debt or eliminates it entirely depending on a patient’s income level.” Lead attorneys John Phillips and Matthew Geyman are seeking class action status for the lawsuit filed in King County Superior Court.  In addition to statutory damages on behalf of the plaintiffs for allegedly violating the state’s charity care law, Consumer Protection Act and Fair Debt Collection Practices Act (FDCPA), Phillips and Geyman want the agency to stop pursuing collections from charity care- eligible patients. They are also asking the court to make the agency establish procedures to allow patients to qualify for charity care that it collects on behalf of Washington hospitals, and notify current and former patients the agency has collected from in past four years that they may be eligible for charity care that may reduce their obligation.    Under Washington statute RCW 70.170.060 , individuals and families with annual incomes below 100 percent of the federal poverty level -- $10,400 for a single person and $42,400 for a family of four living in Washington -- are deemed charity care patients for the full amount of hospital charges, provided that they are not eligible for other public or private health coverage sponsorship. The law also requires various levels of discounts for patients’ whose annual incomes range from 100 percent and 300 percent of the federal poverty level.  The law entitles charity care-eligible patients to who have paid all or portions of their hospital bills to a refund, according to the lawsuit.
    • Self Pay Stratification Above and Beyond the Call Understand which accounts have the highest propensity for collection Allocate resources on the accounts which offer the greatest ROI
    • Work Flow Optimization Above and Beyond the Call 1% to 3% 3% to 10% .5% to 1% 10% to 15% 25% to 35% 50% to 65% Projected Liquidation by Segment
    • Work Flow Optimization Above and Beyond the Call Analysis with Benchmarks and Targets
    • Maximum Payment Estimator Above and Beyond the Call
      • Validate Stated Income via Credit Report
      • Estimated Income Baseline from Block Census Bureau Report and Validated via Credit Report
      Income Estimation
      • Estimation of Assets via Credit History
      • Open Lines of Credit Available
      • Estimated Cost of Living in Geo-Demographic Area
      Financial Profile
      • Amount the Patient Can Pay Without Dire Financial Duress
      Maximum Payment
    • Data Validation
      • Validation of Accounts
      • Sample of Patient Data
      Above and Beyond the Call
    • Platform Algorithm Above and Beyond the Call Patient Demographic Data Credit Report Financial Assessment Algorithm Estimated Income Charity Recommendation History from 15 million accounts Client specific payment history Maximum Payment Recommendation Payment Propensity Work-Flow Management Key Attribute Platform Deliverables
    • Case Study Above and Beyond the Call Measurable Results from Presumptive Charity Policy and Self Pay Stratification Reduced placements of self pay accounts to collection agencies by nearly 50% within first six months Reduced FTE allocation for follow up on self pay accounts by 25% 1 2 3 Increased cash receipts on self pay accounts by over 22% during first 90 days Reallocated 60% of FTE staff previously assigned to charity care application processing 4
    • Return On Investment
      • Reduce internal cost by eliminating a minimum of 2 statements on bad debt segmented accounts thereby improving agency performance on least collectable accounts
      • Reduce charity administration costs by over 80%. (Industry trends indicate the average cost to compile a charity application is approximately $40)
      • Improve internal/external liquidation of self pay accounts by 25% to 40%
      • Capture uncollectible dollars sooner by accelerating Medicaid cost reporting on bad debt segmented accounts while allowing higher collectable accounts to remain at collection agency longer
      Above and Beyond the Call
    • Secure Accurate Platform
      • Annual recalibration of cost of living index
      • Research any anomalies and validate
      • Quality control by dedicated IS staff
      • Secure server with redundant backups – 100% HIPAA compliant
      • Detailed reporting of non-matching data
      • Detailed reporting of missing data elements
      • Trends of registration performance are captured
      Above and Beyond the Call
    • Platform Delivery
      • Platform may be applied in real time at registration or in batch mode at any point in the revenue cycle
      • Integrated mode – assessment delivered through Nebo/Passport’s AMP real time platform (HL7 connection)
      • Batch mode data transferred via a secure FTP site (48 to 72 hours turnaround)
      • Batch data can be downloaded into internal patient account system
      Above and Beyond the Call
    • Notable Features
      • Charity methodology has been reviewed by states and passed general audit testing
      • Address verification can be bundled with charity model or applied as a stand alone
      • Competitive pricing
      • Low implementation costs
      • Rapid deployment of solution
      Above and Beyond the Call
    • Thank You Above and Beyond the Call ? Phil C. Solomon Chief Client Officer UCB, Inc. [email_address] 404-849-8065 Do You Have Any Questions? ? ?