CDW_Transparency and Front End Collection Presentation
1. Transparency and Front End
Collection Methods To Improve
Your Practice’s Financial Viability
Chastity Werner, CMPE, RHIT, NCP
2. Agenda
Trends in consumer-direct healthcare
Impact of payment trends
Strategies to increase revenue and decrease
collection costs
Methods to provide greater cost of care and billing
transparency
Transparency=higher profitability
3. Methods to Provide Greater Cost of Care and
Billing Transparency
Definition of Transparency
“Readily available information on the price of
healthcare services that-together with other
information-helps define the value of those
services and enables patients and other care
purchasers to identify, compare and choose
providers who offer the desired level of value.”
-HFMA Task Force
6. History of Insurance
1850
• Franklin Health
Assurance
Company of
Massachusetts
1890
• Origins of
sickness
coverage
1920’s
• Hospitals offered
services on a
pre-paid basis
1929
• Dr. Justin Kimball
at Baylor
Hospital in
Dallas, Texas (50
cents a
month=21 day
hospital stay)
1930
• Welcome
BCBS/discussion
of Medicare
7. History of Insurance
1940-1960 increase from 20,662,000 to
1960- Indemnity fee-for-service plans
• 80/20
• deductibles
1965- implementation of …
1970’s- medical expenses on the
8. History of Insurance
1973- Legislation passed federal funding
expansion of HMOs
1990’s- Majority of Americans were covered by
Managed Care
11. Exhibit 1. Estimated Source of Insurance Coverage, 2014
Note: The number of uninsured in 2014 was calculated using CPS estimates for 2013 minus an estimated 9.5 million fewer uninsured in 2014.
The number of people enrolled in Medicaid/CHIP in 2014 includes the approximately 9.1 million new Medicaid enrollees in 2014. Estimate of
individual off-marketplace is midrange of ASPE 2014 estimate.
Sources: Analysis of 2014 Current Population Survey by Sherry Glied and Claudia Solis-Roman of New York University for The Commonwealth
Fund; ASPE, How Many Individuals Might Have Marketplace Coverage After the 2015 Open Enrollment
Period? Nov. 2014; Centers for Medicare and Medicaid Services, Medicaid and CHIP: September 2014
Monthly Application, Eligibility Determinations, and Enrollment Report, Nov. 2014; The Commonwealth
Fund Affordable Care Act Tracking Survey, April–June 2014.
6.7 M (2%)
Marketplace
6.3 M (2%)
Military
7.5 M (3%)
Medicare
153 M (57%)
Employer
Affordable Care Act, 2014
Among 269 million people under age 65
10 M (4%)
Individual
Off-Marketplace
50 M (19%)
Medicaid/CHIP
32 M (12%)
Uninsured
12. Impact of payment trends
Covered workers percentage of plans
PPO plans
HDHP with attached savings
HMO
POS
Conventional (Indemnity)
-2014 Kaiser Employer Health Benefits Survey
15. 14%
20%
21%
15%
21%
23%
0%
5%
10%
15%
20%
25%
2003 2010 2013 2003 2010 2013
Exhibit 4. Average Health Insurance Premiums as Percent of Median Income,
2003, 2010, and 2013
Single-person coverage Family coverage
Analysis of 2003–2014 Current Population Surveys by Sherry Glied and Claudia Solis-
Roman of New York University for The Commonwealth Fund.
Source: Medical Expenditure Panel Survey–Insurance Component, 2003–2013.
Percent of median income
16. 2003 2010 2013
Average annual growth
2003–10 2010–13
Share of enrollees who
have a deductible on
their employer-
sponsored plan
52% 78% 81%
Average, all firms
Single-person plan $518 $1,025 $1,273 10.2% 7.5%
Family plan $1,079 $1,975 $2,491 9.0% 8.0%
Average, small firms
Single-person plan $703 $1,447 $1,695 10.9% 5.4%
Family plan $1,575 $2,857 $3,761 8.9% 9.6%
Average, large firms
Single-person plan $452 $917 $1,169 10.6% 8.4%
Family plan $969 $1,827 $2,307 9.5% 8.1%
Exhibit 6. Private Health Insurance Deductibles:
State Averages by Firm Size and Household Type, 2003, 2010, and 2013
Note: Small firms = firms with fewer than 50 employees; large firms = firms with 50 or more employees.
Source: Medical Expenditure Panel Survey–Insurance Component, 2003–2013.
$1,695
$3,761
27. The Why?
A list is created
A budget is made
Prices are compared
Impulse buys have prices
Prices can be calculated
as they put them in the
cart
If they cannot afford it …
they put it back
28. The Why?
The patient schedules
an appointment
Pays a specialty
copayment
The patient is seen by
the doctor
Blood tests are taken
An injection is given
DME is given
Medications are
prescribed
29. The Why?
Higher responsibility
has transitioned
patients to become
shoppers
We cannot afford to
not be prepared.
Our staff has to be
educated, cross
trained, and great
communicators.
30. The Why?
Change our
workflow
We have to be
educators
Invest in our
guests/future
Allow our patients to
choose
“Understanding
Your Health
Insurance Benefits:
A Guide for
Patients”
32. Not optional!
Policies and procedures
Scheduling
• Capture information
Demographics
Insurance
Guarantor
Reason for visit
• Collect balances owed
33. Not Optional!
Set expectations
• Complete paperwork- online/email
• We will be:
Checking benefits
Investigate financial responsibilities
Require payment at the time of service
Insurance issues we will call
• Deposit required/cc Authorization
• Arrive early
34. Not Optional!
Invest in automation
• Check eligibility/benefits
• Reminder calls
Balances
Financial Responsibility
Set expectations of payment
Allow them to “press 1 to pay your balance”
Press “1” to pay
your balance
35. Not Optional!
Make it easy to pay
• Store cc information
• Online
CC
Checking
• Payment plans
37. Where do I start?
Assess your practice/workflow
• Internal
• External
Do not ask
Create procedures that match workflow
Train
• Staff
• Patients
• Referring providers
42. Pre-qualify Patients
Can your staff calculate
expected responsibility?
Do they have the right
tools?
Do they know how to
communicate the
amounts effectively?
43. Information is needed
Tools and knowledge for patients
Educate your staff to educate your patients
• Billed amount
• Contractual amount
• Why it is set-up that way
• Cheaper is not necessarily better
• Vice versa
Invest in
your staff!
44. Free marketing
Maintain a strong, trustworthy relationship with
patients, who are balancing their financial and
health interests.
Sunday dinner discussion
Spread the word - Increase referrals
47. Start now!
You cannot afford not to:
• AR
Pt responsibility as % of AR
$$$$ Written off to collection agency
• 90% of our AR is collected within the first 90
days
49. Chastity D. Werner, CMPE, RHIT, NCP
cwerner@anderscpa.com
(314)655-6651
www.andershealthcare.com
Check out our webinar series!
We will be presenting at MGMA KS in October hope
to see you then!
50. Anders Health Care Services optimizes staff,
resources and revenue for hospitals and
physicians by offering solutions and direction to
complex practice management issues.
We provide an integrated approach from the
financial, operational, compliance and strategic
perspectives.
