3. “
The new legislation will impact emergency
physicians greatly as newly insured patients find it
difficult to find primary care doctors who accept
their insurance.
I recently saw a Medicaid patient who received a
medical card with the name of a doctor who was
to be her primary care physician only to find out
that he was not accepting any new patients.
This lack of good primary care for Medicaid
patients is a tragedy made more acute by the 16
million plus patients who will join the Medicaid
ranks in the years ahead.
Dr. Michael Nauss is an emergency room
doctor in Ohio
4. “
My concern is how quickly (the legislation) was put
together and really how it will actually work.
For example, Massachusetts has passed similar
reform and emergency department visits are
increasing and certain hospitals are cutting back
on services and patients are often waiting longer
for care.
Just passing the bill is not enough. Congress
needs to start working now on the details of the
health care reform plan.
Dr. Paul Kivela — an emergency physician
at Queen of the Valley Medical Center and
co-managing partner of Napa Valley
Emergency Medical Group
6. triage
noun
1 the action of sorting according to quality.
2 (in medical use) the assignment of degrees of urgency to
wounds or illnesses to decide the order of treatment of a
large number of patients or casualties.
verb [ trans. ]
assign degrees of urgency to (wounded or ill patients).
New Oxford American Dictionary
10. Expected Gains
more money, quicker
copay collections
deposits
payment arrangements
prepped accounts
insurance verification
completed forms
information pass-through
decrease time to disposition
eligibility categorization
TOS information gathering
dispersion via matrices
12. “
Rethink
Staggering under a load of bad debt, many
hospitals have started asking patients to pay at
least part of their out-of-pocket responsibility
before they receive healthcare services. Although
the rewards can be great, initiating the program
is not easy because registrars may be
uncomfortable with the responsibility of asking
patients for money.
• Prioritize Collection Events
• Define the Scope and Scale of Collection
Efforts
• Incentives May Increase Collections
Boosting Point-of-Service Collections
HFMA Patient Friendly Billing, Jan. 2010
13. Rethink
staff training
your staff
other departments
patient education
available information
counseling /education
business rules
general goals
predictive assessment
workflow initiatives
documented rules
audit routines
15. “
Retool / Technology
IRS Form 990 Schedule H requires hospitals to
estimate the amount of charity care in their reported
bad debt. Are you ready to document this
information—and prove it?
At a Glance
• IRS Form 990 Schedule H requires hospitals to
estimate the amount of bad debt expense attributable
to patients eligible for charity under the hospital’s
charity care policy.
• Responses to Schedule H, Part III.A.3 open up the
entire patient collection process to examination by
the IRS, state officials, and the public.
• Using predictive analytics can help hospitals
efficiently identify charity-eligible patients when
answering Part III.A.3.
A Form 990 Schedule H Conundrum: How
Much of Your Bad Debt Might Be Charity?
HFM Journal, April 2010
18. Retool / Technology
homebrewed system
tracking system
{charity,
medical assistance,
discounts, cash collections}
status reporting
link back
pros / cons
19. Retool / Technology
bolt-on system
actionable
sophisticated functions
real time categorization
edi with patient acct. system
pros / cons
21. “
Remodel / Workflow
To improve patient flow in the ED, hospitals
should:
• Establish a measure of patient demand by
hour, and design a system to handle it
• Appropriately capacitate triage processes
and systems
• Use a system for patient segmentation and
establish distinct processes for different
patient segments
• Consider using team triage, and examine
current triage protocols
• Devise a method of tracking patients and
results Field a willing staff with a burning
platform
Improving patient flow in the emergency
department.
HFM Journal, November 2008
24. Remodel / Workflow
process flow
connect technology to staff
trace account flow to end
predict disposition and prioritize
use hierarchy for work flow
know the crossover
manage exceptions
25. Example
In a scenario of a busy
emergency room, one person
has 5 patients waiting to be
financially triaged, with only 30
minutes to see them all. All five
patients are covered, and each
has a $100 E.D. co-payment,
and one of the five presented
as a result of a car accident.
28. Example
All five accounts are paid by
insurance. For easy math, let’s say each
account’s balance was $2500, and
insurance paid 30% less the E.D. co-
payment, so insurance paid $720 for
each account. Let us also congratulate
our E.D. personnel and collections
staff, because three patients paid
upfront, and a fourth paid through the
mail. Total collections for these five
accounts was $4000 on $12,500. Not
bad at all.
29. Example
optimal result?
good screening
excellent collections
no loss from insurance
what about the car accident?
30. Example
Staff in the E.D. during the screening
process was able to determine the auto
carrier, and policy number; they even
loaded it as the primary insurance in the
billing system. Unfortunately, the auto
carrier did not pay, as “policy limits
have been met.” The claim, thus, was
billed to the group health plan and paid.
{We’ll overlook that the claim was
denied by the group plan, because of a
missing accident questionnaire.}
35. Example
it takes time
accident information
patient interview
various authorizations
adjuster contact info
36. Example
When we’re done, we only have ten
minutes, so we work with one patient
and collect one co-payment. One out of
five is not a good percentage, but now
let’s jump forward in time, and count
the money again.
37. Example
The four non-accident accounts were paid by
insurance to the tune of $2880, add in the $100
co-payment we collected upfront, and another
$100 paid through the mail, and we’re at $3080.
The one patient still did not pay their co-payment,
and a second patient did not pay either, based
on our missed opportunity to screen them. That
leaves us with the auto insurance account.
Hard work paid off, and by taking the steps
required to actually collect from the auto-carrier,
the hospital received payment of $2500 from the
MedPay policy. In the end, our work in the E.D.
resulted in total collections of $5580, which is
$1580 more. Not bad for a half hour’s work. Also,
keep in mind we saved the patient $100, a definite
plus for patient service.
39. VENDOR PERFORMANCE FORUM
Come be a part of an online forum for
providers and vendors that focuses on
vendor management and performance
based solution acquisition.
vpf.tumblr.com
