The document discusses strategies for optimizing self-pay patient collections. It notes that collecting from self-pay patients is challenging but critical for practices' financial health as more revenue comes from patients. It recommends verifying patient insurance at check-in to collect copays and establish credit card on file programs. Establishing clear policies on collecting balances, offering payment plans, and using agencies only as a last resort are also discussed. The implications of the Affordable Care Act, like grace periods for unpaid premiums, are reviewed along with average exchange plan deductibles. Overall it provides best practices for effective self-pay collection processes and policies.
“Surviving the Changing World of Patient Collections”PYA, P.C.
Many factors brought on by healthcare reform are affecting patient collections—new health exchange plans, newly insured individuals, more high-deductible plans, increased patient co-insurance responsibilities, and higher co-pays. Medical practices and their staff must become more diligent in patient collections to maintain healthy bottom lines. PYA Consulting Principal Lori Foley recently presented “Surviving the Changing World of Patient Collections” during the Business of Medicine Program at Kennesaw State University.
PYA Principal Carol Carden recently spoke on the topic “Valuation Issues in Healthcare” at the Tennessee Society of Certified Public Accountants’ Healthcare Conference.
Evaluating the Brand Value of Healthcare EntitiesPYA, P.C.
PYA Principal Jim Lloyd co-presented with PYA colleague Anna Bhat at the NACVA and Consultants Training Institute’s (CTI) Advanced Healthcare Valuation and Consulting Symposium, December 12-13, 2014, on the topic, “Evaluating the Brand Value of Healthcare Entities,” providing a comprehensive overview regarding:
Healthcare affiliations in which “brand” is a key factor.
Detailed discussion regarding healthcare entity brands.
Methodologies commonly used to value brands.
Evaluating a healthcare entity’s brand strength.
Capitalizing on your entity’s brand.
“Surviving the Changing World of Patient Collections”PYA, P.C.
Many factors brought on by healthcare reform are affecting patient collections—new health exchange plans, newly insured individuals, more high-deductible plans, increased patient co-insurance responsibilities, and higher co-pays. Medical practices and their staff must become more diligent in patient collections to maintain healthy bottom lines. PYA Consulting Principal Lori Foley recently presented “Surviving the Changing World of Patient Collections” during the Business of Medicine Program at Kennesaw State University.
PYA Principal Carol Carden recently spoke on the topic “Valuation Issues in Healthcare” at the Tennessee Society of Certified Public Accountants’ Healthcare Conference.
Evaluating the Brand Value of Healthcare EntitiesPYA, P.C.
PYA Principal Jim Lloyd co-presented with PYA colleague Anna Bhat at the NACVA and Consultants Training Institute’s (CTI) Advanced Healthcare Valuation and Consulting Symposium, December 12-13, 2014, on the topic, “Evaluating the Brand Value of Healthcare Entities,” providing a comprehensive overview regarding:
Healthcare affiliations in which “brand” is a key factor.
Detailed discussion regarding healthcare entity brands.
Methodologies commonly used to value brands.
Evaluating a healthcare entity’s brand strength.
Capitalizing on your entity’s brand.
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
Presented by PYA’s Jim Lloyd (Consulting Principal) and Robert Mundy (Consulting Senior Manager), "Valuation of Dental Practices,” provide valuable insights regarding dental practice operations, merger and acquisition activity, and valuation approaches. The presentation also covers:
Key operating statistics that drive the value of dental practices.
Compensation trends for dentists.
Regulatory constraints and related issues.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
HIPAA & OIG Compliance for Medical Billing Company OwnersKareo
The success of your business relies on timely billing and accurate coding. Whether you’re managing the billing for one provider or 50, it’s a complex job that must meet a variety of regulations, making it easy for medical billing companies to be the target of false claims and fraudulent crimes. As healthcare fraud continues to be a growing issue in the industry, medical billers are increasingly being held liable for their role in the submission of fraudulent claims.
Executive Director of American Medical Billing Association, Cyndee Weston, CMRS, CMCS, CPC, will provide an in-depth analysis of what can be considered fraud when submitting medical claims, how the government is enforcing guidelines, and what you can do to help protect your business as well as your practices.
Get to know the mechanics of how deductibles work, how they are perceived and big data's role and impact. For healthcare marketers, pharmaceutical marketers, health insurance marketers and other healthcare / managed care stakeholders, the deductible feature in health benefit plans has wide reaching impact as does the data and analytics which support it.
... Healthcare Marketing Leader: Pharmaceutical, Medical Device, RPA, SaaS, Digital Marketing Strategy, Managed Care, Market Access - John G. Baresky
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
Helping clients successfully negotiate and structure the transaction and keeping the deal on track
Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
Coordination of Benefits and its implications to Health PlansCitiusTech
Coordination of Benefits (COB) allows plans that provide health and/or prescription coverage with Medicare to determine their respective payment responsibilities (i.e. determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan). Member’s primary plan has the responsibility of paying claims first, followed by coverage by remaining plans. This process of splitting the costs across multiple coverage is called COB. This document introduces COB and how health plans and members benefit through COB regulations.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
The Latest Self-Pay Trends: New Burdens and Opportunitiesathenahealth
Let athenahealth guide you through the burdens of navigating through revenue collections from your patients to make sure your practice has access to all monetary opportunities to ensure financial success.
Boosting Patient Responsibility Collection
Is your billing team maximizing collections? We shared Some important tips to improve patient collections and boost practice revenue.
Read Here: https://www.medicalbillersandcoders.com/blog/boosting-patient-responsibility-collection/
To know more about our medical billing services contact us at info@medicalbillersandcoders.com/ 888-357-3226
#boostingpatientresponsibility #patientresponsibilitycollection #improvepatientcollections #medicalbilling #boostpracticerevenue #medicalbillingservices #RCM #rcmservices #rcmprocess
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
Presented by PYA’s Jim Lloyd (Consulting Principal) and Robert Mundy (Consulting Senior Manager), "Valuation of Dental Practices,” provide valuable insights regarding dental practice operations, merger and acquisition activity, and valuation approaches. The presentation also covers:
Key operating statistics that drive the value of dental practices.
Compensation trends for dentists.
Regulatory constraints and related issues.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
HIPAA & OIG Compliance for Medical Billing Company OwnersKareo
The success of your business relies on timely billing and accurate coding. Whether you’re managing the billing for one provider or 50, it’s a complex job that must meet a variety of regulations, making it easy for medical billing companies to be the target of false claims and fraudulent crimes. As healthcare fraud continues to be a growing issue in the industry, medical billers are increasingly being held liable for their role in the submission of fraudulent claims.
Executive Director of American Medical Billing Association, Cyndee Weston, CMRS, CMCS, CPC, will provide an in-depth analysis of what can be considered fraud when submitting medical claims, how the government is enforcing guidelines, and what you can do to help protect your business as well as your practices.
Get to know the mechanics of how deductibles work, how they are perceived and big data's role and impact. For healthcare marketers, pharmaceutical marketers, health insurance marketers and other healthcare / managed care stakeholders, the deductible feature in health benefit plans has wide reaching impact as does the data and analytics which support it.
... Healthcare Marketing Leader: Pharmaceutical, Medical Device, RPA, SaaS, Digital Marketing Strategy, Managed Care, Market Access - John G. Baresky
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
Helping clients successfully negotiate and structure the transaction and keeping the deal on track
Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
Coordination of Benefits and its implications to Health PlansCitiusTech
Coordination of Benefits (COB) allows plans that provide health and/or prescription coverage with Medicare to determine their respective payment responsibilities (i.e. determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan). Member’s primary plan has the responsibility of paying claims first, followed by coverage by remaining plans. This process of splitting the costs across multiple coverage is called COB. This document introduces COB and how health plans and members benefit through COB regulations.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
The Latest Self-Pay Trends: New Burdens and Opportunitiesathenahealth
Let athenahealth guide you through the burdens of navigating through revenue collections from your patients to make sure your practice has access to all monetary opportunities to ensure financial success.
Boosting Patient Responsibility Collection
Is your billing team maximizing collections? We shared Some important tips to improve patient collections and boost practice revenue.
Read Here: https://www.medicalbillersandcoders.com/blog/boosting-patient-responsibility-collection/
To know more about our medical billing services contact us at info@medicalbillersandcoders.com/ 888-357-3226
#boostingpatientresponsibility #patientresponsibilitycollection #improvepatientcollections #medicalbilling #boostpracticerevenue #medicalbillingservices #RCM #rcmservices #rcmprocess
Financial Strategies for Healthcare Providers Budco Financial
Managing the cost of healthcare continues to be a top concern for consumers and healthcare providers alike. Here are three strategies providers should use to improve self-pay receivables and increase patient satisfaction
Technology: Increase Revenue, Decrease Workload An AOA WebinarHealth iPASS
The growing chorus of patients with high deductible plans places a greater burden on medical providers to implement patient revenue cycle solutions that optimize net collection rates. Patients are now the largest payers in healthcare. Patient payment technology solutions have the unique ability to promote healthcare price transparency by educating and empowering healthcare consumerism with insurance eligibility information, cost-of-care estimates, co-pay and deductible amounts, and estimates of what balance may be owed post insurance claim adjudication. Learn more about how and why implementing a patient payment collection technology solution empowers, engages, educates, and delights patients through a convenient and intuitive patient check-in kiosk. Plus, learn more about the new “vitals” to track patient revenue cycle management to improve patient net collection rates in this webinar slide deck.
Can Billing Partner Help Improve Your Revenue.pptxOmniMD
Increasing the number of new patients while retaining current patients is vital to the success of any physician’s practice. But, unless that practice receives steady, profitable cash flows throughout most revenue cycles,contact us at https://www.omnimd.com
Can Billing Partner Help Improve Your Revenue.pptxOmniMD
Can a Billing Partner Help Improve Your Revenue Increasing the number of new patients while retaining current patients is vital to the success of any physician's practice. But, unless that practice receives steady, profitable cash flows throughout most...
Can Billing Partner Help Improve Your Revenue.pptxOmniMD
Increasing the number of new patients while retaining current patients is vital to the success of any physician’s practice. But, unless that practice receives steady, profitable cash flows throughout most revenue cycles,contact us at https://www.omnimd.com
With patient responsibility becoming an increasing part of clinics AR, you need to make sure you have an effective strategy in place. Learn how to maximize your collections without negatively impacting your relationships with your patients.
Denial Management in Medical Billing.pdfalicecarlos1
Medical Billers and Coders (MBC) is a leading revenue cycle company providing complete medical billing services. Our medical specialty-wise RCM experts ensure all the denied claims are addressed properly to receive accurate insurance collections.
Home Health Agencies: Understanding Fraud, Waste and AbuseCiara Lewin
With the new PDGM effective January 1, 2020 along with the scrutiny posed on HHAs, this training will help you to understand the following:
What is FWA and how does it impact HHA
What you need to know about PDGM and your agencies sustainability
Where you may be at risk today and how you can mitigate
How to quickly assess the readiness of your operations and coding/billing team
What steps should be taken before January 1st is here and to prepare for continual success
Denial Management in Medical Billing.pptxalicecarlos1
Medical Billers and Coders (MBC) is a leading revenue cycle company providing complete medical billing services. Our medical specialty-wise RCM experts ensure all the denied claims are addressed properly to receive accurate insurance collections.
Process Improvement: A Consultant's View of your Healthcare Revenue Cycle | A...Meduit
Get a look at how well your revenue cycle processes are functioning and learn how to identify the initiatives your healthcare facility can take to reduce days in A/R and boost revenue! Download the live event recording here: https://lab.meduitrcm.com/process-improvement-innovationlab-webinar/
Collecting Patient Payments During COVID-19 and Beyond - a Blueprint for SuccessKareo
The impact of COVID-19 is substantial and the way healthcare providers practice medicine has changed, and it’s not going back. Make sure your business has the right blueprint for success so you can continue collecting patient payments while providing quality care to keep your patients healthy and your practice profitable.
Commercial Payor Behavioral Health Audits: How to Avoid Getting Wiped OutEpstein Becker Green
The number of commercial payor audits of behavioral health facilities has been steadily rising, forcing closures of multiple treatment facilities, straining resources, and setting up an increasingly contentious conflict between treatment providers and payors.
This webinar will examine the most common issues arising in payor audits (including medical necessity; patient financial responsibility; and other issues asserted to constitute fraud, waste, or abuse) and the common arguments used as grounds for the nonpayment or recoupment of fees by insurers. The presenters will also review responsive strategies in commercial payor audits and examine defensive strategies and best practices to avoid fraud, waste, and abuse.
Presented by:
Paul D. Gilbert – Member, Epstein Becker Green
John A. Mills – Partner, Nelson Hardiman
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/how-to-avoid-getting-wiped-out-by-the-wave-of-commercial-payor-behavioral-health-audits-medical-necessity-and-waivers-of-co-insurance-and-deductibles/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Learn more about our simple, smart, fast, and reliable behavioral health solutions. We’ll help you enhance care quality, better coordinate care, streamline workflows, and grow your bottom line.
Through the innovative use of technology and proprietary revenue cycle management methodologies, NextGen RCM Services, helps practices maximize their revenue cycle results, while minimizing their tedious daily functions of billing and collecting.
NextGen Practice Management: Powerful. Smart. Efficient.NextGen Healthcare
Learn how to increase revenue and gain better control of your operation like thousands of practices that have already improved their productivity and enhanced their cash flow with NextGen® Practice Management (PM).
Tap into our integrated system. See how your organization can achieve a new level of care and financial success. Leverage the NextGen Healthcare Ambulatory Ecosystem for your healthcare IT needs.
Today it’s critical for providers to devote time to patient education; inform patients about their conditions and how to prevent, treat, and manage them. Proper management of chronic conditions extends well beyond episodic and infrequent visits to a provider’s office. This population health white paper discusses why patients must become responsible for their day-to-day disease management. Patients will frequently be required to self-monitor their health indicators, observe symptoms, and note behavior, but they must also adhere to complex medication regimens
White Paper - Building Your ACO and Healthcare IT’s RoleNextGen Healthcare
The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light. Patient Centered Medical Homes play a vital role in the path toward accountable care and technology, staff, and workflow transformation are necessary to achieve PCMH recognition. This transformation allows healthcare providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience.
White Paper - An Integrated Electronic Dental Record (EDR): The Missing Piece...NextGen Healthcare
This paper discusses the value of a single patient record for a CHC, FQHC, or tribal health center. These centers have medical and dental units that can achieve higher levels of patient care and focus in the continuum of patient care with a unified patient record.
eBook - Top Ten Reasons Cloud Computing is Inevitable in DentistryNextGen Healthcare
This eBook provides a list of reasons behind the certainty of the cloud and cloud based technology in dentistry, and provides the "top ten" reasons for dental professionals to move their electronic dental record (EDR) and practice management (PM) data management systems to the cloud.
eBook - Tools, Resources, and Expertise for your ACO/Collaborative Care JourneyNextGen Healthcare
Learn how NextGen Healthcare can equip you with the tools, resources, and expertise needed to reach your Accountable Care Organization (ACO), Meaningful Use (MU), and Patient Centered Medical Home (PCMH) goals.
eBook - Top Six Ways an Integrated EDR Improves Your Health CenterNextGen Healthcare
If you have doubts about whether you need an electronic dental record (EDR), look no further. This eBook packs the punch you need to see how the right EDR can really revolutionize your practice.
Learn the essential difference why working with QSIDental in implementing and deploying your new enterprise software is unlike working with any other dental software company.
The number of patients with high-deductible plans continues to grow. Effective collection of patient financial responsibilities must be a priority for a practice to stay on the path of financial health. Download this eBook to learn key straegies for optimizing patient collections.
Gain insights from data analytics and take action! Learn why everyone is making a big deal about big data in healthcare and how data analytics creates action.
1. NextGen Healthcare Self-Pay Collections
Optimizing Patient Collections
Patient collection is mission critical1
Collection processes that work2
Self-pay policies that work3
Establish a credit card on file program4
Implications of Affordable Care Act5
Best practices for self-pay you can execute today6
2. The number of patients with high-deductible commercial
plans continues to grow. Effective collection of patient
copay and additional financial responsibilities must be a
priority for a practice to stay on the path of financial health.
Collecting from self-pay, high-deductible, or health
savings account patients is one of the biggest
challenges for medical practices.
““
Susan L. Turney | MGMA CEO MD, MS, FACMPE, FACP
4. Getting paid for what you do is critical.
Today, a greater percentage of practice revenue than ever is coming from patients. And with healthcare premiums
exceeding the rate of inflation every single year for the past 14 years, better performing practices are taking every
step possible to minimize bad debt and optimize patient collection.
% of Revenue from Patients
40%
30%
20%
2002 2007 2009 2012 2013
10%
0%
Source: Intuit 2012, MGMA 2012, McKinsey & Company 2013
88%increasein commercial deductible
amount since 2006
What you collect from insurance
companies covers your overhead.
What you collect from patients
goes to your bottom line.
Medical Economics
“ “
5. According to a 2013 study on Patient A/R by SuccessEHS, only 21% of patient balances not collected up front
are ever collected. Only 21%! That’s why it’s never been more important to proactively bill patients and collect
balances at every opportunity.
No amount of cost cutting can compensate for inadequate patient collections. According to a 2013 study
(we did this math independently), a practice would have to cut costs by 31% to make up for lost patient revenue.
What are the odds you can find a way to cut 31% of your overhead? What are the odds that these cuts would
have an adverse effect on the level of care delivered to your patients?
Avg. Collections
per Primary
Care FTE
$470,000
Amount of
Patient Balances
Collected
$34,545
% Collections
that are
private pay
35%
Avg. Overhead
per Primary
Care FTE
$420,000
Amount of
Patient Balances
Actually
Collected
21%
=
You would have to
cut costs by -31%
to make up for
$129,955
lost patient
revenue
Source: SuccessEHS
7. According to a 2012 survey1
, about 60% of Americans are insured through their employers.
To cut costs, these employers are passing fees on to employees through increased copays,
deductibles,co-insurances, and decreasing overall benefit coverage.
Determining patient responsibility at the time of service, through technology and best practice, gives providers
the opportunity to ask patients for payment at check-in. That all starts with checking a patient’s eligibility.
So use an eligibility tool to verify a patient’s eligibility, plan specifics, copays and deductibles.
1. SOURCE: 2012 Survey of Employer Sponsored Health Benefits conducted by the Kaiser Family Foundation,
NORC at the University of Chicago, and the Health Research and Educational Trust
It is important to check eligibility
so you can:
• Obtain upfront collection of copays
and deductibles
• Eliminate claim denials, claim
resubmittals, and unpaid patient
balances in A/R
• Verify insurance coverage and
benefits before patients are seen
8. Estimate total patient responsibility for
procedures and everyone wins.
Costs of procedures can be quite high and patients do not
want to know how much their procedure will cost, they want
to know how much it will cost them. This involves calculating
procedural charges, analyzing historical data, evaluating
contract pricing between your organization and the payer,
and applying patient insurance benefit information to
establish an estimated patient financial obligation at the
earliest point of patient contact.
Help your patients pay upfront.
According to a 2012 study2
, 78% of patients know their financial
responsibilities, but do not commonly volunteer payments
if not asked at time of service. But there are ways to get creative
in collections. For example, universal kiosk technology, like
that now used in airports, offers a familiar way to improve upfront
collection of patient copays and outstanding balances, as well
as increase check-in efficiency. Technology is not averse to asking
for payment like some employees are.
With this type of technology, patients can view their bills and
pay with a credit card, eliminating the need for costly letters
or phone calls. This solution streamlines collections and
increases office efficiencies.
2. Source: InstaMed Trends in Healthcare Payments Annual Report: 2012
79%
21%
Collected
Uncollected
Patient responsibility collected
after time of service
79%
21%
Collected
Uncollected
Patient responsibility collected
after time of service
Benefits of pricing estimation:
• Increase price transparency
• Increase point-of-service collections
• Improve patient satisfaction
• Reduce days in accounts receiveable
9. Key workflow areas that positively affect collections.
To ensure optimal self-pay collections (both true self-pay and self-pay after insurance), it is crucial to understand where and how you
can affect collection performance. This workflow chart can provide valuable tips on when, where, and how to improve collections.
Comparing the methods of collecting part of a patient balance before a statement goes out shows some methods are more complex
than others. For example, any estimation of patient balance after insurance will require contract maintenance, which can be difficult.
Patient Collections Workflow
= Direct opportunity for cash collections
Appointment
Scheduling
Patient Care
Event
Pre-Visit CheckoutCheck-In Follow-up
Collect
demographics
and identify
uninsured
patients
Communicate
financial policy
Collect past
due balances
•
•
Verify insurance
Qualify uninsured
patients for charity
care, Medicaid, or
exchange
Flag patients with
bad debt
•
•
•
Remind patient to
stop at checkout
•
•
•
Collect copays
Collect past
due balances
Collect prompt-
pay deposit
Confirm financial
agreements
Collect copays
and past due
balances
Collect cash-pay
amount due
Collect est.
patient
responsibilty
Balance out-
bound patient
calls, statements,
and letters
Establish /
maintain
consistent bad
debt policy
Manage bad
debt vendor
•
10. Comparing Methods of Collecting
Patient Balance at Time of Encounter
METHODS
Collects
Deductible
Collects
Balance After
Insurance
Requires
Estimation
Limited
Scope
Requires Payer
Contract
Modification
State Law? Timeliness Complexity
Collect Copay No No No No No No Same Day Low
Eligibility
Request
(to determine
met deductible
copay)
Yes No Yes No Possibly Possibly Same Day Medium
Estimate
Patient’s
Responsibility
(scope -
procedures)
No* Yes Yes Yes Possibly Possibly Varies,
same day
possible
Medium -
High
Estimate
Patient’s
Responsibility
(scope -
all services)
No* Yes Yes No Possibly Possibly Varies,
same day
possible
Medium
Hybrid - Check
deductible then
use estimator
(scope
all services)
Yes Yes Yes No Possibly Possibly Varies,
same day
possible
High
Credit Card
on file
Yes Yes No No No No Copay same
day, Balance =
insurance
turnaraound
Low
*Collection methods subject to change
Low Efficiency Medium Efficiency High Efficiency
Efficiency level based on the strain on resources to deploy compared to degree of revenue optimization.
ASPECTS TO CONSIDER
12. Incentivize your patient and everyone wins.
Because patients pay their balances slower than third-party insurers, providers should incentivize patients to resolve balances
quickly, ideally at time of service. A 2010 MGMA study shows that 74% of better performing practices assist patients with
finances, offering financial incentives to resolve balances faster. This approach is mutually beneficial to both patient and provider.
Often, lack of payment may not be due to a patient’s inability to pay. Therefore, providers should help patients resolve medical
bills by offering more financing options. Many patients want to settle their balances when given a payment plan.
Lack of financing options
I just received my statement
I forgot to pay or was confused about what I owe
Healthcare is a right, I shouldn’t have to pay my bill
37%
19%
17%
8%
19%
Lack of financing options
I just received my statement
I forgot to pay or was confused about what I owe
Healthcare is a right, I shouldn’t have to pay my bill
Other
37%
19%
17%
8%
19%
SOURCE: 2009 McKinsey Survey of Retail Health Care Consumers
Stated Reasons for Nonpayment, Percentage
of Insured Respondents
13. How effective are collection agencies?
According to ACA International, on average a practice recovers just $13.80 for every $100 owed once a patient’s bad debt is turned
over to a third-party collection agency. The majority of money collected by agencies is from the first letter sent to the patient.
To head this off, practices need to establish bad debt policies, make patients aware of them, and enforce them. Target bad debt
aggressively and use an outside collection agency only if absolutely necessary. Using collection agencies is often less successful
and not as profitable. Good bad debt policies and better point-of-service collections can reduce the need for collection agencies.
Lost recovery
Average collection rate
86.2%
13.8%
Lost recovery
Average collection rate
86.2%
13.8%
Average Collection Agency
Recovery Rate
Typical Collection Agency Cost:
25% – 30%
The average recovery rate
for collection agencies:
13.8%Source: ACA International
15. For the best collection optimization,
establish a credit card on file
(CCOF) program.
This accelerates collections and improves cash flow.
But it should only be offered if card information can
be stored according to PCI guidelines and payer
contracts allow for this.
It is recommended that practices which accept credit/debit
cards, or use a credit card on file program, become familiar
with their credit card processing statement and keep
looking for lower rates and better terms.
As a provider, your business is valuable to credit card
processors, and you have the hammer in competing on
price. Don’t sign a contract for processing. This allows you
to shop around at any time for better pricing. Otherwise,
you may spend too much on processing charges.
Use technology to speed credit
card payments.
It all starts with the right technology. With the right practice
management (PM) system, you can automate and configure
triggering of credit card processing at time of service. Look
for a PM system that allows you to store a unique identifier
while the actual credit card info is kept in your credit card
company’s PCI-compliant system. This unique identifier
in the PM system allows for A/R-related processes like those
that trigger auto-payment and auto-PM payment posting.Credit card processing is an
important part of:
• Managing payments
• Maximizing revenue
• Maintaining the financial
health of a practice
16. Steps for configuring a successful
CCOF program.
Patient
Check-In:
• Insurance
Card
• ID
• Credit Card
Collect/
Charge Copay
Encounter/
Claim
Submisson
Receive
ERA/EOB
Trigger
Auto-Payment
using credit
card on file
Auto-post to
PM System
Recurring
Payment
if needed
New Process New Required Automation
17. Results of implementing a credit card
on file program.
Change Comment
Improved Collections Patient balances collected are in the MGMA 90th percentile
Improved Cash Flow Steadies cash flow, stabilizes finances
Statements Eliminated Reduces collection expense, deposits, and staff workload in posting payments
Automated Electronic
Payment Plans
Policy-driven but flexible, secure; “set it and forget it”
Manual Patient Refunds Eliminated It’s easier and faster than refund checks; reduces staff workload
and improves patient satisfaction with fast refunds
Bounced Checks Eliminated Reduces/eliminates in-house collection expense
Deposits Reduced /Eliminated Possible to stop operating a cash drawer; CCOF requires no deposits
Faster Check-in Checkout No need to check patient balances and ask for payment
Paper Receipts Reduced/Eliminated Possible to eliminate receipts; save time and expense
Collection Agency Fees Eliminated No need to send to collections unless credit card expires
Cash Drawer Issues Reduced/Eliminated Reduces risk of theft, eliminates handling of money
19. A promising outlook.
The future of the Affordable Care Act (ACA) promises some positive outcomes, including allowing practices to access
more specific real-time adjudication from carriers. When this change does come about, it will mean greater patient
responsibility collections accuracy. Currently, there are several loopholes that keep participating practices out of luck
when it comes to receiving their money.
Affordable Care Act loophole.
Under the ACA, insurers are obligated to give a three-month grace period for policy premium payments. This means
insurers have to keep people active for three months of coverage from the last payment, but only pay benefits for the
paid month. What does this mean for you? It means providers won’t get paid by insurers for the previous two months
if their patient doesn’t pay their premium.
• Health plans will pay for the first 30 days after a patient misses a premium payment
• Days 31 to 90 may result in withheld payments to physicians – or retroactive takebacks
The Exchange’s Three-Month Grace Period for Non-payment of Premiums
First month of delinquency Second month of delinquency Terminated after three months of delinquency
• Normal payment of claims
• Plan effectively treats this month
as paid even if enrollee is eventually
terminated for non-payment
• No provider notification of the
patient’s delinquency
• Plan has the option to pend claims for
services performed until the enrollee pays
the outstanding premium balance
• Providers submitting claims during these
months are notified to the potential for a
denied claim
• If enrollee pays off the premium balance,
providers’ claims are paid at that time
• Plan has the option to deny all claims for
services performed in the second and third
month of delinquency
• Providers may seek payment for denied
claims from the patient
• Patients may then enroll in a different
exchange plan during the next open
enrollment period regardless of whether
they pay off premium balance with
previous insurers
20. Average Deductible on Health Exchanges.
The trend of high deductibles and higher out-of-pocket expenses is not going away. With some of the new exchange
plans, the options leave patients with deductibles as high as $5,081. Examples of these plans and deductibles include:
$347 $1,277
$5,081$2,907
22. Self-pay best practices you can execute today.
Have a thorough plan as it relates to workflow at the front desk and patient check-in.
Consider implementing these self-pay policies:
• When patients call for an appointment, if there is an outstanding balance, try to collect it on the call
or ask them to be prepared to make the payment at their appointment.
• When making the appointment, the patient should be reminded to be prepared to make their copayment at their visit.
• When the patient arrives at the visit, the copayment should be collected as well as any other outstanding balance.
• Additional steps can be taken to ask patients to sign an agreement to take future funds from their credit card on file.
This should only be offered if the credit card information can be stored according to PCI guidelines.
Implement some creative ways to collect patient payments other than traditional statements, including:
• Electronic point-of-service check-in solutions (Kiosks hand-held)
• Patient Portal
• E-statements
• Stop seeing patients who owe money
1
2
3
Using our electronic point-of-service check-in solution, practices
increase collections by 13% on average. Some practices see results
as high as a 50%-90% increase per patient encounter.
““
Chaim Indig | CEO | Phresssia
23. Prepare your practice to succeed.
The “self-pay” patient population is dramatically changing and growing. Since January 2014, a large influx
of previously uninsured individuals has moved into insurance coverage options, either through Health Insurance
Exchanges/Marketplaces or through expansion of Medicaid programs. To continue generating consistent cash flow,
practices need to ensure they develop proactive policies and procedures to identify, educate, and verify which
patients are self-pay and which have limited, supplemental, or full coverage.
Thousands of dollars can be lost every year if a
doctor’s office does not diligently bill patients
and collect outstanding balances from them.
In short, patient receivables can be the
difference between having a profitable and
an unprofitable practice!
HMBA February 2013
“
“