optimizing & accelerating patient payments...optimizing & accelerating patient payments amy...

© 2016 Aprima Medical Software, Inc. All rights reserved. Aprima is a registered trademark of Aprima Medical Software. All other trademarks are the property of their respective owners.© 2015 Aprima Medical Software, Inc. All rights reserved. Aprima is a registered trademark of Aprima Medical Software. All other trademarks are the property of their respective owners.

OPTIMIZING & ACCELERATING PATIENT PAYMENTS

AMY ROGERS & JOSEPH JENKINS

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Yearly Healthcare Spending To Exceed $10,000 Per Person For The First Time

National health expenditures will hit $3.35 trillion this year, which works out to $10,345 for every man, woman, and child. The annual increase of 4.8 percent for 2016 is lower than the forecast for the rest of the decade.

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Yearly Healthcare Spending To Exceed $10,000 Per Person For The First Time

The report also projected that OUT OF POCKET COST paid directly by consumers will continue to increase as the number of people covered by high-deductible plans keeps growing.

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REVENUE CYCLE• FRONT END Referrals / Orders Scheduling Financial Clearance Charity / Public Assistance Registration POS Collections

• MID CYCLE Charge Capture Documentation / Coding Medical Necessity Transition of Care / Case Management

• BACK END Claim Creation, Scrub, Submission Insurance Collections / Cash Self-Pay Collections Payment Posting Denials & Appeals Management

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SCHEDULING & INTAKE

FINANCIAL CLEARANCE,

REGISTRATION, POS, $

CHARGE CAPTURE, DOCUMENTATION,

CODING

CLAIM BUILD, SCRUB, SUBMISSION

INSURANCE ADJUDICATION,

PAYMENY, SELF-PAY, COLLECTIONS, EARLY

OUTS

DENIALS & APPEALS, CASHING POSTING

EMR

CONSUMER FINANCIAL PROTECTION BUREAU

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Medical debts account for a majority (52%) of debt collection actions that appear on a consumer credit report.

Kaiser Family Foundation – 1 in 3 Americans struggle to pay medical bills - 70% of those who do are insured.

Unpaid medical bills are the highest cause of bankruptcy filling.

Once in debt, people may delay or forego other needed medical care to avoid incurring further unaffordable medical bills.

INTERESTING FACTS

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Deductibles• 2003 - $518• 2013 - $1273

Percent of workers with a deductible• 2003 - 52%• 2013 - 81%

Premiums have tripled in the last 10 years.

IN THE LAST 10 YEARS

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108% - increase in deductibles

72% - increase in premiums

23% - increase in workers wages

SHIFT IN PAYMENT

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Consumers now pay more for medical costs than their employers.

Consumers shoulder a greater up-front cost burden.

Medical providers must collect payment directly from the consumer, not the insurer.

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SHOPLIFTING CARE

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Come in! Get it!Bill later! -

(Wonder if we are going to get paid.)

Health Care is the only industry that lets people shoplift.

NEED TO THINK DIFFERENTLY

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PATIENT COLLECTION IS MORE THAN CO-PAY AT

TIME OF SERVICE!

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A patient’s cost responsibility at the time of service is just a person’s co-pay?

1. True –

2. False –

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PATIENT’S COST RESPONSIBILTY

46%15

If not collected at the time of service what is the estimated percent that will be written off?

If the patient’s cost responsibility is not collected at the time of service what is the estimated percent that will be written off by a practice?

A. 25% -B. 46% -C. 18% -D. 35% -

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PATIENT IS CONFUSED

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What is my coverage?

What does this cost?

How much am I going to pay?

I can’t afford this?

What do I do now?

STRATEGIES

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Scheduling / Registration – Insurance Card

Insurance Verification • Authorizations, Medical Necessity, Estimates

Self Pay Rates – opt out of insurance

Asking the patient• “How would you like handle your cost responsibility today?”

CHECKLISTS

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Collection

• Preservice• Point of Service• Payment Plans• Loans / Credit

Estimation

• Matrix• Estimator• Ability to pay• Federal Poverty Level

Verification

• Benefits• Authorization• Medical Necessity

Eligibility

• Insured• Self Pay

CAN BE CUSTOMIZED TO MAKE THIS WORK!

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MACRA

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ONEWAY COMMUNICATION

IN PERSON COMMUNICATION EDUCATION

TRI-STATE VEIN CENTER’S RESULTS

Patients are generally willing to pay their entire responsibility at the time of the first procedure.

98% of our superbills have cleared the insurer in less than 30 days per the Aging Account Report. (generally cleared within 3 weeks)

United Health Care has complimented our office several times about our paperwork that is submitted for prior authorization.

Numerous patients have reported that they really like the fact that they know what their responsibility is prior to any procedure.

The only patients that receive a mailed statement are those that have be initially evaluated at a free vein screening and had a bilateral venous duplex ultrasound completed prior to their initial provider evaluation. (The patient’s health insurance has not been checked.)

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Does your office talk with a patient about their payment responsibility, prior to carrying out services within your office?

1. Yes –

2. No –

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