strategies for self-pay in healthcare

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Success Strategies for Self-Pay

Wendy JacobsManager, Small Group Sales

Learning Objective

2

Evaluate your current self-pay strategy

1 Explore how practice management can support your self-pay strategy2

Increase in Patient Deductibles2009-2011

4

20%Increase

20%Increase

20%Increase

47%Increase

Midwest

West South

Northeast

Deductibles are a significant percent of your contracted rate

5

11%DEDUCTIBLES

FamilyPractice

7%DEDUCTIBL

ES

Pediatrics

9%DEDUCTIBL

ES

InternalMedicine

8%DEDUCTIBL

ES

OB/GYN

11%DEDUCTIBL

ES

OrthopedicSurgery

8%DEDUCTIBL

ES

Surgery

50% of overall patient responsibility goes uncollected.

6

Source: Online Resources Corp. (ORCC), “Short on Money, Will Your Customers’ Pay Your Bill?” December 2008.“The ‘Retailish’ Future of Patient Collections,” Celent, February 2009

Bills Consumers are Least Likely to Pay if Lacking Funds to Pay All Bills

40%

35%

30%

25%

20%

15%

10%

5%

0%Credit Card

PhoneHealthcar

eOther

UtilityLoan

InsuranceMortgage

Oct 07

Apr 08

Oct 08

% o

f onlin

e h

ouse

hold

x

Deductible and coinsurance dollars take longer to collect…

7

12

0

10

0

80

60

40

20

0

Average Insurance Claim

CoPaymentDeductible

Coinsurance

No InsuranceDays in AR

…and are more likely to be written off!

8

12

0

10

0

80

60

40

20

0

Average Insurance Claim

CoPaymentDeductible

Coinsurance

No InsuranceDays in AR Percent Written Off

35

%

30

%

25

%

20

%

15

%

10

%

5%

0%

Understanding the consumer is key to success

9

* Trends in Healthcare Payments Annual Report: 2011. InstaMed.

A 2011 survey of patients offers the following insights.

32%Don’t know

their payment responsibility

when they leave the

office.

70%Are interested

in making payments

online.

63% Would use a

payment plan if it was made

available.

10

Create a Self-Pay Policy1 Use technology to build efficiencies and automation into your self-pay efforts2Make self-pay collection part of your practice workflow3

Essential Parts of a Self-Pay Policy

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Section 1: Describe what the policy covers.

Section 2: Describe generally that you hold patients responsible for the fees that they properly owe.

Section 3: Tell the patient when you expect payment.

Section 4: Clearly describe any late payment charges or any discount plan you may offer, making sure that you communicate all conditions and limitations recommended by your legal advisor. Section 5: Consider describing the consequences of non-payment (e.g., possible referral to a collection agency or an attorney). Section 6: Patient acknowledgement (optional).

Title: Announce the policy to the patient.Consider the following:- “Financial Policy” or

- “Policy on Patient Responsibility for Fees”

12


13

Reminder

Calls

Payment Estimator

Credit Card

Processing

Text Message

Reminders

Live Operator

Patient Portal

Bill on EOB

What your HIT vendor should do…

14

Pre-visit scheduling Check-in Intake Exam Orders Check-out Follow-up

• Provide scripts to help staff collect co-pays, deductibles, and previous balances

• Provide access to real time adjudication

• Enable processing of credit card, HSA/FSA card, and checks

• Enable secure storage of credit card information to pay future balances

• Enable creation of automatic credit card payment schedules

• Provide portal to accept payment, deliver summarized EOB and statement

• Provide 2 automated follow-up calls every statement cycle

• Provide 2 automated follow-up emails every statement cycle

• Provide live operator services for after-hours bill payment

• Mail up to 4 printed statements if needed

• Enable insurance card scanning

• Enable processing of payments via credit, HSA/FSA cards, and checks

• Enable secure storage of credit card information to pay future balances

• Enable creation of automatic credit card payment schedules

• Provide patient portal to communicate self-pay policy, post anticipated co-pay amounts, and take payments

• Enable swift insurance eligibility checking

15


Make self-pay collection part of your practice workflow

16

It is important to work with your staff on self-pay best practices: • Help them understand the importance

of collecting self-pay amounts

• Provide scripts for your front desk staff to help them ask for co-pays, deductibles, and previous balances

• Identify and appoint collection “aces” – these people should be in client-facing roles. And remember, asking for money is a talent. Keep this in mind when recruiting new staff

• Explore incentives or recognition opportunities for self-pay staff achievements

Consider policies and measures to encourage payment

17

Here are some policies that you might consider (with the help of your legal advisor):

• Time-of-service payment discount

• Cash discount

• Extra charge if bill is not paid at time of service or by a certain deadline

• Separate internal policy to cover fee waivers, discounts, and write-offs

What your practice should do…

18

Pre-visit scheduling Check-in Intake Exam Orders Check-out Follow-up

• Use scripts to help staff request co-pays, deductibles, and previous balances

• Ask if patient wants credit card info securely stored to pay future balances

• Request payment for existing balances or establish electronic payment plan if payment can’t be made immediately

• Allocate time for billing inquiries

• Collection agency management and account selection for collection agencies

• Confirm demographics

• Collect co-pays & deductibles

• Scan insurance cards

• Collect completed HIPAA forms

• Create materials to clearly communicate policy to patients

• Consider policies for special circumstances

• Make reminder call in advance of apt

• Remind patient to speak with front desk about payment

When all else fails, employ a collection agency

19

Once a month, review all patient balances that have aged over 120 days and send those accounts to your collection agency.

You also need to monitor your collection agency’s recovery rate and customer service skills in order to make sure that they are being both courteous and effective.

We offer five services which combine to help caregivers thrive

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athenaCollector® Life Cycle of Claim

• 32% average improvement in client DAR• 6% average improvement in collections• Reduced administrative work

• 95.4% Meaningful Use attestation in 2013• 1,329 clinical documents processed on average per

physician per month (PPM)• 98% adoption rate

• 8% average decline in no-show rates• 121 patient interactions via portal per PPM• 2.6% decrease in self-pay days in accounts receivable

• Increased volume and revenue capture from patients and insurance companies• Reduced administrative work for both sender and

receiver

• Mobile medical software for drug interaction, EHR, drug prices, dosing, disease, medical dictionary, ICD9 Code, Medicare Part D, and CME

athenaClinicals®

Life Cycle of the Chart

athenaCommunicator®

Life Cycle of the Patient Relationship

athenaCoordinator ®

Life Cycle of the Order

EpocratesPoint of Care Medical

Applications

2000

2006

2010

2011

2013

WHY IT MATTERS

A Success Story – San Antonio Orthopaedic Group

21

Prior to implementing athenaCommunicator: • Self-pay DAR of 147.1

• No patient portal

• No online credit card processing

• No automated reminder call service

• No ability to take payment by phone outside of business hours

With athenahealth:• Self-pay DAR of 62.3

• athenaCommunicator sends e-mails to patients that allow them to review their statement and pay their bill online in the portal

• In 2012, the practice sent 42,676 automated self-pay reminder messages which resulted in 772 payments within 72 hours totaling $91,638.91

“athenahealth has improved our ability to collect and has streamlined the billing process for our practice and patients.

- Chris KeanChief Operating Officer

The athenahealth Solution

22

Reminder

Calls

Payment Estimator

Credit Card

ProcessingText Message

Reminders

Live Operator

Patient Portal

Bill on EOB

Self-Pay Success

23

93MSelf-pay reminder

notifications sent out in 2013

$34.8M collected on our Patient Portal in

2013

24

6% increase in collections

8% decrease in no show rate

95.6% Meaningful Use attestation rate

32% reduction in days in accounts receivable

97% provider adoption rate