The below proposal was submitted by John E. Kivimaki, director of patient accounts at Mary Rutan Hospital in Bellefontaine, OH, to identify areas in the revenue cycle where losses could be reduced by focusing on upfront efforts. It was accepted by the hospital's administration, and implementation is underway.

This proposal could reduce significant losses in revenue cycle

Name: Relias Media
Price range: $

January 1, 2011

Mechanical Thrombectomy for Stroke
Lawsuit Claims Hospital Kept Patient Alive to Boost Metrics
Profits Before Patients, Betrayal of Trust
Hospital Reduces Patient Falls by 80%
TJC Issues Sentinel Event Alert on Responding to Severe Weather Incidents

FRONT END BEST PRACTICE	CURRENT SITUATION
Healthcare management system	Automated
Insurance Verification	Automated
Address Validation	No automated address validation technology in place: exposure to returned mail costs and denied claims, which slows revenue recognition
Capacity to Pay	No capacity to pay technology in place: hard to apply discounting policies according to patient's ability to pay and hard to apply charity policies consistently leading to compliance exposure
Business Rules and Policies	Business rules and policies in place today: no technology to automate the application of those business rules and policies across all patient accounts
Charity Policies & Guidelines	Charity policy in place today
Red Flag Rule Compliancy	Red Flag process in place today: no automated Red Flag compliancy technology in place to ensure process is followed and to provide reports if audited by the FTC
Price Transparency	No automated price transparency technology in place today
Payment Plan Development	No payment plan negotiation technology in place today leading to longer revenue cycle and reduced net patient revenues
Promissory Notes	No automated promissory note development technology in place
Front End Collections	Limited front-end collections capability: averaging $2 per registration today

FRONT END BEST PRACTICE	CURRENT SITUATION
Healthcare management system	Automated, but searching for a new one. One proposed system can interface with current and future system. Will only charge for first interface, second one is on the house once system chosen
Insurance Verification	Next-generation and simplified insurance verification tool included with proposed system.
Address Validation	Real-time address validation, which verifies address provided is actual U.S. address and validating the patient is associated with the address via web resources available Reduces returned mail, reduces denied claims and identifies potential fraud (FTC Red Flag compliancy)
Capacity to Pay	Real-time capacity to pay determination based on non-credit scoring, web-based data utilizing over 57 resources Rates patient based on the market and provides insight into the patient's capacity to pay via both income and net worth criteria
Business Rules and Policies	Automated business rules and discounting policies, provides a script to the registrar telling them exactly how to process every patient based on their capacity to pay and based on if they are insured, uninsured or charity Reduces registration time, provides process consistency across all patient accounts and limits exposure to lawsuits
Charity Policies & Guidelines	Automated charity policy process, determines if patient qualifies based on household income and federal poverty guidelines, and provides appropriate forms in a web format for completion on the spot
Red Flag Rule Compliancy	Automated Red Flag rule compliancy ensuring hospital is compliant with FTC Red Flag rules
Price Transparency	Automated price transparency built into the system based on your most common procedures Provides a balance to negotiate and settle on with patients before they leave the hospital, accelerates the revenue cycle
Payment Plan Development	Payment plan calculator built in, providing a tool to negotiate payment plan with patient based on associated discounts and balance Provides ability to settle patient balance before patient leaves the hospital
Promissory Notes	Automated promissory note developed, which includes balance, payments and negotiated terms
Front-End Collections	Clients average $35 in cash collected and $100 in terms negotiated per registration leading to incredible front-end collections. Improves cash on hand (improving bond rating and ensuring compliancy with bond covenants), improves net patient revenues and reduces bad debt

This proposal could reduce significant losses in revenue cycle

Subscribe Now for Access