Collection goal doubled for 2014
The total amount of patients' out-of-pocket responsibility is about $140 million annually at Cincinnati (OH) Children's Hospital Medical Center, but less than half of this amount is collected upfront.
"Unfortunately, we are only collecting about 41% of this in 30 days or less," says Christopher Lah, senior director of patient access. He adds that some areas have had more success with collections than others. "The areas with the strongest front-end ownership have the best pre-collect performance," says Lah.
Not surprisingly, the emergency department (ED) remains the most challenging area to collect from. "The ED only makes up about 15% of the parent's out-of-pocket available for pre-collect, but that is on the increase," says Lah.
Improving upfront collections is a key area of focus for fiscal year 2014 for the hospital's patient access leaders. These changes were made:
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The department purchased price estimation and pre-collection software.
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Early in the process, the department piloted a moderate discount of 10% to patients paying their balance in full.
Increasing the discount to 15% increased the number of patients who choose to pay upfront from 16% to slightly over 30%, reports Lah.
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A goal of $2.5 million was set for fiscal year 2013.
"We have not hit the goal yet, but we are well over halfway there after only four months into our fiscal year," reports Lah. For pre-pay patients, the amount includes any elective surgical services, most imaging and imaging-related tests, select consults/office visits, and behavioral medicine visits. For prompt pay patients, the scope includes all services.
"We plan on doubling that our next fiscal year, once we have our new pre-collect and price estimating software completely rolled out," says Lah.
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Full time equivalents (FTEs) were added to improve collections.
"Over the past 24 months, we have added an additional three FTEs to the program," Lah says "We now have five people dedicated to the process."
Four of the new FTEs are estimating analysts who work with the ear, nose and throat (ENT) and behavioral health divisions to maximum collections while ensuring accuracy. The other FTE handles existing escalating pricing concerns, questions, and complaints. "To justify the hiring of the FTEs, we did a fairly informal ROI [return on investment]. We mainly compared our upstart program with other hospitals that had purchased the same price estimating software," says Lah. Patient access leaders did this research by contacting several hospitals they were familiar with and also by using some contacts provided to them by the vendor.
Patient access leaders made these changes at Ochsner Medical Center — North Shore, Slidell, LA to increase collections and decrease bad debt:
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All registrars were trained in insurance verifications.
"They understand what constitutes a copay, deductible, and coinsurance," says Tammy Flair, patient access manager. "Knowledge of these components is the most important part of the collections."
If staff members aren't confident in their approach, they won't make the patient feel comfortable discussing their finances, she adds.
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The department partnered with Bank of Nevada, which allows the patient to choose a comfortable monthly payment to suit their needs.
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Patients are pre-registered.
"We have found that at pre-registration, our success at collection before the service is 98%," says Flair. This amount decreases to 70% if staff collect on the day of service, and after discharge, it plummets to about 30% and is likely to end in a collection agency placement.
By pre-registering patients, staff members have some lead time to obtain authorization and make sure they have the proper order from the patient's physician.
"This process cuts down on billing issues for the facility," says Flair. "For the patient, it allows them to make an informed decision about their medical treatment."
