Point-of-Service Collections Improve Cash Flow Through

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Point-of-Service Collections Improve Cash Flow Through Powered By Docstoc
					Automating Estimation of Patient Services

Jonathan G. Wiik, MSHA, MBA Imaging Operations Manager Boulder Community Hospital

Val Kraus, MBA Director of Admissions & Case Management Boulder Community Hospital
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Estimation of Patient Services
– Introduction

The overall cost to collect is typically reported between 2 and 3 percent…

Front-end processes are important … especially in this era of increasingly high co-payments and consumerdirected health plans. …. the more time that passes following the patient’s discharge, the cost to collect on that account continues to go up while the chance of actually collecting payment goes down. Therefore, any payment that can be collected early in the patient encounter is more valuable in the long term.
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Estimation of Patient Services
– Introduction

Why Should the Patients Pay in Advance?
Patients need to be educated and understands their financial obligations for the care they are receiving Eliminate discharge delays
 Eliminate worry about how to cover patient-pay portion

 Maintain or establish good credit record  Patients earn piece of mind knowing their obligations have been met  Avoid future collection headaches
The Advisory Board Company – HWORKS initiative

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Estimation of Patient Services –
Current Trends

"The immediate goal is to make sure there are more people on private insurance plans.

I mean, people have access to health care in America…..after all, you just go to an emergency room.”
- President George W. Bush

AFP PHOTO/Saul LOEB

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Estimation of Patient Services –
Objectives

Session Objectives:
1. Discussion of trends in current Health Care market 2. Identify best practices to maximize collection efforts 3. Understand components of Estimating PreService 4. Streamline scheduling and reception workflows 5. Outline training for front-line staff
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Estimation of Patient Services

6 Current Trends

Estimation of Patient Services –
Current Trends
The problem of the uninsured is continuing to grow. The federal government estimates that nearly 45 million individuals lacked health insurance coverage of any kind during 2005. Other research shows that tens of millions more Americans go without health coverage for shorter periods of time.
Percentage of Non-elderly Adult Workers Without Health Insurance, 1987-2005

Source: Employee Benefit Research Institute estimates from the Current Population Survey,
March 1988-2006 Supplements

.

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Estimation of Patient Services –
Current Trends
Uninsured 16%

47.4 Million Uninsured!
EmployerSponsored Insurance 53% Medicaid/ Other Public 12%

Medicare 14% Private NonGroup 5%

2006 Total = 296.1 million

NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, SCHIP, other state programs, and military-related coverage. Those enrolled in both Medicare and Medicaid (1.8% of total population) are shown as Medicare beneficiaries. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

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Estimation of Patient Services
– Current Trends
$4.3T
$4,500 $4,000 $3,500 $3,000 2,555.1 2,725.8 2,905.1 3,097.8 3,305.0 3,523.6 3,757.0 4,277.1 4,007.8

Dollars in Billions

$2,500 $2,000 $1,500 $1,000 $500 $0

2,105.5

2,245.6

2,394.3

2006*

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

NHE as a % of GDP:

16.0

16.3

16.6

16.9

17.1

17.4

17.7

18.0

18.4

18.8

19.1

19.5

*2006 are actual data from the 2006 National Health Expenditure Accounts; 2007-2017 are projected data from the 2006 National Health Expenditure Accounts. Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp#TopOfPage (see Projected; NHE Historical and projections, 1965-2017, file nhe6517.zip) and http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2006; file nhegdp06.zip).

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Estimation of Patient Services
– Current Trends

What are a BILLION or TRILLION Dollars?!!
$ 1,000,000,000,000……”12” zeros…..or….. “one-thousand-billion”:
– One Million dollars stacks up 500 feet - as tall as the big pyramid in Egypt – One Billion dollars is 10 times higher than Mt. Everest – One Trillion dollars is 1/4 of the way to the Moon or 60,000 miles. – It would take someone more than 30 years to “count aloud” to one Billion – If you had gone into business on the day Jesus was born [~2013+ years ago], and your business lost a million dollars a day, day in and day out, 365 days a year, it would have taken you until October 2737 to lose just ONE Trillion dollars
www.buelahman.wordpress.com/2008/05/06/what-does-a-trillion-look-like www.jimloy.com/math/trillion.htm www.scoroncocolo.com/debt.html www.ehd.org/science_technology_largenumbers.php

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Estimation of Patient Services
– Current Trends
Percent who say each of the following happened to them/their family member as a result of the financial cost of dealing with cancer…
Used up all or most of savings
46% 22% 30% 10%

Borrowed money from relatives

Unable to pay for basic necessities like food, heat, or housing

41% 7% 6% 3%

Declared bankruptcy

Ever uninsured Always insured
11

Source: USA Today/Kaiser Family Foundation/Harvard School of Public Health National Survey of Households Affected by Cancer (conducted Aug 1-Sept 14, 2006)

Estimation of Patient Services
– Current Trends

Financial Burden of Medical Bills by Insurance Status, 2005
Percent of adults (age 19-64) reporting in past 12 months
Medical Bills Had a Major Financial Impact Spent Less on Basic Needs to Pay for Health Care Contacted by Collection Agency about Medical Bills 29% 14% Insured 34% 12% Uninsured

18% 9%

NOTE: Insured includes those with public or private insurance coverage. SOURCE: Kaiser Commission on Medicaid and the Uninsured analysis of the Kaiser Low-Income Coverage and Access Survey 2005: National All-Income Sample.

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Estimation of Patient Services
– Current Trends
% OF US DOLLAR SPENT BY CONSUMER 2008
TRANSPORTATION 4% CAR FUEL 4% RECREATION 4% HOUSEHOLD/FURNITURE 4% CAR 4% CLOTHING 4%

MEDICAL CARE* 17%

RENT/MORTGAGE 16%

FOOD 14%

•Medical care includes all expenses, including premiums, prescriptions, and out-of-pocket costs ** Other includes food other than groceries, alcohol, tobacco, luxury items, etc.

OTHER** 14%

UTILITY BILLS 15%

Bureau of Economic Analyis - Personal Consumption Expenditures by Major Type of Product and Expenditure www.bea.gov/national/nipaweb/nipa_underlying/TableView.asp?SelectedTable=19&FirstYear=2007&LastYear=2008&Freq=Qtr

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Estimation of Patient Services
– Current Trends

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Estimation of Patient Services
– Current Trends

Average annual premium for family of four in 20081?…. $3,300 Average out-of-pocket costs for family of four (incl. Premium above)2?….

$6,075
Average annual health care costs for family of four2?….

$16,000
1.
2.

National Coalition on Health Care 2008. www.nchc.org/facts/cost.shtml
Medical News Today (Coverted to 2008 using 10% inflation rate)

www.medicalnewstoday.com/articles

15

Estimation of Patient Services –
Current Trends

Having a job, even a full-time job, does not guarantee access to health insurance.
Uninsured Non-elderly Population by Work Status of Family Head, 2005

Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2006 Supplement

16

Estimation of Patient Services –
Current Trends
Many workers are paying higher co-payments for physician visits in HMOs.
Percentage of Covered Workers Facing Various HMO Co-payment Amounts for Physician Office Visits, 1996-2006

Source: Kaiser Family Foundation/Health Research and Educational Trust.

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Estimation of Patient Services –
Current Trends
Distribution of Deductibles for Employee-Only PPO Coverage, 2000-2006

Source: Kaiser Family Foundation/Health Research and Educational Trust.

18

POS COLLECTIONS
– Current Trends
Distribution of Health Plan Enrollment for Covered Workers, by Plan Type, 1988-2007
1988 1993 1996 1999 2000* 2001* 2002* 2003 2004 2005* 2006 2007
10% 8% 7% 4% 5% 5% 3% 3% 3% 21% 20% 21% 24% 27% 24% 25% 27% 28% 29% 46% 52% 54% 55% 61% 60% 57% 46% 31% 39% 42% 73% 21% 28% 24% 21% 23% 18% 17% 15% 15% 13% 13% 4% 5% 16% 26% 14% 11% 7%

0%

20%

40%

60%

80% Conventional HMO PPO POS HDHP/SO

100%

* Distribution is statistically different from the previous year shown (p<.05). No statistical tests were conducted for years prior to 1999. No statistical tests are conducted between 2005 and 2006 due to the addition of HDHP/SO as a new plan type in 2006. Note: Information was not obtained for POS plans in 1988. A portion of the change in plan type enrollment for 2005 is likely attributable to incorporating more recent Census Bureau estimates of the number of state and local government workers and removing federal workers from the weights. See the Survey Design and Methods Section from the 2005 Kaiser/HRET Survey of Employer-Sponsored Health Benefits for additional information. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2007; KPMG Survey of Employer-Sponsored Health Benefits, 1993, 1996; The Health Insurance Association of America (HIAA), 1988.

19

Estimation of Patient Services

20 Industry Best Practices

Estimation of Patient Services
– Best Practices

OUR JOURNEY…
BCH POS COLLECTIONS TIMELINE
3/28/05: BDY SITE POS COLLECTIONS GO LIVE (PILOT) 9/1/07: CCI ACTIVE ALL IMAGING SITES 4/1/06: BCH POS COLLECTIONS INTIATIVE (CICP/WECARE/HWORKS) 8/28/06: CCI PAY GO LIVE BDY SITE (PILOT) 1/1/08: BCH SITE PILOTS ESTIMATOR 1/27/09 PRESENTED RESULTS AT HFMA SYMPOSIUM

8/22/05: FTH SITE POS COLLECTIONS GO LIVE

Jan-05

Jun-05

Dec-05

Jun-06

Dec-06

Jun-07

Dec-07

Jun-08

8/29/05: BMC SITE POS COLLECTIONS GO LIVE 8/15/05: CMC SITE POS COLLECTIONS GO LIVE

1/25/07: POS COLLECTIONS TASK FORCE INCEPTION

4/1/2008: ELGIBILITY AND BENEFITS FOR SCHEDULED PATIENTS 11/1/07: DEDICATED INSURANCE SPECIALIST HIRED

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Estimation of Patient Services
– Best Practices
IMAGING SELF PAY PRICING TABLE
DEPT CT CT CT CT CT CT CATEGORY ANGIO / RUNOFF NON ANGIO ABDOMEN SCREENING** CT VIRTUAL COLONOSCOPY** CARDIAC SCAN CALCIUM SCORE** LUNG SCREENING** ** Discount does not apply with these exams DEPT CATEGORY DX SPINAL PROCEDURE (I.E. MYELO) DX ARTHROGRAM DX FLUORO (GI/GU) DX LUMBAR PUNCTURE DX DEXA DX PLAIN FILMS (ALL OTHER) DX PLAIN FILMS (< 3 VIEWS)
NOTE: This Pricing Table is for quoting/collecting amounts on SELF PAY PATIENTS ONLY, w ho pay at the time of service

(REV 3/20/06) SELF PAY DISCOUNT PRICE $1,900.00 $900.00 $965.00 $695.00 $490.00 $390.00 SELF PAY DISCOUNT PRICE $1,100.00 $600.00 $500.00 $300.00 $200.00 $200.00 $75.00

** < 3 VIEWS M NEUM ONIC EXAM PLES INCL: " KNEE" , " FINGER" , " SCAPULA" ," CLAVICLE" ," ELBOW" ," PELVIS" ," KUB" ," SACCOC" ," HUM ERUS" ," HAND" , ETC.

DEPT MA MA MA MA MA DEPT MR MR MR MR

CATEGORY STEREO BX (Deposit Platform*) NEEDLE LOC / GALACTOGRAM DX MAMMO (BILAT, incl CAD) SCREEN MAMMO (BILAT, incl CAD) DX MAMMO (UNILAT, incl CAD) CATEGORY BREAST MR LOC / BX W & W/O CONTRAST BREAST MR W or W/O CONTRAST

$ $ $ $ $

SELF PAY DISCOUNT PRICE 2,000.00 800.00 160.00 130.00 100.00 SELF PAY DISCOUNT PRICE 2,500.00 2,400.00 1,700.00 1,100.00 SELF PAY DISCOUNT PRICE 700.00 400.00 200.00 SELF PAY DISCOUNT PRICE 750.00 SELF PAY DISCOUNT PRICE 1,000.00 2,500.00

$ $ $ $

DEPT CATEGORY US PROCEDURE (INCL DRAIN, BX, VEIN MAPS, ETC) US OB, BREAST SONO, OTHER US LIMITED OR F/U, GEN COUNSELING DEPT CATEGORY IS ALL (DEPOSIT PLATFORM)* DEPT CATEGORY NM ALL (DEPOSIT PLATFORM)* PET ALL (DEPOSIT PLATFORM)*

$ $ $

$

$ $

* Deposit Platform is a partial payment (deposit), patient will be billled for the remainder at a 40% discount. OVERALL ESTIMATE (USE ONLY IF ABOVE NOT DETERMINED) DEPT AVG PRICE CT $ 1,422.14 $ DX $ 358.33 $ IS $ 1,216.98 $ MA $ 485.26 $ MR $ 2,217.66 $ NM $ 1,658.62 $ PET $ 3,504.00 $ US $ 540.02 $

OVERALL ESTIMATE 750.00 150.00 750.00 150.00 1,250.00 1,000.00 2,500.00 250.00

22

Estimation of Patient Services
– Best Practices
BOULDER COMMUNITY HOSPTITAL POS COLLECTIONS 2004 TO CURRENT
$7,000,000

CURRENTLY: ~25% Collection Rate or 1.2% of Gross A/R
45000

42474
$6,000,000

$5.8M 35757 $5.2M

40000 35000 30000

$5,000,000

28735 22342 18747 $2.3M $2.0M $2.9M

AMOUNT

$3.3M

$3,000,000

20000 15000 10000 5000 0

$2,000,000

$1.4M $1.1M
$1,000,000

$1.2M

$2004 AMOUNT COUNT 2005 2005 CCI$ 2006 2006 CCI$ PERIOD 2007 2007 CCI$ 2008* 2008 CCI$*

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COUNT

$4,000,000

25000

Estimation of Patient Services
– Best Practices

DO THE MATH!: Annual self pay losses versus savings in upfront collection:
Would you like to lose “$3.5M” OR “$2.0M” this year ???
- Point of Service Collections, Techniques that Work, HFMA, Sandra Wolfskill

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Estimation of Patient Services
– Best Practices

Have clear intentions…
 Patients First, Collections Second1  Treat ALL patients equitably, with dignity, with respect, and with compassion2  Serve the Urgent and Emergent needs of everyone, regardless of their ability to pay2  Assist patients who cannot pay for their part of the care they receive2  Provide resources, NOT restrictions  Make it an EXPECTATION
1. Point of Service Collections, Techniques that Work, HFMA, Sandra Wolfskill

2. Patient Friendly Billing Project, February 2005 Report

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Estimation of Patient Services
- Best Practices

Best Practices of Top-Performing Facilities:
– Adopt guiding principles and communicate the message – Set the expectations, and establish accountability – Update the mission, job descriptions, policies, and procedures – Couple patients with the best funding mechanism available
– “best” could be charity care
Overwhelming The Bad Debt Crisis - HWORKS Patient Friendly Billing Project, February 2005 Report

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Estimation of Patient Services
– Best Practices

Identify and address the “barriers”:
We do not know what to collect?! I‟m not asking people for money?! This is against our policy?! You have never collected this from me before?! Public Relations and Communications Insignificant Dollars
- Point of Service Collections, Techniques that Work, HFMA, Sandra Wolfskill

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Estimation of Patient Services

Components and Tools
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Estimation of Patient Services
– Components and Tools

Components of a Successful POS Collection Program:
1. 2. 3. 4. 5. Metrics (Data) Executive-Level Support Active Participation at All Levels Policy, Procedure, Protocol and Scope Patient Education

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Estimation of Patient Services
– Components and Tools

1. Metrics - DATA
High Level
– – – – Billed Revenue Reimbursement Up-front (POS) Collections (if any) Bad Debt Write-offs ($)

Detail
– – – – – – Payer Mix including Self-Pay (uninsured) Account Aging and Costs (A/R, Collections agency, etc.) Patient Mix (Outpatient, Inpatient, ED) Number of Scheduled Patients and Walk-ins Modality Mix (CT, MRI, XRAY, ULTRASOUND) Access Points and Volume at each area (Scheduling/Reception/Intake/Admissions)

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Estimation of Patient Services - Components and Tools
Why so much data?!
• • • • • Get a Baseline (What can we track?) Identify Priorities (Why is this important?) Focus efforts (Who will be impacted?) Establish Goals (When can we do this?) Determine Needs (How can we do this?)

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Estimation of Patient Services
– Components and Tools

KNOW your numbers….
• • • • • How much should an uninsured person pay? What do we collect if it is not on the card? What do we do if data is not available? How do (or can) we estimate allowable? What can we (or can we not) estimate in advance?

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Drill down to the core…. Components and Tools

Estimation of Patient Services –

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Estimation of Patient Services
– Components and Tools

2. Executive-Level Support
• Bottom-up, top-down, sideways, and up-side-down, the organizational CULTURE must live, breathe, and act consistently • Every person, from the Radiologist to the Receptionist, from the Office Manger to the patient, must clearly understand the project and its rationale • Services should not be reduced in a POS Collections Program – they should be ENHANCED

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Estimation of Patient Services
– Components and Tools 2. Executive-Level Support (cont.) Typical POS Collections Team:
• • • • • Executive - VP/CFO, Owner, Office Manager Director / Site Manager (s) Billing and Contracting Admissions / Scheduling / Reception Others?

– If multi-site/functional areas, leads from each access point should be represented – Should end up with 6-8 “key” personnel involved in patient and billing flow
* This group should have a philosophical, business-decision discussion concerning “boundaries” PRIOR to any implementation
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Estimation of Patient Services
– Components and Tools

3. Active Participation at All Levels Administration and Management Billing Financial Counselors Clinical Personnel Other Areas
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Estimation of Patient Services
- Components and Tools

Letters/Communication do not hurt…..

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Estimation of Patient Services
– Components and Tools

3. Policy, Procedure, Protocol and Scope
“Three Doors” for funding their care: Insurance No Insurance (self-pay) Other Funding Mechanism (be specific)
ONE (AND ONLY ONE) OF THE ABOVE MUST BE ELECTED BY THE PATIENT PRIOR TO RENDERING SERVICES – NO EXCEPTIONS!!!
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Estimation of Patient Services
– Components and Tools

• “DOOR” will determine direction and conversation we take with the patient:
– “Collection Advisory” List
• Medicare/Medicaid • Third Party Liability (Work comp, MVA, Litigation) • “Agreements”

– Patient Types
• • • • ED, STAT, URGENT, SAME DAY ADD-ONS Procedure changes Oncology, Mammography, DEXA Indigent, Homeless, Out-of-network
39

Estimation of Patient Services
– Components and Tools

40

Estimation of Patient Services
– Components and Tools

41

Estimation of Patient Services
– Components and Tools

3. Policy, Procedure, Protocol and Scope(cont.) Be VERY clear on the following:
     who is asked when the question is posed what is said what happens when people refuse or get upset who is contacted for service recovery

42

Estimation of Patient Services
– Components and Tools

When is the question posed?
• • • • At Physician‟s office? At Scheduling? At Reception? On the Table?
– ELIMINATE SURPRISES

– Earlier and the more frequent, the better

What is said?
• Tailor the conversation to fit the situation…
43

Estimation of Patient Services
– Components and Tools

$

44

Estimation of Patient Services
– Components and Tools

What‟s Realistic?
– Scripting is difficult and does not afford flexibility, however in some cases you must ensure consistency – Key Phrases are best where possible – The 4 “C”‟s:
• • • • Confident Competent Compassionate Collaborative
45

Estimation of Patient Services
– Components and Tools

EXAMPLES:
– Key Phrases
• All of our patients are expected to…. • Do you know what your payment is today? • We have several options available for payment, our best is…? • We typically do ______ when patients ______…. • Most patients elect this option as it….

46

Estimation of Patient Services
– Components and Tools

How much should I ask for??
– Remember the Bull‟s Eye
1. 2. 3. 4. Self-Pay Indigent Copay Known Insurance Patient Portion Unknown Insurance Patient Portion

47

Estimation of Patient Services
– Components and Tools

Strategies to Determine Amounts:
1. Self-pay
• Take average net-deduction-in-revenue (NDR) and add 510% for “administrative savings” For example, if block of business has an NDR of 25%, make the self-pay amount 35% Take charge master and reduce billed amounts by 35% to establish Prompt Pay Fee Schedule by Category and/or line-item CPT “ALL PATIENTS WHO PAY AT TIME OF SERVICE WHO DO NOT HAVE INSURANCE ARE ELGIBLE FOR THE PROMPT PAY DISCOUNT. PAYMENT MUST BE MADE IN FULL AT TIME OF SERVICE TO BE ELIGIBLE”
48

•
•

•

Estimation of Patient Services
– Components and Tools

Strategies to Determine Amounts:
2. Indigent Amounts
• • Program Copay, Coinsurance, Deductibles Sliding scale to Federal Poverty Level (FPL)
MRI, CAT WECARE INPATIENT OUTPATIENT SCAN, LAB RATING COPAYMENT SURGERY NUC MED ER VISIT WORK X-RAY N $15.00 $15.00 $15.00 $15.00 $5.00 $7.00 A $65.00 $65.00 $65.00 $25.00 $10.00 $15.00 B $105.00 $105.00 $105.00 $25.00 $10.00 $15.00 C $155.00 $155.00 $155.00 $30.00 $15.00 $20.00 D $220.00 $220.00 $220.00 $30.00 $15.00 $20.00 E $300.00 $300.00 $300.00 $35.00 $20.00 $25.00 F $390.00 $390.00 $390.00 $35.00 $20.00 $25.00 G $535.00 $535.00 $535.00 $45.00 $30.00 $35.00 H $600.00 $600.00 $600.00 $45.00 $30.00 $35.00 I $630.00 $630.00 $630.00 $50.00 $35.00 $40.00 J $1,500.00 $1,500.00 $1,500.00 $200.00 $100.00 $125.00 Z $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

PEOPLES CLINIC CICP DISCOUNT RATING PLAN N C-5 A C-10 B C-20 C C-30 D C-40 E C-50 F C-60 G C-70 H C-80 I C-90 N/A N/A Z N/A

* Peoples Clinic Discount Plan is equivalent to Boulder Community Hospital's WeCare Plan.

*A patient will be charged multiple copays for multiple services done during the same admission or the same visit. same visit.

49

Estimation of Patient Services
– Components and Tools

Strategies to Determine Amounts:
3. KNOWN insurance amounts

–

Collect what is on the card:
 Copays  Coinsurance/Deductible • Estimate allowable amount(s) • BEWARE of the “floating deductible”

– – –

Have patients bring in Benefits Screen Prints/EOBs Have patients or staff call insurance in advance ASK patient and collect that
50

Estimation of Patient Services
– Components and Tools

* DATA IS FICTIONAL – NOT ACTUAL CHARGES
51

Estimation of Patient Services
– Components and Tools

Strategies to Determine Amounts:
4. UNKNOWN insurance amounts
• • Consider benefits of collection versus downstream costs to refund Avoid “over collecting”
    Customer Service issues Refund Turn Around Time Inflated Results Carrier and Employer “ripple effect”

•

Credit Card on File
52

Estimation of Patient Services
– Components and Tools

Strategies to Determine Amounts:
Credit Card on File • • Store Credit Card Numbers for subsequent billing Line of Credit
• Compare to when you check into Hotel and they take a card for “incidentals”

• •

Several vendors offer a software solution that integrates/replaces existing credit card terminals BCH Imaging alone generates ~600-700 per month, or approximately $100K+ in downstream revenue per month!
53

Estimation of Patient Services
– Components and Tools

Other considerations with Amounts:
– Distribution and communication of amounts is critical
– Paper or Plastic?
• • • • Do you have hard copy price sheets, or do you have software Version Control Usability/Math Accuracy
54

Estimation of Patient Services
– Components and Tools

Other considerations with Amounts:
– Estimators
• Homegrown
– Spreadsheet, Database, Calculators, Abacus, Paper » PROs: Cheap and Easy » CONs: Time investment, Maintenance, Inaccurate

•

Proprietary
– Real-time estimate and/or eligibility – Configured to managed care contracts » PROs: Accurate, Fast, Professional » CONs: Initially can be expensive with hardware/software, interface/integration concerns
55

Estimation of Patient Services
– Components and Tools

Other considerations with Amounts:
– Estimators (Continued):
But we “NEED” this fancy new thingy?!!!

– Prove it:
» » » » Pilot/Trial in focused area to demonstrate value ROI Proformas Customer Service

•

Huge Opportunities –
– – – several vendors “buyers market” currently ROI is typically a matter of months
56

Estimation of Patient Services
– Components and Tools

Estimators (Continued):
• • • • Determine Risk at front end from Eligibility, Auth, Benefit/OOP, and propensity to pay Couple with Credit Scoring to establish eligibility to other funding mechanisms Pre-qualify scheduled appointments Streamline estimation and eligibility checks

57

Estimation of Patient Services
– Components and Tools

58

Estimation of Patient Services
– Components and Tools

ELIGIBILITY AND BENEFITS ESTIMATION TOOL JUSTIFICATION
PROJECTED 2008 - BCH IMAGING
$120,000

NET ADDITIONAL REVENUE 2008: $359,000
$100,000

$80,000

$60,000

`

$40,000

$20,000

$JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

REVENUE WITH TOOL

REVENUE WITHOUT TOOL

59

Estimation of Patient Services

Streamlining Workflows
60

Estimation of Patient Services
– Streamling Workflows

Implementation Suggestions:
Test the workflow Role Play Roll out in Phases Focus efforts on simple items first
low-hanging fruit, e.g. uninsured/self-pay

61

Estimation of Patient Services
– Streamling Workflows

Keep it simple…..
– “It is an expectation of your job to ask for patient portions” – Ask the simple question – “Do you know your amount to pay today?” – Provide Options, NOT ultimatums – Start small, use paper, then expand to system-wide integration
62

Estimation of Patient Services
– Streamling Workflows

63

Estimation of Patient Services–
Streamlining Workflows

LOOK BEFORE YOUR LEAP… Know the amounts (even if a estimates) before you ask people, to ask patients, for it Know how you are going to handle and process the money Know how to handle customer service issues and complaints Know how to defend the mission of the POS Collections Effort Know how to adjust the process quickly
64

Estimation of Patient Services
– Streamlining workflows

Workflow Development:
– Develop POLICY to support the PROCEDURE within the SCOPE of the project – Determine:
• • • • • When (Specific Steps) Who (Collection Advisory) Why (“Doors” and “Bulls eye”) What (how much $) How (Scripting/Key Phrases)
65

Estimation of Patient Services –
Streamling Workflows
Patient scheduled and pre-registered (where possible) Patient Arrives
Opportunity to communicate collection efforts to patient

POS COLLECTION WORKFLOW DRAFT
? FINANCIAL COUNSELOR ROLE HERE

ADMIT PATIENT

PRE-REG AND REGISTRATION:     Patient Verification Order Verification Insurance Verification Copay Determination

PRP REQUIRED OR SELF PAY ?

NO

YES

CURRENT OPTIONS TO DETERMINE/COLLECT PATIENT RESPONSIBILITY PORTION (PRP) 1. SSI FEED 2. "CHARGE ANTICIPATION" FEE SCHEDULE (IF COINSURANCE EXISTS) 3. MINIMUM COLLECTION OF BILLED($ OR %) 4. CREDIT CARD/BLANK CHECK

SEE SCRIPT

FINANCIAL RESOLUTION ACHIEVED? YES

SELF-PAY:PATIENT INSTRUCTED THAT EXAM RESCHEDULED NO INSURED: ATTEMPT COLLECTION, ALLOW EXAM IF UNABLE TO PAY, REINFORCE POLICY

REQUEST PAYMENT/ SIGNATURE (SEE SCRIPT)

Enter Tests to be Performed

EXAM PERFORMED

66

Estimation of Patient Services –
Streamlining workflows
EXAM SCHEDULING COMPLETE

POS COLLECTIONS Scheduling / PreRegistration Workflow

START YES
SELF-PAY? NO NO DNC LIST? YES

POS COLLECTIONS RECEPTION WORKFLOW
SR = SERVICE REPRESENTATIVE (RECEPTION)

PRP collections active?

NO

SR: "Did your insurance company determine the patient portion of your exam today?"
NO YES

BYPASS ALL

YES

YES DNC LIST?

AMOUNT KNOWN?

YES

PT PORTION? NO

YES

SR: "Great. How would you like to pay this amount today, by Credit Card or Check"?
(ISR verifies amount)

NO

NO

Patient/ Physician /Faxed Order ?

Physician/Faxed Order

SCHED/PRE-REG AWAITS PATIENT TO CALL FOR SCHEDULED TIME (IF TIME PROVIDED BY PHYSICIAN OUTBOUND CALL WILL BE NECESSARY BY SCHEDULING / PRE REG) BYPASS ALL

YES

SR: "I would like to go over the insurance information you have provided so far to make sure we complete and accurate information to file a claim with your insurance company. Let's go over this, and please feel free to interrupt me if you don't understand something."

(SR REVIEWS INSURANCE INFO WITH PATIENT AND MAKES ANY NECESSARY CHANGES)

Patient Scheduler: "BCH expects payment of the Patient Responsibility Portion (PRP) for exams at the time of service. If you have insurance, we encourage you to contact your insurance company prior to your appointment to determine your insurance benefits and any out-of-pocket expense for your exam. Please bring information from your insurance company (last explanation of benefits from insurance (EOB), on-line print screen, etc) that indicates the amount you owe for your exam. We will be collecting that patient portion of your exam when you arrive for your test, in the form of a credit card, personal check, or cash. If you cannot determine your portion, or are a self-pay patient, we can estimate the amount that we will be collecting. [use pricer or estimated cost of care down payments] If your PRP cannot be easily determined, a credit card imprint will be obtained to bill for your portion once determined."

SR: "I can estimate the amount for you based off of some information we have from various insurance companies and our charges. If you are not comfortable with an estimate, w collect an e imprint of a credit card to allow the hospital to bill for your portion of your exam(s) today. That portion will be determined after the claim is submitted to your insurance company, in approximately 60 days. Ten days prior to that time, the billing office will send you a letter to notify you of the amount and charge it to your credit card. This will allow you time to review your charges prior to them being billed.
IF INSURED, REINFORCE POLICY. BILL WILL BE SENT, PAYMENT WILL BE EXPECTED NEXT TIME, AND EXAM CAN OCCUR. IF SELF PAY, SEE NEXT PAGE

NO

ESTIMATE

ESTIMATE / CCI / NONE ?

NONE

CREDIT CARD? NO Pt: "I don't have a credit card."

YES

Scheduler: "Thank you, we will collect payment in that form. If you have insurance, make sure you check with your insurance before you come in. We will see you for your [exam] at [time] on [date] at the [facility] Campus. Is there anything else I can help you with today?"

COVERAGE AMOUNT DETERMINED?

NO

CCI
NO

Yes CREDIT CARD? Yes SR; "W e collect "x" Yes
NO

SEE NEXT PAGE

Scheduler: "If you do not have a credit card, we can accept a personal check"
YES Y/N? YES YES

Personal Check? NO
cash?

Scheduler: NO "Have a nice day" (Call ends)

NO
Additional billing questions?

Place appointment in "Pending"

Scheduler: "Let me transfer you to our financial counselors at (303) 440-2139 (or other area as appropriate) to address your questions. Please call us back once your questions have been answered and we will complete the scheduling of your exam. Thank you for your patience." (Call transferred to appropriate area)

amount for the test you are receiving today(refer to Pricer or Estimated Cost of Care Downpayment). We can accept payment via cash, credit card or check. "

PT: "Yes, I have my Credit Card"

For unknown amounts with a CCI, SR takes the credit card and imprints it, writing "[AREA] EXAM - PATIENT PORTION" in the description field of the Credit Card Slip. The CUSTOMER copy is given to the patient, and the MERCHANT copy is attached to a face sheet. The Credit Card Slip is hand delivered to the PBA and held until the account is processed. Note: Known amounts are processed through the credit card machine and posted into the Cashier Drawer.

SR: "Thank you. I will prepare your receipt" END

SR: "Thank you again, and if you have any questions, please contact our billing department at(303) 544-5744"

Patient is provided with a "Copay Collection information sheet"

67

Estimation of Patient Services
– Streamlining workflows

Be prepared to handle the following scenarios with patients:
 They may not have their wallet  They may not have their ins card  Their may not have cash on hand  They may not have credit cards  Their deductible may be too high

68

Estimation of Patient Services–
Streamlining workflows
COPAY COLLECTION TASK FORCE
RECEPTION WORKFLOW (continued - NO CREDIT CARD, NO CHECK, NO CASH - RESCHEDULE IF SELF-PAY)

NO CASH OR PERSONAL CHECK?

No

PT: "I do not want to pay with a check at this time." OR "I do not wish to pay a copay at this time".

YES SR: "I understand. We must collect a credit card imprint or check for the estimated payment portion to bill more efficiently. SEE PRIOR PAGE

[**** IF PATIENT OR PHYSICIAN INDICATES EXAM IS AN EMERGENCY (I.E. STAT EXAM), AND INDICATES THEY ARE UNABLE TO PAY, CONTACT THE SITE MANAGER, DIRECTOR, OR SUPERVISOR TO DETERMINE IF EXAM NEEDS TO BE PERFORMED TODAY. IF A SUPERVISOR, MANAGER, OR DIRECTOR IS NOT AVAILABLE, ALLOW APPOINTMENT TO BE PERFORMED. IN CASES WHERE THE EXAM IS DEEMED AN EXCEPTION THOUGH ABOVE THEN DOCUMENT, “EXAM IS DEEMED MEDICALLY EMERGENT”, IN THE BLUE COMMENTS FIELD OF THE REGISTRATION SCREEN, PRINT IT, AND PROVIDE TO SITE MANAGER OR DIRECTOR. ALSO DOCUMENT EXCEPTION ON EXCEPTION LOG.]

INSURED PATIENTS:
Please be aware that a bill will be sent to you outlining the charge(s) for the procedure(s) performed today. Payment in full will be expected at that time. At your next visit, please be prepared to pay for your exam(s) before services are rendered. [REFER TO FINANCIAL COUNSELING/PBA IF FURTHER FINANCIAL ASSISTANCE IS NEEDED

SELF-PAY CICP/WECARE:
Unfortunately, we cannot perform your exam unless you provide us payment. Would you like to speak with Financial Counseling at x2139? (303) 440-2139? You can reschedule your exam after you have made arrangements for payment. [Provide numbers and “commonly asked questions sheet”]

ISR: "Is their anything else I can help you with today"

(ISR provides patient with a Copay Collection Form and addresses any outstanding issues)

69

Estimation of Patient Services
– Streamlining workflows
EXAM SCHEDULING COMPLETE

POS COLLECTIONS Scheduling / PreRegistration Workflow

PRP collections active?

NO

YES

YES DNC LIST?

NO

POS COLLECTIONS – QUICK SCRIPT
Physician/Faxed Order SCHED/PRE-REG AWAITS PATIENT TO CALL FOR SCHEDULED TIME (IF TIME PROVIDED BY PHYSICIAN OUTBOUND CALL WILL BE NECESSARY BY SCHEDULING / PRE REG)

Scheduling/Pre-reg
1. PHYSICIAN/OFFICE: Insured Patient:

Patient/ Physician /Faxed Order ?

Patient

Scheduler: "BCH expects payment of the Patient Responsibility Portion (PRP) for exams at the appointment to determine insurance benefits and any out -of-pocket expense for their exam. We time of service. If you have insurance, we encourage you to contact your insurance company prior to your appointment to determine your insurance benefits and any out-of-pocket expense will be collecting that patient portion when they arrive for their test, in the form of a credit card, for your exam. Please bring information from your insurance company (last explanation of personal check, or cash. Please inform your patient of th policy. Thank you.” is benefits from insurance (EOB), on-line print screen, etc) that indicates the amount you owe for your exam. We will be collecting that patient portion of your exam when you arrive for your test, Self-Pay / CICP / WECARE Patient: in the form of a credit card, personal check, or cash. If you cannot determine your portion, or are a self-pay patient, we can estimate the amount that we will be collecting. [use pricer or estimated cost of care down payments] If your PRP cannot be easily determined, a credit " Payment in full is required prior to services being rendered. There is a discount SR: card imprint will be obtained to bill for your portion once determined."

BYPASS ALL SR: "BCH expects payment of the Patient Responsibility Portion for exams at the time of service. We encourage patients to contact their insurance company prior to their

To see the binder spines, turn to page 2 of this publication.

CREDIT CARD? NO Pt: "I don't have a credit card."

YES

program available, where if paid at time of service, a discount off the price can be applied. If payment in full is not received at the time of service, this discount may be less or after 30 days, Scheduler: "Thank you, we will collectnot available. WeIfencourage your patient to contact us as soon as possible to discuss payment payment in that form. you options make sure you have insurance, regarding their exam(s). Please inform your patient of thispolicy. Thank you.”
check with your insurance before you come in. We will see you for 2. PATIENT: your [exam] at [time] on [date] at the [facility] Campus. Is there anything Insured with today?" else I can help youPatient:

START YES
SELF-PAY? NO NO DNC LIST? YES

POS COLLECTIONS RECEPTION WORKFLOW

Scheduler: "If you do not have a credit card, we can accept a personal check"
YES

Personal Check? NO
cash?

YES

SR: "Did your insurance company determine BYPASS ALL SR: " Do you happen to know your insurance benefit or patient responsibility portion the patient portion of your exam today?" Scheduler: for the exam(s) that have been ordered for you?” “YES” SKIP TO OPTION [If Y/N? NO "Have a nice NO (1)]"BCH expects payment of the Patient ResponsYES ibility Portion for exams at the time day" (Call ends) SR = SERVICE REPRESENTATIVE (RECEPTION)
Scheduler: "Let me transfer you to our AMOUNT PT SR: "Great. on information from your insurancecompany (last explanation of benefits from insurance (EOB),How would you like to pay this YES YES financial counselors at (303) 440-2139 KNOWN? (or PORTION? amount today, by Credit Card or Check"? other area as appropriate) etc) that your line print screen, to address indicates the amount you owe for your exam. We will be collecting (ISR verifies amount) questions. Please call us back once your that patient portion of your exam when you arrive for your test, in the form of a credit card, NO questions have been answered and we will personal check, or cash. NO complete the scheduling of your exam. Thank [3 OPTIONS – (1) USE AMOUNT PROVIDED, (2) ESTIMATE AMOUNT, (3) CREDIT you for your patience." (Call transferred to appropriate area) CARD IMPRINT] SR: "I would like to go over the insurance information you (SR REVIEWS have provided so far to make sure we complete and INSURANCE INFO WITH accurate information PATIENT AND MAKES Self-Pay / CICPYES WECARE Patient: to file a claim with your insurance / company. Let's go over this, and please feel free to ANY NECESSARY CHANGES) interrupt me if you don't understand something."

of service.YES encourage you to contact your insurance company prior to your appointment to We determine your insurance benefits and any out -of-pocket expense for your exam. Please bring

NO
Additional billing questions?

Place appointment in "Pending"

POS COLLECTIONS – QUICK SCRIPT
Scheduling/Pre-reg
1. PHYSICIAN/OFFICE: Insured Patient:

SR: ”Payment in full is required prior to services being rendered. There is a discount

SR: "BCH expects payment of the Patient Responsibility Portion exam(s) today. at the time be determined after the claim for exams That portion will your of service. We encourage patients to contact their insurance company prior to your [ESTIMATE CHARGE(S) FOR insurance company, in approximately 60 days. is submitted to their EXAM AND PROMPT PAY DISCOUNT]

program available, wher "I can estimate the of service, a based off ofoff the price can be applied. If SR: e if paid at time amount for you discount some information at the time of service, this discount is not payment in full is not receivedwe have from various insurance companies and our available. Please wait a charges. If moment while I determine theyou are notfor the exam(s) in which w collect an charge comfortable with an estimate, e are receiving you ”
imprint of a credit card to allow the hospital to bill for your portion of

NO

appointment to determine insurance benefits and any out -of-pocket expense priortheir exam. We office will send you a letter to Ten days for to that time, the billing will be collecting that patient portion when theySR: “The exam test,notify be form of a credit charge it to your credit card. This will this exam is$xxx. arrive for their that willthe performed isand card, in you of the amount a[PROCEDURE]. The charge for allow you time to review your charges prior to being billed. personal check, or cash. Please inform your patient of th policy.to $xxx ifyou.” at the time of service per themdiscount policy I mentioned earlier. is It is discounted Thank paid the Again, please note that this discounted priceonly applies if the amount is paid in full BILL WILL IF INSURED, REINFORCE POLICY. Self-Pay / CICP / WECARE Patient: ESTIMATE / BE SENT, PAYMENT WILL BE EXPECTED prior to services being rendered. ESTIMATE NONE
CCI / NONE ?

SR: " Payment in full is required prior to services being rendered. There is a discount CCI COVERAGE NO program available, where if paid at time of service, a discount off the priceAMOUNT applied. If can be DETERMINED? payment in full is not received at the time of service, this discount may be less or after 30 days, not available. We encourage your patient to contact us as soon as possible to discuss payment Yes options regarding their exam(s). Please inform your patient of thispolicy. Thank you.” CREDIT
CARD?

NEXT TIME, AND EXAM CAN OCCUR. IF SELF PAY, SEE NEXT PAGE

NO

NO

SEE NEXT PAGE

2. PATIENT: Insured Patient:

Yes SR; "W e collect "x" amount for the test you are receiving

Yes

PT: "Yes, I have

my Credit today(refer to Pricer or SR: " Do you happen to know your insurance benefit or patient responsibility portion Card" Estimated Cost of for the exam(s) that have been ordered for you?” “YES” SKIP TO OPTION [If Care Downpayment). We can accept (1)]"BCH expects payment of the Patient Responsbility Portion for exams at the time i

For unknown amounts with a CCI, SR takes the credit card and imprints it, writing "[AREA] EXAM - PATIENT PORTION" in the description field of the Credit Card Slip. The CUSTOMER copy is given to the patient, and the MERCHANT copy is attached to a face sheet. The Credit Card Slip is hand delivered to the PBA and held until the account is processed. Note: Known amounts are processed through the credit card machine and posted into the Cashier Drawer.

SR: "Thank of service. We encourage you to contact your insurance companypayment via cash, " appointment to you. I prior to your credit card or check. determine your insurance benefits and any out -of-pocket expense for your exam. Please will prepare your bring receipt" information from your insurancecompany (last explanation of benefits from insurance (EOB), on line print screen, etc) that indicates the amount you owe for your exam. We will be collecting that patient portion of your exam when you arrive for your test, in the form of a credit card, SR: "Thank you again, and if you have any questions, personal check, or cash. please contact our billing department at(303) 544-5744"

END Patient is provided with a "Copay Collection information sheet"

Point of Service (POS) Collections Manual

[3 OPTIONS – (1) USE AMOUNT PROVIDED, (2) ESTIMATE AMOUNT, (3) CREDIT CARD IMPRINT]

Self-Pay / CICP / WECARE Patient: SR: ”Payment in full is required prior to services being rendered. There is a discount

program available, wher if paid at time of service, a discount off the price can be applied. If e payment in full is not received at the time of service, this discount is not available. Please wait a moment while I determine the charge for the exam(s) in which you are receiving ”
[ESTIMATE CHARGE(S) FOR EXAM AND PROMPT PAY DISCOUNT] SR: “The exam that will be performed is a[PROCEDURE]. The charge for this exam is$xxx.

It is discounted to $xxx if paid at the time of service per the discount policy I mentioned earlier. Again, please note that this discounted priceonly applies if the amount is paid in full prior to services being rendered.

Jonathan Wiik PH: (303) 440-2049 PG: (303) 509-0176 E-mail: jwiik@bch.org
Version 1— 6/13/06

70

Estimation of Patient Services

TRAINING FRONT LINE STAFF
71

Estimation of Patient Services
– Training • Be empathetic not sympathetic
– understand patient‟s situation but pursue reasonable payment options with the patient

• Put yourself in the patient‟s shoes
– how would you want the situation explained, presented and handled?

• We must be sincere when empathizing with the patient

Overwhelming The Bad Debt Crisis - HWORKS

72

Estimation of Patient Services
– Training

How Do You Request For Payment In Advance?
• Registrars must choose their words carefully and be respectful, yet be direct with the patient

• Registrars need to be aware of their tone of voice when speaking with the patient • Be firm about hospital policy and reassure the patient that paying in advance is for their benefit
Overwhelming The Bad Debt Crisis - HWORKS

73

Estimation of Patient Services
– Training

“The goal of the BCH POS Collections Program is not to collect money. Our goal is to educate patients as to the costs of their care, and help them navigate these costs”

„Boulder Community Hospital strives to help patients understand their health care costs. In that effort, coverage is verified, costs are discussed, and payment arrangements are made - in advance. Through this, bad debt is reduced and the operations of our hospital remain financially viable to continually serve our community”
74

Estimation of Patient Services–
Training “I never had to pay at time of service before.”

REGISTRAR RESPONSE
I understand that you may have not been asked before. Since you were here last, we have made changes to our processes that no longer allow us to delay collecting payments. Also, there are many advantages of paying up-front. Foremost, you know the costs of your health care upfront, and we can process your payment using a variety of options available to you right now. How would you like to pay today? We accept check, cash, credit cards.
75

Estimation of Patient Services
– Training

Incentive Plans
 Health Care is moving to retail, business-like atmosphere Should not pay people to their jobs, it is an expectation Award successes and good performance Set awards at roughly 3-6% of salary

Incentives work, but are risky Ensure Longevity of plan before launching Large Policy and procedure
76

POS COLLECTIONS
– Training
INCENTIVE AS COMPARED TO CCI ADJ COLLECTIONS
$140,000 $1,600

$120,000

$1,400

$1,200 $100,000

POS COLLECTIONS

$1,000 $80,000 $800 $60,000 $600
AWARD PAYOUT

$40,000 $400

$20,000

$200

$JAN FEB MAR APR MAY JUN CCI ADJ $ JUL AUG SEP* OCT* NOV* DEC*

$-

AWARD

77

Estimation of Patient Services

Conclusion
78

Estimation of Patient Services
– Closing Thoughts

In Summary…
– Critically analyze market trends and evaluate best practices – Adopt what would work well in your organization – Identify the components and scale the project to the resources you have available – Train, retrain, and adapt the workflows – Educate your coworkers, customers, and community

79

Estimation of Patient Services–
Closing Thoughts

Develop a Strategy and Collection Mechanism that is:
Easily deployed Elegant and simple Flexible by role and patient type Supported by management Scalable

80

Estimation of Patient Services
- Closing Thoughts

Have clear direction and momentum:
1. Have a meeting
 At an early stage, ensure to include the people who are going to ask people for their money

2. 3. 4. 5. 6. 7. 8.

Assemble a team Build from existing workflows and add to them Develop the “plan” Test the workflows and track your results Discuss Challenges and Celebrate Successes Lead by example Do not ever give up
81

Estimation of Patient Services
- Closing Thoughts

THANK YOU
Questions?

Jonathan G. Wiik, MSHA, MBA Imaging Operations Manager

Val Kraus, MBA Director of Admissions and Case Management

Boulder Community Hospital
(303) 440-2049 jwiik@bch.org

Boulder Community Hospital
(303) 440-2124 vkraus@bch.org 82


				
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