We are revenue cycle management consultants within the healthcare industry. Our company works with the HFMA and the MGMA. As you are probably aware, the entire industry is aggressively discussing the growing challenges associated with, and the dire need to be able to better manage, the billing and collection of the “Patient Pay” portion of fees due to providers.
Most in the industry have a solid handle on collecting fee’s due from the insurance companies. However today, with more people moving to higher deductible insurance plans, using self directed plans and implementing more self-pay options; the result has been continual increases in the patient billing area of the business. The challenges that have been created are to the point that they are now threatening the very viability of practices, facilities and hospitals of all sizes nationwide. Plus, with the recent passing of the healthcare bill, these problems are only expected to become even further complicated. The bottom-line is this, the ability to collect payments from patients in a timely manner, if at all, has become a major issue nationwide.
The following challenges are being observed:
• Increased self-pay & patient-out-of-pocket responsibility. The patient pay portion is presently at 40% of the “total” gross revenue nationally. In 2001 it was 10%.
• The Patient-Pay Bad Debt sector is presently at 49.3% nationwide.
• When attempting to collect from patients, as much as 50% is being written off in many cases. This is huge and it is as much as 20% of the total gross revenue; (insurance and patient paid combined).
• Patients are putting off care due to finances; resulting in decreased patient volume.
• Providers are unable to tell patients what they owe at the point-of-care.
• Increases in insurer payer processing delays Fortunately, there is a solution now available that eliminates most of these issues and makes our industry more financially sound and it doesn’t require drastic changes in current processes and it does not add more cost. In fact, it rescues and returns typically $100K per physician, per facility, per year.
Below are the more prevalent and urgent issues encountered nationwide.
Problem: Obtaining In-Depth Health Insurance Verification: The process to verify insurance is time consuming and nearly impossible to accomplish with each patient until after the patient has left the office. Many are not verifying. Rather, they depend on the EOB to be correct. If verification is accomplished by telephone it typically takes 20 minutes. As such, many verify only a few out of a hundred. If the process is accomplished via a PMS or EMR program the process is less time consuming. However, even then, the staff is forced to go to each individual insurer’s website where they must navigate through the payors unique pages to complete the process. While some time is saved, it still takes five to ten minutes per patient. Further, not enough payors provide websites to ensure that one can obtain current and accurate information prior to the patient leaving the office. The provider is then left at risk for invalid insurance and at the mercy of the insurance payer to pay the correct amount and with no way of knowing whether they did or not.
Solution: Our system allows medical facilities to complete detailed verification within seconds. It works with over 400 national and regional payors. In-depth data is brought back to the user in a single consistent web portal. This means the same consistent functions and views are displayed for all payors. The result is the staff navigates through the information much more expeditiously, saving a great deal of time in labor. This greatly enhances the office efficiency and it provides complete and current data. The detailed data provided includes the following:
• Verification of current insurance coverage via a 271 transaction
• Co-pay due
• Deductible (and whether it has been met, if not, what amount has been met)
• In-network and out-of-network information
• Primary and secondary payer information
• Out of pocket annual information (and whether it has been met, if not what amount remains to be met).
• A patient responsibility calculator that provides an accurate estimate of patient out-of-pocket fee’s by calculating for services using CPT codes and going against the providers contracted rates and fee schedules.
• This same data collection process then generates at check-out, by entering CPT information for services received during the visit, a detailed patient friendly statement, or Mock or Pre-EOB, that reflects the patient out-of-pocket amount and the amount the payer should pay relative to your billed charges and allowed amounts for each specific payer. The process calculates patient charges against the providers contracted rates with that payor. This calculation occurs in real time, all done systematically for your staff and all in one easy to use system. You receive in-depth and detailed eligibility verification and a patient friendly Pre-EOB, to be provided at check out and “all within seconds!”
Note: All insurance data is systematically kept current as providers modify or update their plans. Yet, this unique real-time verification is just a “side” benefit and just a means to the true value of the system.
Problem: Patient Billing & Collection: The national average for uncollected billing directly to patients is 49.3%. A total that today could equal as much as 20% of a provider’s total gross revenue. As a result, providers are spending far too much to collect money that will never be paid or that will take months to collect. In 2001, patient direct billing was a mere 10% of the gross revenue. Today, in 2010 it equals as much as 40% of the total gross revenue. The issue of uncollected patient receivables has created a very real issue for providers. Staffers dedicated to billing spend most of their time getting the payer billing correct and very little time getting the patient billing collected in a timely and efficient manner. This is putting financial stress on practices causing lay offs, overtime and even more drastic corrections like having to see more patients per day (affecting the quality of care), or hiring outside billing companies (that do not reduce or enhance collections but do take a large percentage of every dollar collected, not to mention the software costs). Some physicians are taking on additional work in ED’s to meet financial means.
Solution: Our systems verification allows the provider to determine what the patient owes at the time of service and has a next generation payment processing system that allows the processing of real-time payments or the ability to set automated pre-authorized payment arrangements, i.e. one time delayed or budget plan payments at the point-of-care “while the patient is still in the office”. This process works exactly like a hotel check-in process. This eliminates the need to send confusing statements “after” receiving the EOB. The beauty of the system is it saves in labor time, billing, collections, supplies and postage. It rescues and returns “real revenue” and it immediately “increases cash flow”. The patient receives a patient friendly detailed statement, a Pre-EOB and agrees to the amount at the point-of-care. The patient no longer disputes the balance with the staff. Payments are made in real time or via automated pre-authorized payments debited from their credit/debit card or ACH checking accounts.
As a result of many consultations with providers, we have researched hundreds of PMS and EMR programs claiming to offer the same services; yet they simply do not achieve the same results. In conversations with providers using the system, they universally add up to $100K per doctor, per year, per facility in revenue without adding additional patients, hours or staff. In short, this program will help you provide better care, accelerate collection of patient receivables and eliminate the need for billing by up to 90%. The system is truly next generation technology and is the “only” system that provides the following:
1. Calculates an accurate patient pay and insurance payor estimate for use by the staff and to give the patient a copy of at check out.
2. Factors in a providers contracted rates with the insurance payor.
3. Loads your patient demographic data. Is HIPAA and PCI DSS Level One Compliant, is a Red Flags compliant solution for health care.
The system is eliminating up to 90% of Billing and Collections. It is also reducing the Patient Pay Bad Debt sector, currently at 49.3% nationally, by up to 90%.
All of the association meetings are telling providers that they need to address the growing patient billing and collection challenges. The Revenue Maximizer is the proven solution.
Most health care facilities are not prepared for the rapid influx of the increased patient pay responsibility. As a result, many are jumping to expensive and un-proven software systems that fall short of solving the entire problem.
Summary: We represent an authorized national provider of this system that is the proven solution that:
• Facilitates upfront patient collections, improves “cash flow” and eliminates patient direct billing & collections by up to 90%.
• Reduces Patient Bad Debt sector, currently nationally at 49.3%, by up to 90%.
• Increases staff efficiencies and productivity.
• Supports multiple users from multiple locations
• Web-based & easily blends along side of all PMS and EMR systems.
• Requires No Expensive Software and is remarkably affordable.
• Includes “Real-Time, in SECONDS in-depth verification”.
• Card on File: Lets you securely store patient bank account or credit card data to collect a one-time payment or for future use against post-insurance balances. Obtain patients approval via a system generated authorization form that the patient signs.
• Has a Patient Responsibility Calculator – calculates patient charges against contracted rates with 400+ national and regional payors. Patient receives a patient friendly detailed statement; a Pre-EOB reflecting patient & payor responsibility.
• Integrates with our Payment Processing System to enable collection of consumer out of pocket via real-time payments or by setting pre-authorized and automated delayed or budget payment plans. Works just like a hotel-check-in process.
• Robust, desktop instant reporting 24/7: Daily Dashboard; Daily Totals, Payment Transactions, Scheduled Payments by patient, provider, number of installments, remaining balance, start date and status.
• HIPAA & PCI DSS Level 1 Compliant – A Compliant Red Flags Law Solution.
• Training is provided; on-going 6 day system support; on-going account manager.
• Systems enhancements are made available at no additional cost to the client. Over 1300 practices, hospitals and facilities are already significantly reducing their staff’s workload.
This enables them to address other areas that need attention. The patient experience is improved as they know their out-of-pocket costs; so confusion is eliminated and the level of satisfaction with the provider is increased; as they no longer have to delay their healthcare visits due to their financial situation.
We can provide a complimentary confidential assessment of your facility; it only takes about 40 minutes. You will find that after we talk that you will have new ways of dealing with these challenges; ways that will actually increases your revenue and will immediately increases cash flow. We will walk through how you currently verify eligibility; assess patient responsibility and discuss your patient billing and collection process. I’ll ask for your input regarding cost associated with your processes. We will analyze the man hours or outside services used to bill and collect from patients. This will enable me us offer some simple solutions as to how you can greatly excel the patient pay process. There is no obligation and I am certain you will see the value added benefits of this surprisingly affordable, web-based system.
Our business analysis will reflect your personal “projected annual increase in revenue” and it will reflect the total cost to implement the system. The system literally pays for itself within one month of full usage.
Our team works with you through implementation. Training is provided and is simple; we ensure all questions are answered. We provide an ongoing Account Manager. Our customer service continues long after the sale and implementation.
As a side benefit, our merchant services are in the top 4 in the nation and typically at least 1% to 1.5% less than those obtained on the open market.
Call and ask us to send you a demo and news video.