Self-Pay Collections is a Whole New Animal

Payment to
healthcare providers involves three key processes in the revenue cycle:
Insurance follow-up, denials management, and self-pay management. Historically,
the first two have rightfully consumed most of the attention from hospitals,
doctors, and their business offices. But that was then, and this is now: With
the rise of High Deductible Healthcare Plans (HDHPs), and shrinking
reimbursement from government insurers, healthcare providers are seeing a large
portion of their revenue tied up in patient receivables. With little experience
on how to efficiently tackle this problem, providers are faced with a big
challenge. 

To help weather
the storm, we have identified four objectives providers can accomplish to
improve patient follow-up processes in the revenue cycle:

• Build more efficient workflows with a focus on compliance
• Understand your patients’ level of financial ability
• Enhance patient engagement with a full contact management strategy
• Manage disparate data sources for a single patient
  experience 

Establish efficient workflows with a focus on compliance

Between
501(r), a newly-looming gaze from the CFPB, and continuously-evolving patient
and regulatory demands, keeping your train on the rails while speeding up is a
difficult but important task. As you build out your strategy for patient
follow-up, compliance needs to be a key component in the process. Most providers
understand the need to be well-versed when dealing with regulatory standards,
but aren’t particularly savvy when it comes to TCPA, UDAAP, and other regulations
that directly affect how and when they can contact and collect from the patient.
Strict regulations governing how you gain permission to call patients on their
cell phones is one example of limitations they put forth.  As you navigate these obstacles and set up
your processes, be sure to use resources like the insideARM Compliance
Professionals Forum to ensure you have the right procedures in place. 

Understand and act based on each patient’s
ability to pay

Once you
have these processes established, it’s important your operation comes to understand
each patient’s financial ability.  Some
patients can afford to pay while others struggle. Determining these financial capabilities
enables you to focus on helping the latter cases obtain financial assistance or
charity care, in turn driving the approach with each group. For example, those
with an ability to pay should not be contacted immediately after their visit. Give
them time to reach out with questions or make the payment on their own from the
statement they receive. On the other hand, patients with less of a financial
ability to pay should be assigned them to financial counselors for qualification.
The middle range group, those who could have some level of financial ability, may
need structured, long-term payment plans. Reach out to these patients sooner
than later so they understand their options before time elapses and they get
too far behind.   

Create multiple engagement channels

Once you
have your process built and groups identified, providers need to build a full
patient contact engagement strategy.  Create
multiple engagement channels beyond the usual statements, including online portal,
IVR, and live agents to engage the patient on their terms.  This not only helps to resolve the balance
but improves patient satisfaction as well. 
With HCAP scores tying Medicare and Medicaid reimbursements directly to
survey results from the patient, providers need to make the patient experience
better enhancing every interaction with their billing process, including the
billing experience.  By building a
patient engagement strategy through your contact management program, you end up
speaking with the right people, at the right time, about the right information.

Combine all patient information in
one place

Finally,
providers need to pull all of the information from their disparate systems into
a single integrated platform.  Most
providers inevitably have resulting from an acquisition, affiliation, or simply
different versions of the same software. 
To the patient, the provider is one. Most find it difficult to
understand why they get more than one bill from their provider.  This creates inefficiencies at the CBO level
as providers rely on multiple patient accounting offices, instead of managing a
single, holistic process. Combining all of this data into one integrated system
enables a single experience for the patient through all of your patient
engagement touch points including your portal, IVR and inbound call center.  It also improves productivity, giving you the
chance to pool resources into one team. 
This gives you one patient, one system, one experience.    

Flexibility
is important when it comes to each and every one of these objectives. Some
providers choose to outsource financial assistance processes and/or self-pay
collections while others do everything in-house, or opt for a hybrid model. Whichever
way you choose, ensure that these four objectives are made standard. Doing so more
often than not results in an efficient, compliant process that provides the
patient centric process you need.