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How to Handle Patient Deductibles

Published on November 13, 2017

With patients taking control of their healthcare-related finances and aiming to maximize value while reducing premiums, it is little surprise that high-deductible health plans have grown in popularity. Between 2006 and 2015, out-of-pocket costs for a patient rose almost 230 percent, while the average patient deductible now sits at over $2,500.

However, for revenue cycle departments, the increase in deductibles, coinsurance, and co-pays is a cause for concern. Perhaps the biggest problem of all is the increase in bad debt.

While hospitals may have traditionally collected 80% of their reimbursement from payers and just 20% from patients, as much as 40% is now collected from patients. As a result, some hospitals have seen bad debt triple, often as the result of higher out-of-pocket costs and the failure of patients to pay premiums.

Within the revenue cycle department, there are several steps you can take to reduce your risk of bad debt and protect your bottom line.


1. Work with patients to fulfill their financial obligations before they receive care in many cases, the best advice is to discuss financial obligations openly with your patients before beginning costly care plans.

2. Implement an upfront collections program. It is easier to collect payments early, rather than chase them after treatment has been given.

3. Use point-of-service collections. If you require whole or partial payment at the time of an appointment, you are in a position to collect payments more effectively.

4. Establish your available payment plans. Encourage patients to meet their payment obligations with a flexible approach. You could offer different payment plans, payment incentives, and reductions on the total cost.

5. Use credit card payments. The more ways you allow your patients to pay for their care, the more likely they are to meet their obligations and pay diligently.

6. Implement your own loan program. Working with a bank, you could offer loans to help patients pay their healthcare bills.

7. Conduct screening and help with assistance applications. At the earliest stages, screen patients and try to build a better understanding of their ability to pay. If they could use some additional financial assistance, work with them towards this.

8. Automate your financial processes. Finally, automation has a big role to play in handling high-deductible health plans. Many of the suggestions above come with an additional workload, but automating your eligibility verification, patient identity verification, financial screening, and charity application processes will empower you to do more while minimizing the burden on your time and money.

Jim Yarsinsky is engagement partner at Zinserv Healthcare.  He can be reached at jyarsinsky@zinserv.com

 


Zinserv Healthcare, LLC - "We Launched!"

Published on March 19, 2016

The healthcare revenue cycle won't be getting simpler any time soon. And not only is the revenue cycle increasing in complexity, managing it properly is more important than ever to maintain positive cash flow and bill with accuracy. Both the small critical access hospital (CAH) and the large healthcare system require sophisticated solutions to today's billing and revenue challenges, and when the right personnel with the right skills are difficult to find, meeting those can be difficult.

In many cases, special expertise is only needed for a limited time in order to get existing staff up to speed on a new technology solution or to cope with a backlog of work due to a staffing shortage. In other cases, however, a longer term, outsourced solution is the best way to maintain strong cash recoveries and enhance revenue. Zinserv Healthcare, LLC is there to help either way.

How an Onsite Healthcare Revenue Cycle Expert Can Help

When a hospital CFO retires or leaves the company, finding a replacement isn't easy. Locating and hiring a CFO with the level of experience and expertise hospitals want takes time, and rushing into a hiring decision can be phenomenally risky. Zinserv offers interim professionals, including CFOs, to carry your facility through with skill and proficiency until you find the right CFO to take on the job permanently. We also provide on-site healthcare revenue cycle experts and accounts receivable "SWAT teams" on an interim basis to get your revenue cycle back on track when problems develop. And we don't send just anyone. We only work with revenue cycle professionals who possess at least a decade of relevant experience.

Offsite Solutions Can Boost Revenues

Other challenges, like aging and neglected accounts receivable, a higher than acceptable claim denial rate, and problems with efficient and accurate coding can slow the healthcare revenue cycle down. This is especially true in the wake of last fall's ICD-10 transition. Zinserv provides offsite extended business office services that can help you gain control of accounts receivable, increase your clean claims rate, and ensure that coding is accurate, timely, and maximally productive. These services can make a fast, measurable improvement in hospital revenues, shorten the revenue cycle, and improve a hospital's financial outlook significantly. And as with our onsite professionals, our offsite solutions specialists are carefully chosen for their experience and skills set.

Streamlining Relationships with Payers

Making the relationship between hospitals and payers as efficient as possible requires that several aspects of the hospital-payer relationship be assessed and, if need be, modified. Zinserv's healthcare revenue cycle experts have the experience and skills mix necessary to understand this complex business relationship and to identify where opportunities for streamlining exist. Could, for example, the right patient eligibility software result in fewer denied claims? Could an online patient portal help you collect out-of-pocket expenses more quickly? Zinserv has the ability to observe, analyze, and evaluate your payer relationships and define the steps necessary to improve them. The fewer claims that are rejected or denied, the less time your team wastes and the more efficient your cash cycle becomes.

As-Needed or Long Term Options

At Zinserv, we understand that hospitals have to demonstrate agility to thrive in today's healthcare economy. And that means that sometimes short term solutions (like a comprehensive A/R work-down) are necessary and that other times longer term solutions (like placement of an interim CFO) are required so that the facility can take the time necessary to hire well. We understand that experience is critical, and that's why we only work with experienced professionals with healthcare revenue cycle proficiency. We invite you to contact us at any time to discuss your healthcare revenue cycle needs.


When Receivables Go Awry!

Published on April 5, 2016

Any number of revenue cycle issues can affect a hospital's cash flow. Because the medical revenue cycle is so complex and involves so many stakeholders, it may not be obvious where a cash flow problem originates, and such problems may have several contributing factors. The revenue cycle is where the clinical practice of medicine meets the business of providing medical services, and there are any number of places in the revenue cycle where things can go off track.

You have to consider financial, operational, and technical aspects of the revenue cycle individually, and as they relate to one another, to get to the root of revenue cycle problems and make medical accounting more efficient. Here are the steps you should follow for revenue cycle success.

Revenue cycle problems can be tricky to track down.

1. Divide Your Revenue Cycle Into Phases

The phases of a medical revenue cycle aren't completely concrete, and they affect each other, but by considering the phases separately, you can prevent being overwhelmed by your medical accounting situation and tackle the cycle a little bit at a time. For the typical physician practice, you might divide your revenue cycle into:• Registration and patient financial clearance• Medical coding• Claims submission• Claims rejections and denials.

2. Evaluate the Registration and Financial Clearance Process

Many tasks can be taken care of before the patient arrives for his or her appointment, and doing this can simplify medical accounting tasks further along in the cycle. When a patient schedules an appointment, verify insurance eligibility, coverage limitations, and any special eligibility requirements, such as pre-certifications. With the right software, you can interact with payers and get an idea of how much the insurer will cover and how much the patient will be responsible for. When the patient arrives for the appointment, collect his or her co-pay upon sign-in.

3. Assess Coding Effectiveness

You can compare your practice's coding with benchmarks such as those reported by the Centers for Medicare and Medicaid Services (CMS). Coding audits by expert coders may seem unnecessary, but they can alert you to potential problems before they cause cash flow disruptions. External coding experts can help ensure your practice's coding is accurate enough so that you are reimbursed properly for the services you provide.

Consulting with a coding expert can help you improve coding accuracy.

4. Calculate Your Clean Claims Rate

You can't improve your reimbursement rate if you don't know how many of your claims are sent back for being inaccurate or incomplete. Some medical accounting software packages can help you with tracking clean claims and claims that were sent back. But even if you have to do it yourself, finding out how many claims out of 100 are rejected or denied is important. A clean claims rate of at least 90% can help keep cash flowing and keep the number of days accounts spend in accounts receivable to a minimum. Knowing which claims were rejected and which were denied can help you strategize about how to address the problem.

5. Manage Claim Rejections and Denials

Rejected claims are sent back because of inaccurate or incomplete information. In some cases it's as simple as a misspelled patient or provider name, or an incorrect ID number. This is one reason it's critical to always have copies of patients' most recent insurance ID information. Denied claims are claims that are determined to be "unpayable," often due to questions of medical necessity. Denied claims can be successfully appealed, however. Look for patterns in rejected and denied claims to see if they are more common with one insurer, or if they are traceable to a particular claims submission specialist so you can address the situation properly. Because medical accounting is part of a complex revenue cycle that is acted upon by a number of stakeholders, identifying revenue cycle problems can be challenging. Breaking down the cycle into phases and evaluating each in turn can help you do this without being overwhelmed.


Benefits from Hiring Experienced Interim Revenue Cycle Professionals.

Published on August 15, 2017

It happens. Sometimes hospital receivables go awry, at time a lot awry!

You may never have considered hiring an A/R SWAT team, but there are several revenue cycle situations where it is an ideal solution. The most obvious scenario is when hospitals do not have sufficient "revenue cycle horsepower" to reach your cash and AR objectives.

Revenue cycle operations must go on, despite hiccups with accounts receivable.

But there are many other reasons why hospitals bring in experienced interim AR resolution specialists. One of the main reasons they do so is because accounts receivable (AR) days have increased and cash flow problems loom. Hospitals can benefit in multiple ways when you hire experienced interim revenue cycle consultants. Here are four of them.

1. By Unblocking Stalled Cash Flow

In some cases, new technology may have problems that need to be worked out, while at the same time bills need to be sent out and collected. When problems with revenue cycle technology accumulate, or when a hospital is implementing a new system, it is not uncommon for accounts receivable days to climb by at least10. Those prolonged AR days can account for significant reduction in cash flow.

But by bringing in an A/R SWAT team to work alongside your existing staff, hospitals can identify, document and fix billing snags to communicate to vendors, pursue more aggressive follow-up with all payers, and even implement accounts receivable monitoring procedures which can unblock stalled cash flow and prevent similar problems from happening later.

2. By Reducing Accounts Receivable Days

Sometimes a number of factors come together and cause accounts receivable days to increase. The key to turning it around is identifying all the contributing factors and addressing them. In situations like these, providers may temporarily bring in AR Resolution Specialists to cope with the backlog to get the problem under control.

Within a matter of 60 days or so, you could see a significant reduction in accounts receivable days and a corresponding increase in cash flow.

3. By Reversing Long Term Revenue Loses

Hospitals are essential to communities, but when they post revenue losses year after year, keeping the doors open may eventually become impossible. Slowing, stopping, and reversing revenue losses is a big job, but with the right revenue cycle horsepower, it can be done. In these cases, a facility may request interim revenue cycle specialists to turn things around.

With the right revenue cycle expertise, even long-term losses can be corrected.

By bringing in onsite accelerated recovery professionals, struggling hospitals can get an honest assessment of what is causing annual losses and begin addressing those causes. When problems are identified and addressed, and the right staffing mix is in place, losses can turn around, and struggling hospitals can start posting profits once again.

4. By Filling Interim Positions Successfully

When essential patient financial services (PFS) employees goes on leave, or when a facility needs interim professionals to fill in until a permanent employees can be hired, experience is absolutely critical. You need PFS folks who can step in and get to work right away, to minimize the effects of an unfilled positions and to make things as smooth as possible when employees are on leave returns or when a permanent employees are eventually hired.

Being able to request experienced revenue cycle professionals and being confident that they will be able to be productive from the start makes it much easier for hospitals to cope with interim staffing difficulties.
Conclusion

When hospitals are struggling with their revenue cycle, they often turn to outside help. Outsiders can bring a new perspective that allows them to address problems within revenue cycle department. Often the best solution is to bring in revenue cycle consultants that can bring a new perspective to get receivables under control.

Zinserv Healthcare has a proven track record of providing hospitals with all the benefits listed above and more. All Zinserv Healthcare revenue cycle professionals have an average of 13 years of experience, and have expertise in all aspects of the healthcare revenue cycle. We have provided interim directors, helped facilities make challenging technology transitions, and assisted with identifying and addressing all types of issues with accounts receivables and the revenue cycle. We're ready to get to work right away, so you don't waste time in solving your problems. If you'd like to learn more, we invite you to contact us at any time. Zinserv Healthcare is ready to help you solve your healthcare revenue cycle problems starting today.


Zinserv and The Revenue Cycle

Published on July 31, 2017

The healthcare revenue cycle won't be getting simpler any time soon. And not only is the revenue cycle increasing in complexity, managing it properly is more important than ever to maintain positive cash flow and bill with accuracy. Both the small critical access hospital (CAH) and the large healthcare system require sophisticated solutions to today's billing and revenue challenges, and when the right personnel with the right skills are difficult to find, meeting those can be difficult.

In many cases, special expertise is only needed for a limited time in order to get existing staff up to speed on a new technology solution or to cope with a backlog of work due to a staffing shortage. In other cases, however, a longer term, outsourced solution is the best way to maintain strong cash recoveries and enhance revenue. Zinserv Healthcare, LLC is there to help either way.

How an Onsite Healthcare Revenue Cycle Expert Can Help

When a hospital revenue cycle employee retires or leaves the company, finding a replacement isn't easy. Locating and hiring a revenue cycle employee with the level of experience and expertise hospitals want takes time, and rushing into a hiring decision can be phenomenally risky. Zinserv offers interim professionals to carry your facility through with skill and proficiency until you find the right revenue cycle specialist to take on the job permanently. We also provide on-site healthcare revenue cycle experts and accounts receivable "SWAT teams" on an interim basis to get your revenue cycle back on track when problems develop. And we don't send just anyone. We only work with revenue cycle professionals who possess at least a decade of relevant experience.

Offsite Solutions Can Boost Revenues

Other challenges, like aging and neglected accounts receivable, a higher than acceptable claim denial rate, and problems with efficient and accurate coding can slow the healthcare revenue cycle down. Zinserv provides offsite extended business office services that can help you gain control of accounts receivable, increase your clean claims rate, and ensure that coding is accurate, timely, and maximally productive. These services can make a fast, measurable improvement in hospital revenues, shorten the revenue cycle, and improve a hospital's financial outlook significantly. And as with our onsite professionals, our offsite solutions specialists are carefully chosen for their experience and skills set.

Streamlining Relationships with Payers

Making the relationship between hospitals and payers as efficient as possible requires that several aspects of the hospital-payer relationship be assessed and, if need be, modified. Zinserv's healthcare revenue cycle experts have the experience and skills mix necessary to understand this complex business relationship and to identify where opportunities for streamlining exist. Could, for example, the right patient eligibility software result in fewer denied claims? Could an online patient portal help you collect out-of-pocket expenses more quickly? Zinserv has the ability to observe, analyze, and evaluate your payer relationships and define the steps necessary to improve them. The fewer claims that are rejected or denied, the less time your team wastes and the more efficient your cash cycle becomes.

As-Needed or Long Term Options

At Zinserv, we understand that hospitals have to demonstrate agility to thrive in today's healthcare economy. And that means that sometimes short term solutions (like a comprehensive A/R work-down) are necessary and that other times longer term solutions (like placement of an interim revenue cycle specialist) are required so that the facility can take the time necessary to hire well. We understand that experience is critical, and that's why we only work with experienced professionals with healthcare revenue cycle proficiency. We invite you to contact us at any time to discuss your healthcare revenue cycle needs.



A/R SWAT Team - "help is on its way!"

Published on July 17, 2017

An accounts receivable (A/R) crisis slowly creeps up at most hospitals, even though signs are evident that the revenue cycle is lagging and breakdowns in workflow and processes are numerous.

But, it usually takes some singular event or development that proves, once and for all, that receivables are getting out of hand and immediate, quick help is needed to reduce A/R - and rejuvenate a flagging A/R process.

Signs You Need Emergency A/R Help?

There are many signs that point to the need for a concerted, focused effort to work down aging receivables.

Perhaps the starkest sign of all is when 28 percent or more of your A/R has aged more than 90 days or greater (a benchmark set by the Hospital Accounts Receivable Analysis report on statistical data related to hospital receivables).

Before you ever get to this point, however, look out for other warning signals that your A/R is creeping up to an unmanageable state:

1. Your A/R accounts are timing out regularly

Third party insurance carriers set deadlines for filing claims and if you don't submit in time, you won't get paid. If you don't submit in time, or properly, the amount of unclaimed reimbursement will creep up to a "breaking point."

2. Cash flow problems

You've just flipped the calendar and year-end is nearing and your cash flow is not where it should be - and your A/R days are 10-14 days higher than last year.

This is the time you need to quickly, systematically lower your A/R and improve cash flow - not to mention improve your bond rating and show the hospital board that things are under control.

3. Computer conversions gone awry

Switching to new software or even more involved computer conversions wreak havoc on accounts receivable. Traditionally, A/R days spike up 10 A/R days outstanding due to conversions and take a while to come back down to pre-conversion levels.

Other important, yet less blatant signs include: high staff turnover rate, growing number of denials, a breakdown in the patient registration process and simply, just an immense volume of unmanageable claims for the patient financial services staff.

Arming the A/R Swat Team

Handling an A/R crisis should be swift, focused and handled by a pool of resources that are focused on accounts that are the source of the A/R crisis. In other words, tackling aging A/R should be a separate project and not added to the staff's current workload.

Focused A/R Team Pays Off

Some hospitals will decide to manage A/R emergencies themselves, but this is often difficult and unrealistic with existing workloads. Rather than outsourcing - and having to work with off-site staff on separate computers and systems - many hospitals opt to "in-source," bringing in a dedicated, professional team of patient financial services experts and directors to work on-site and execute an A/R swat team approach.

Stop Wheel Spinning

When A/R ages to the point of no return, hospitals need to recover cash quickly and work down aging receivables. Hiring an in-sourced "swat team" allows CFOs and directors to oversee an A/R operation that can quickly get into the system, resolve issues with laser focus and get out with more cash in hand and a rejuvenated and improved revenue cycle.

As-Needed or Long Term Options

At Zinserv Healthcare, we understand that hospitals have to demonstrate agility to thrive in today's healthcare economy. And that means that sometimes short term solutions (like a comprehensive A/R work-down) are necessary and that other times longer term solutions (like placement of an interim revenue cycle specialist) are required so that the facility can take the time necessary to hire well. We understand that experience is critical, and that's why we only work with experienced professionals with healthcare revenue cycle proficiency. We invite you to contact us at any time to discuss your healthcare revenue cycle needs.