3 Ps to Successful Claims and Reimbursements Processing: Provider, - - PowerPoint PPT Presentation

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3 Ps to Successful Claims and Reimbursements Processing: Provider, - - PowerPoint PPT Presentation

Oct 08, 2022 567 likes •939 views

3 Ps to Successful Claims and Reimbursements Processing: Provider, Payer & Patient Todays Speakers Sheila Augustine Rick Heise Director of Senior Vice President Patient Financial Services CommerceHealthcare Nebraska Medicine 2

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3 Ps to Successful Claims and Reimbursements Processing: Provider, Payer & Patient

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Motivating a New Culture of Collections | December 20, 2018

Today’s Speakers

Sheila Augustine

Director of Patient Financial Services Nebraska Medicine

Rick Heise

Senior Vice President CommerceHealthcare

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Motivating a New Culture of Collections | December 20, 2018

3 Ps to Successful Claims & Reimbursements Processing: Provider, Payer & Patient

Agenda

Introductions Provider Healthcare Trends Provider: Process, Practice, Performance Payer Healthcare Trends Payer: Maximizing Relationships Patient Healthcare Trends Patient: Enhancing Experience Q&A

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3 Ps to Successful Claims and Reimbursements Processing: Provider, Payer & Patient

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Motivating a New Culture of Collections | December 20, 2018

Provider Healthcare Trends

Top recent trends impacting the healthcare industry

Vertical Integration

94%

Technology Entry of Non-Traditional Players Employer Activism Health System M & A Emergence of Alternative Models Other

69% 63% 31% 25% 13% 6% Percent of Health Systems

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Provider Healthcare Trends

Lower reimbursement rates Significant delays in cash flow Changing where and how services are provided Shifting EFT mandates and fees Changing remittance process

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Provider: Process, Practice and Performance

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Motivating a New Culture of Collections | December 20, 2018

About Nebraska Medicine

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Motivating a New Culture of Collections | December 20, 2018

Key Drivers and Catalysts of Change

Strengthen Relationships Change Processes Failed Collections Patient Care Key Drivers of Change: Key Catalyst of Change: Consolidate Groups

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4 Keys to Successfully Implementing Claims & Reimbursements Process Change

Incorporate into Culture Training & Education Employee Engagement KPIs & Metrics

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Motivating a New Culture of Collections | December 20, 2018

Training Crosswalk During Consolidation

Information SA 20 SA 10 Account Maintenance SA 10 Guarantor Account Maintenance Guarantor Overview Guarantor Snapshot Enterprise Guarantor Summary Guar Summary or Prof Snapshot Balances Guarantor Snapshot Enterprise Guarantor Summary Guar Summary or Prof Snapshot Workqueue History Guarantor Snapshot Status Summary (HB Accts) Prof Snapshot (PB accts) Contact History Guarantor Snapshot Contact History Coverage Summary Guarantor Snapshot Cvg Summary Cvg Summary or Prof Snapshot Visit Visit Inquiry Prof Visit Inquiry Prof Visit Inquiry or Prof Snapshot Enter a New Activity Guarantor Snapshot Acct Activities Guar Acct Note Charges on Account Tx Inquiry Prof Tx Inquiry Prof Tx Inquiry Invoice Invoice Inquiry Prof Inv Inquiry Prof Inv Inquiry Billing History Billing History Enterprise Guarantor Summary or Account Contact Guar Summary or Statement History Pending Charges Pending Charges Prof Tx Inquiry Prof Pend Chgs Aging Aging Patient Summary Patient Summary Patient Summary Account Notes Account Notes Acct Activities Guar Acct Note Guarantor Account Edit Guarantor Account Edit Registration Registration CRM List CRM List Account History CRM List

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Motivating a New Culture of Collections | December 20, 2018

Training Crosswalk During Consolidation

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Motivating a New Culture of Collections | December 20, 2018

Weekly Training Schedule

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Motivating a New Culture of Collections | December 20, 2018

4 Keys to Successfully Implementing Claims & Reimbursements Process Change

Incorporate into Culture Training & Education Employee Engagement KPIs & Metrics

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Motivating a New Culture of Collections | December 20, 2018

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Motivating a New Culture of Collections | December 20, 2018

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3 Ps to Successful Claims and Reimbursements Processing: Provider, Payer & Patient

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Payer Integration

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Payer Healthcare Trends

Ever-changing coverage and billing policies Narrowly designed plans or provider networks Shifting Risk: Emphasis on value-based contracting Shifting care outside the hospital setting Increasing Payer and Provider Partnerships

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Payer: Maximizing Relationships

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Motivating a New Culture of Collections | December 20, 2018

Key to Success: Strong Payer Relationships

Payer Relationships

  • Simplify patient billing and increase collections
  • Understanding each payers requirements
  • Reduce claim denials and aging
  • Payers have an incentive as well to keep your aging down
  • Reduce customer service calls
  • Proactively finding issues before the patient
  • Influence payer coverage and coding policy
  • Payers are not right all the time.
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Motivating a New Culture of Collections | December 20, 2018

Collection Conversations: Insurance Follow-Up

Provider Section GROUP NUMBER SUBSCRIBER NUMBER PT FIRST NAME PT LAST NAME PROVIDER TIN ICN / CLAIM NUMBER FRST DATE OF SRV LST DATE OF SRV TOTAL BILLED CHG Patient Account Number PROVIDER CLAIM ISSUE COMMENTS Issue Comments Who added to the spreadsheet?

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3 Ps to Successful Claims and Reimbursements Processing: Provider, Payer & Patient

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Motivating a New Culture of Collections | December 20, 2018

Consumerism in Healthcare

Immediate Access to Care Precision Medicine Digital Healthcare Health Data Ownership Cost of Care

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Patient Healthcare Trends

Shift in who pays Price transparency and simplification of statements New patient payment models Connection between patient satisfaction and payments Employer defined benefit plans

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Patient: Enhancing Experience

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Motivating a New Culture of Collections | December 20, 2018

Payment Evaluation Process

Payment Evaluation

  • Reorganizing revenue cycle and improving processes
  • Analyze patient payment trends and preferences
  • Identify options to solve for gaps and drive payments
  • Communicate and education staff, payers, patients on
  • ptions
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Motivating a New Culture of Collections | December 20, 2018

Implementing New Patient Payment Options

Payment Plans Payment Process

  • 1. Attempt to get full payment
  • 2. Full payment with an informal payment discount
  • 3. Offer short-term payment plan

a) Individuals: minimum $25 per month over 6 months b) Employees: Payroll deduction for up to 36 months

  • 4. Offer long-term payment option through Health

Services Financing Plan

  • 5. Collections
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Motivating a New Culture of Collections | December 20, 2018

Patient Lending (HSF) Portal

  • 1. Full historical data and

customized reporting

  • 2. Funding and Credit

Transactions

  • 3. Service Fees and

Payments

  • 4. Recourse Transactions
  • 5. Aging Breakdown
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Motivating a New Culture of Collections | December 20, 2018

Health Services Financing Plan (HSF)

By the Numbers

7,225 enrolled 61,862 transactions $17,659,065 funded

Since November 2016 Before HSF

  • Managed 3 year and 6 month plans

with $8 Million in funding After HSF

  • Manage 6 month plan with $2

Million in funding

  • HSF managed by Commerce Bank,

funded in 14 days Recourse Rate 8% 12%

Nebraska Medicine National Average

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Motivating a New Culture of Collections | December 20, 2018

Patient Experience: Collection Conversations

Collection Conversation

  • 1. Insurance follow-up
  • 2. Patient insurance information request
  • 3. Proactively reaching out to identify potential issues

and find solutions

  • 4. Transparency regarding non-covered charges
  • 5. Improves patient experience
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Motivating a New Culture of Collections | December 20, 2018

Account comes active Contact patient

  • Identify insurance information was received, make note on account
  • If yes, add new insurance if applicable
  • If no, term current insurance

Denial received Check EHR for additional insurance

Collection Conversations: Patient Information Request

  • If other insurance is located, update coverage
  • If not proceed to next step
  • Received information, update account, make note on account
  • Voicemail, set tickler/deferral, make note
  • No contact, make note on account, send CINS letter
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Motivating a New Culture of Collections | December 20, 2018

3 Ps to Successful Claims and Reimbursement Processing

Provider Payer Patient

5 Keys to Success

  • Focus on highest return
  • Communication is key for staff,

payers, patients

  • Develop automation with payers
  • Focus on the patient & simplify the

payment process

  • Track and measure performance
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Q&A

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Motivating a New Culture of Collections | December 20, 2018

Thank you

Rick Heise

Senior Vice President Richard.Heise@CommerceBank.com

Sheila Augustine

Director, Patient Financial Services SAugustine@nebraskamed.com

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