Is Your Collection System Receiving the Right Dose of Automation? Presented to HFMA New Jersey and Philadelphia Metro Chapter 2011 Annual Institute

Transcription

1 Is Your Collection System Receiving the Right Dose of Automation? Presented to HFMA New Jersey and Philadelphia Metro Chapter 2011 Annual Institute

2 Payment Points in the Revenue Cycle A/R Creation Financial Settlement Eligibility Pre-admit/ treatment Treatment/ Admission Discharge Billing Status check/claims processing Payment and remittance advice/settlement Patient acct. updated Follow-up Patient prescreening Registration / eligibility requirements (ANSI 270/271) Charge capture procedures performed Medical record documentation Bill generation / submission Payor claims adjudicated Supplemental billing Insurance remit & pmt (ANSI 835 or EOB) Check/EFT Patient data transmission (ANSI 835) (ANSI 837 or paper) Benefit data, co - pay collection, reconciliation and posting Patient pay billing Claim status inquiry (ANSI 276/277) Patient co-pay Check/other Supplemental payment (ANSI 835) Denials mgt /recovery

3 Revenue Cycle Payment Topics Payment options Available technology Pros and cons of available technology Evaluating options

4 Registration Payment Options Collecting payment before service Payment plans Credit cards POS, WEB and TEL ACH payments

5 Credit Cards Multi-function credit card terminals Set terminals to auto-settle POS Internet gateways/card swipes Monitor volumes and periodically reevaluate discount rates

6 Credit Cards: Pros and Cons Pros Relatively inexpensive technology Widely accepted by patients Immediate collection Few charge backs in healthcare industry Cons Discounted payment Logistics of distributed technology (terminals) Automatic posting to patient billing system requires integration

7 POS, WEB and TEL ACH Payments POS = check conversion at point of service WEB = e check initiated via the Web TEL = e check initiated via telephone

8 POS, WEB and TEL: Pros and Cons Pros Low-cost collection methods Becoming more widely accepted by patients Faster availability of funds Few returns in healthcare industry if transactions are properly identified Cons Consumer law allows delayed returns Cost to implement technology Automatic posting to patient billing system requires integration

9 Collecting from Patients After the Encounter Patient lockbox Prompt payment discounts Auto-posting lockbox payments Merging other types of payment files On-line bill payments Collection agency payments RPPS bill payment files ebill presentment and payment WEB and TEL

10 Patient Lockbox Best Practices Scannable document with OCR line Patient number for unscannable payments is keyed if available Credit card payments are authorized during the lockbox process Information is mapped to an 835, or other file format, for automatic posting to the billing system Transmission is balanced to the lockbox deposit total to facilitate reconcilement Check number or last four digits of credit card number are posted along with the payment to facilitate customer service Patient document/check copies are imaged Virtual sorting is used to identify exceptions and facilitate reconciliation

11 Daily lockbox deposits should balance to deposit totals appearing on bank statements. Posted payments, plus any exceptions keyed manually, should equal the lockbox deposit.

12 Images of individual payments are captured and stored. Images can be used to research patient inquiries and to obtain information needed to post unprocessable transactions to the patient billing system. With an image index file, images can be transmitted to a document imaging system.

13 Patient Lockbox: Pros and Cons Pros Best practice with proven results Accelerated availability of funds Reduced risk Automatic, accurate, posting of payments Files can be posted by most patient billing systems Reduced number of second statements Reduced number of accounts sent to collection Relatively easy implementation: simple posting rules Cons Technical implementation requires MIS resources Out-of-town address perception issue Printing a scannable document to meet technical requirements Handling guarantor, multiple physician, or hospital/physician payments

14 Insurance Payments Direct 835s Manufactured 835s (IOCR) Matching payments and remittances before posting

15 Payer Maps and Patient Responsibility Cash posting in other industries: apply to invoice or client open account Healthcare: Identify payer Identify insurance plan/financial class code Post to specific claim Handling of remaining amount due: Driven by adjustment reason code Bill secondary, or tertiary, insurance plan? Bill patient? Write-off remaining balance? Some newer billing systems post by encounter, reducing posting complexity

16 Direct 835s vs. Manufactured 835s Direct 835s Manufactured 835s Single payer file Multi-payer file with payer identified in GS segment Multi-payer file with payer identified in BPR segment HIPAA reason codes Proprietary reason codes 835 content and optional data segments may vary widely by payer Standard 835 format with consistent information by payer (as printed on EOB) Unfunded file must be matched to payment traveling separately Funded file, since 835 is typically created from documents received with a check

17 The Manufactured 835 Process (IOCR) Provider transmits 837 or Master Patient Index claim information Images of lockbox documents (checks, EOBs,correspondence, zero dollar EOBs) are transmitted to the Operations site Correspondence is reviewed by staff and sorted into virtual batches for processing $0 EOBs are sent to be converted to 835s Patient letters and other correspondence may be indexed by patient ID Template software captures data from the EOB images EOB information is verified against claim data then mapped to the 835 format 835 is balanced back to the lockbox deposit, then transmitted to provider Indexed images are stored on-line for 7 years Images and an image index file can be transmitted to the provider

18 Automated Reassociation of 835s and Payments 835 types: direct and manufactured Payment types: ACH and check Matching criteria: trace number (HIPAA guideline), check number, payment amount, effective date of payment, provider ID, payer ID. Automated solutions match 85 percent, at best, so exception processing must be considered

19 Direct 835s: Pros and Cons Pros Standard file format Reduced posting cost per payment Faster A/R application, secondary bills, denial appeals Easy implementation, if payer data is consistent More consistent payer monitoring and reporting Facilitates denial management process Cons File content is not always standard Many payers send non-compliant files (syntax errors, etc.) For systems requiring a payer map, implementation can be timeconsuming Requirements of patient billing systems can make implementation complex

20 Manufactured 835s: Pros and Cons Pros Standard file format Reduced posting cost per payment Faster A/R application, secondary bills, denial appeals Process normalizes information sent by payers by repairing from claim file, using document templates Cons Implementations can be time-consuming Claim files are sometimes hard to produce Payer maps require extensive pre-work, or changes in business processes Many vendors use off-shore data entry Many vendors use data entry vs. document templates, causing repetitive human errors Requirements of billing systems can make implementations complex

21 Other Payment-Related Acronyms Patient snippet XML HL7