With expanded access to healthcare services, growing numbers of uninsured and underinsured, and a shift to greater patient financial responsibility, it is important for healthcare organizations to secure reimbursement prior to service. For our fiscal health, we believe the most important step occurs before any services are actually performed. That critical step is the background processing identifying the financial responsibilities for an upcoming procedure or service, which enables you to set expectations with the patient and conduct point of service (POS) collections. For that conversation, you must be able to accurately answer fundamental questions such as:

  • What does my insurance cover?
  • What is my copay?
  • What is my remaining financial responsibility?
  • How were these figures calculated?
  • What are my options for meeting this responsibility?

Streamlining Reimbursement by Automating Our POS Capabilities

Several years ago, Health First couldn’t provide answers to all of those detailed questions prior to service. Our POS capabilities were hampered by the lack of an automated point-of-service collection system. For example, we often couldn’t determine a patient’s financial responsibility at admission, although we could generally determine the copay (usually posted on the insurance company’s website). We could determine eligibility, but we could not accurately determine contract “allowables.” For self-pay patients, we weren’t able to determine true ability or propensity to pay.

To address pre-service collections, we created spreadsheets and collected estimated minimum payments. If we didn’t estimate properly, we had to issue refunds or credits. This created unnecessary back-end work and confused patients. The process was paper-intense, complex, and inefficient.

To improve the effectiveness of our operations and speed reimbursement, we implemented a POS financial solution that automates verification of patient insurance eligibility, coverage and copays. It enables us to more easily develop timely, accurate billing estimates and determine:

  • Patient contract benefits
  • Total charges
  • Amount paid by patient insurance plan
  • Cost owed by the patient based on doctor, procedure, etc.
  • Allowed contractual amount
  • Determination of co-insurance and patient responsibility amount

Access to this data enables our staff to build comprehensive charge estimates and more confidently explain to patients how these fees are determined. It also helps us spot errors if a patient gives incorrect information at registration.

Impressive Results from Automating POS

Since automating our POS procedures in April 2011, Health First has seen significant improvements. As of December 31, 2012, we have increased monthly point-of-service collections by 29% and reduced bad debt write-offs by 41%.

Strengthening Pre-registration and Insurance Certification

POS automation has enabled us to quickly and easily identify contract allowables and co-insurance rates. We used to collect $100,000 a month through preregistration. Now we’re averaging over $250,000 per month in preregistration collections.

Improving A/R levels by Early Error Detection and Correction

Filtering POS collection reports through our quality control system enables us to correct processing errors within our three-day bill-hold period. Correcting errors prior to submission helps prevent delays. Our monthly billed A/R days have decreased by 15%.

Bringing Medicaid Claim Scrubbing In-house

POS automation has eliminated the need for a third-party vendor to verify Medicaid eligibility claims. We analyze self-pay patients ourselves to check if they are Medicaid-eligible. We’ve increased our monthly charity qualifications by 36% in the last year and a half.

Adjusting Workflows to Improve POS Collections

As part of improving our POS collections, we have added a benefits advisor function to our process. Staff members discuss insurance benefits and payment options with patients during their hospital stay instead of only at admission.

This new approach enables us to be more proactive, and it helps ensure patients aren’t surprised when they receive their bills. For self-pay patients, we try to help them obtain third-party charity sponsorship, verify Medicaid eligibility, gain access to primary care physicians, get the drugs they need, or help qualify them for food stamps.

Moving Forward

It’s been nearly two years since Health First began automating POS collection. Today some 350 employees use these capabilities, including in patient access (scheduling, preregistration, registration, benefits advising and financial counseling), pre-authorization and outside facilities (clinical staff as well as radiology, rehabilitation and pain clinic ancillary departments). The data enables staff to take meaningful actions to improve our bottom line by securing collections before or at the point of service. Having detailed information upfront means staff is better equipped to provide comprehensive financial counseling to patients.

Health First Gains Financial Improvements via POS Collections

In 19 months, Health First was able to make the following improvements with the help of an automated point-of-service collections solution.

  • Point of service (POS) collections – improved by 29%
  • Charity care qualifications – increased by 36%
  • Bad debt write-offs – decreased by 41%
  • Monthly decrease in billed AR days – decreased by 15%
 
Michelle Fox

About the author

Michelle Fox is Director of Revenue Operations/Patient Access at Health First in Brevard County, Fla. She directs revenue cycle front end operations of the Patient Access department with 200+ associates supporting four non-profit hospitals and six diagnostic centers. She has earned a Gallup Survey World Class Leader designation and is nationally certified in Healthcare Access Management. She has a Bachelor of Health Science Education, a Master of Health Administration and an MBA from University of Florida. Health First manages plans with more than 63,000 covered lives, 246 physicians, and outpatient and wellness services sites.