New revenue cycle management ideas and processes

1. Breakthrough Strategies Breakthrough Strategies Leading Practice Self-Pay Solutions Presented by: Phil C. Solomon NC HFMA Chapter – March 17, 2009 Proprietary and ConfidentialThis information is not to be copied or otherwise utilized without the written consent of UCB, Inc.

2. Page 2 Session Overview Breakthrough Strategies Learning Objectives: Healthcare industry financial overview Review the economic factors causing the rise in self-pay Identify new tools, technologies and strategies to help you to address the increasing self-pay patient population

3. Page 3 Session Overview Breakthrough Strategies “If you think you can….. or if you think you can’t….. you're right” ~ Henry Ford

4. Page 4 Question Breakthrough Strategies The new healthcare bill will eliminate all self-pay accounts? TRUE or FALSE? Chat

5. Page 5 Answer Breakthrough Strategies Expect increase co-pays deductibles Premiums increases Patients look to reduce premiums

6. Page 6 Healthcare Industry Overview Breakthrough Strategies 2009 U.S. $ 14.2 Trillion GDP Gross Domestic Product (GDP) consumption + investment + government spending + (exports – imports) U.S. Healthcare $2.7 Trillion UK Total GDP $2.67 Trillion

7. Page 7 Healthcare Industry Overview Breakthrough Strategies CMS Estimates by 2019………… U.S. Healthcare $4.5 Trillion

8. Page 8 Healthcare Industry Overview Breakthrough Strategies From 2006 to 2015 CMS estimates health spending growth will exceed 7.2% (three times faster than U.S. GDP)

10. Page 10 Self-Pay Factors Breakthrough Strategies Nationally, 17% of the population under 65 has insurance – North Carolina 18% (source U.S. Census Bureau) 25 million adults under age 65 were underinsured in 2008(source Commonwealth Fund) Underinsured population increased over 60% from 2003 to 2009 Uninsured equals approximately 48 million Americans(source U.S. Census Bureau)

11. Page 11 Self-Pay Factors Breakthrough Strategies How large is 48 million……. All Americans age 65 and older (35.9 million)(source Center for American Progress)

12. Page 12 North Carolina Self-Pay Factors Breakthrough Strategies North Carolina

13. Page 13 North Carolina Self-Pay Factors Breakthrough Strategies North Carolina

14. Page 14 North Carolina Self-Pay Factors Breakthrough Strategies North Carolina

15. Page 15 North Carolina Self-Pay Factors Breakthrough Strategies North Carolina

16. Self-Pay Factors Breakthrough Strategies Do More with Less Operational Budgets Page 16

17. Self-Pay Factors Breakthrough Strategies Distribution of Deductibles for Employee-Only PPO Coverage 48% Source: Kaiser Family Foundation and Health Research & Educational Trust, 2000-2008 Survey of Employer Health Benefits Report. Page 17

18. Page 18 Self-Pay Dilemma Breakthrough Strategies 70% of Hospital Systems Report Increase in Uninsured Self-Pay Patients (source HFMA View Live Poll June 2009)

19. Page 19 Self-Pay Dilemma Breakthrough Strategies The Good News: The Healthcare Industry is Growing An Uncertain Future

20. Page 20 Question Breakthrough Strategies ? What are the solutions…

21. Page 21 Question Breakthrough Strategies ? What do we focus on first?

23. Engage in pilot programs

24. Seek new technologies

27. Incorrect insurance information entered at pre/registration

28. Insurance eligibility and pre-cert not verified at pre/registration

29. Costly to administer charity

30. No collection at POS - Co-pays or deductibles

32. Denials

33. Additional Rework

34. Excess Bad Debt

35. Missed Cobra 60 day rule

36. Increase in A/R – DaysOther Registration Quality Effects? Chat

38. Enable POS collections by utilizing patient payment estimation tools

39. Validate past due payment history with real time systems – Ask for money pre & POS

40. Real time screen for charity – consumer behavior tools

41. Real time technologies identify COBRA – unemployed

42. Real time registration quality monitoringRegistration Solutions

43. Page 27 Breakthrough Strategies Registration Tracking

45. Flat fee pricing

46. Waterfall cascade check:

47. Medicare/Medicaid

48. Commercial

49. Commercial propensity

50. Prime, second, tertiary

51. Patient historical data

52. Employer

54. Page 30 POS Collection Tools Breakthrough Strategies

57. Do you have a credit card on file with us?

58. Let me show you how you can take advantage of our prompt payment and self-pay discount

60. Costly to process charity accounts

61. Lack of participation by patient

62. Issues in the ER

63. Systems lacking to track patient payment history

64. Where is the money? – Who can pay?

66. Patient apathy – learned behavior

67. Excessive mail returns

68. Excessive Bad Debt

69. Missed collection opportunity – vendors lacking latest tools

70. Increase in A/R – DaysOther Self-Pay Effects? Chat

72. Automated charity screening

73. Screen all self-pay at POS and BAI accounts

74. Real time systems assess a patient’s financial situation

75. Use Medicaid Wizard Questionnaire to determine eligibility

77. Page 36 Self-Pay Modeling Validation Who will pay their bill? Charity –High– Medium–Low– Unlikely–Need Data Breakthrough Strategies With Modeling & Analytics Early Out Self Pay Scoring Medicaid Eligibility Revenue Cycle Outsourcing Payer Search Know how much they can pay Bad Debt

79. Unbiased and defensible

80. Tax-exempt - accurate classification and reporting of community benefit for IRS Form 990

81. Cost reduction strategy

82. Scrutinize patients total financial profile

83. Guard against charity fraudHFMA Statement 15 Section 3.7 supports credit validation

84. Charity Processing Breakthrough Strategies Consider this: “Manual Charity Processes = variable interpretations and applications of policy” Financial Counselor Financial Counselor Financial Counselor Financial Counselor Financial Counselor Financial Counselor Page 38

85. Charity Processing Breakthrough Strategies What does it cost to process a single charity application? Financial Counselor Financial Counselor Financial Counselor Financial Counselor Financial Counselor Financial Counselor Chat The Answer Is? Page 39

86. Page 40 Best Payment Likelihood Model Breakthrough Strategies Customized Model Blending Patient Payment History Actual Patient Payment History & Patterns Similar Patient Profile History and Patterns Generic Propensity of Payment Model, Including: Credit Bureau Report Demographic Profile Non-Credit Lifestyle Profiling

87. Page 41 Segmented Collection Strategy Breakthrough Strategies 80/20 Rule

88. Work Flow Optimization Qualify & Process Maximum Resources Modified Work Flow Accelerate to Bad debt Skip Trace & Process Breakthrough Strategies Page 42

90. A continuous non paying patient

91. A warning from the government

92. An activity which indicates actual identity theft

93. An activity indicating the possibility of identity theftSelf Pay Scoring Medicaid Eligibility Revenue Cycle Outsourcing Chat Payer Search Bad Debt The Answer Is?

94. Page 44 Answer Breakthrough Strategies Early Out A pattern, practice, or specific activity that indicates the possible existence of identity theft Self Pay Scoring Medicaid Eligibility Revenue Cycle Outsourcing Payer Search Bad Debt

96. Suspicious documents

97. Suspicious personal identifying information

98. Unusual use of, or suspicious activity relating to, the covered account

99. Notices from customer, victims of ID theft, law enforcement authorities, or other persons regarding possible ID theft in connection with covered accounts held by the organizationEarly Out Self Pay Scoring Medicaid Eligibility Revenue Cycle Outsourcing Payer Search Bad Debt

101. Zip+4 Census Data

102. Actual Collection Performance Validation

103. Patient Payment History – Custom Model

104. Financial Credit Bureau Data

105. Non-Credit Economic Data

106. Red Flag Alerts

107. Skip Trace Data Validation

108. Dual Validation Income Estimator

109. Charity Lifestyle EvaluationSelf Pay Scoring Medicaid Eligibility Revenue Cycle Outsourcing Must be delivered in real time Payer Search Bad Debt

111. Good or bad?

112. Healthcare Credit Cards

114. Stigma about placement – conflict with mission

116. Know which accounts to write off sooner with modeling

117. Analytics and segmentation minimizes the need for champion vs. challenger

119. Page 51 Question Breakthrough Strategies In order to meet Medicare cost reporting guidelines, you are required to work accounts internally for 120 days? TRUE or FALSE? Chat

121. No real time collection statistics available

122. No patient payment analytics readily available

123. Limited address validation reporting

125. Provide instant feed back to internal staff

126. Identify trends and act rapidly for cost containment

129. Reduce internal cost for government eligibility programs by 25%

130. Reduce charity administration costs by over 80%

131. Reclassify up to 20% of bad debt accounts as charity

132. Reduce statement cost by 25%-70%Self Pay Strategies Page 55

134. Improve liquidation by 25% to 40%

135. Add 10% to 15% in incremental revenue through eligibility cascade

136. Accelerate Medicare cost reporting on bad debt segmented accounts – allowing collectable accounts to remain at agency longerSelf Pay Strategies Page 56

137. Page 57 ? Do You Have Any Questions? Thank you ? ? Phil SolomonChief Client OfficerUCB, Inc.404-849-8065psolomon@ucbinc.com