collections

Tools for managing the self-pay patient

Anne Zieger — Thu, 19 Jun 2008 03:04:19 -0400

At this year's show, expect to see a lot of vendors pitching technologies and services designed to help you manage collections for the self-pay patient. It's telling, for example, that Forthright Solutions, a vendor of transaction processing and claims administration services in the dispute resolution market, is pitching a "self-pay recovery system" to HFMA attendees. Another vendor targeting the self-pay sector aggressively is Connance, whose technology mixes the experience of health systems with credit scoring firm Fair Isaac's predictive analytics capability to, among other things, sort out which patients are likely to pay.

Seeing vendors like this make a lot of noise is hardly surprising, given that the self-pay patient is top-of-mind for most providers these days--and that most aren't sure they're ready to deal with patient debt efficiently. That being said, tightening up collections management isn't the only way to get things done. I'm eager to see what vendors are offering by way of web-based payment solutions--an option Tenet recently rolled out for all of its hospitals using NCR Corp.'s Online Bill Pay. This solution--and related ones like bill-payment kiosks--could improve collections substantially just by making it convenient to pay promptly.

Tenet Healthcare offers patients ability to pay bills online

Wed, 28 May 2008 06:59:56 -0400

For-profit hospital chain Tenet Healthcare has begun offering patients at its hospitals the ability to pay their bills online. To access the online payment system, patients treated at any of its 53 facilities will need to complete an enrollment process from their hospital's website. Once enrolled, they'll be able to make payments, update their profiles, set up recurring payment plans, access a glossary of billing terms and view answers to frequently asked billing questions. The application supporting the billing functions is NCR Corp.'s Online Bill Pay, which Tenet pilot-tested earlier this year.

To learn more about this application
- read this Healthcare Finance News article

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Study: Uninsured ranks could be much lower

Wed, 14 May 2008 06:59:56 -0400

I know, you do everything you can to qualify patients for government programs when they're uninsured and need care. Despite that, uninsured patients continue to generate high bad debt levels for providers; in fact, according to the American Hospital Association, the industry provided $31.2 billion in uncompensated care in 2006.

Millions of patients are slipping through screens designed to hook patients up with government programs, according to research by the National Institute for Health Care Management Foundation. For example, one in four who are eligible for Medicaid or the State Children's Health Insurance Program aren't enrolled, a total of about 12 million people.

Of course, the problem doesn't lie just with the provider's eligibility screening process. Often, the uninsured are overwhelmed by the administrative requirements involved in applying for such programs, while current enrollees frequently are dropped when they don't fill out renewal forms. Meanwhile, a 2005 law requiring applicants to show proof of citizenship to be eligible has also led to delays in enrollment for many citizens, foundation researchers said.

To learn more about the report:
- read this InsideARM article

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MN governor vetoes medical debt history bill

Wed, 14 May 2008 06:59:55 -0400

Minnesota Gov. Tim Pawlenty (R) has vetoed a bill that would have banned healthcare providers from collecting, using or sharing medical debt information to qualify patients prior to providing elective services. The bill, which had passed both of the state's legislative chamber's by a broad margin, permitted providers to determine patient income levels and assets, but only to qualify them for charity programs or state and federal reimbursement programs. Pawlenty, however, called the bill "extremely broad," and said that it could force providers to make big changes in how they offer routine medical services. Supporters of the bill say they'll probably rework the text to try and meet the governor's objections.

To learn more about the bill:
- read this Modern Healthcare article (reg. req.)

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MN bill blocks hospitals from using debt info pre-care

Wed, 07 May 2008 06:59:56 -0400

Arguing that such a practice is coming, even if it isn't widely observed yet, Minnesota legislators have approved a bill forbidding hospitals from using information about a patient's medical debt history to decide whether or not to treat that patient. The bill forbids providers from sharing or obtaining medical debt information until after care is delivered. Hospitals are entitled to determine patient income and assets, but only for the purpose of qualifying the patient for charity programs or state and federal reimbursement.

Right now, a small number of providers have begun financially qualifying patients who need elective procedures. That could conceivably disqualify a substantial minority of patients seeking care, as one in five Americans have medical debt, according to research by the Commonwealth Fund.

To learn more about the bill:
- read this piece from the Minneapolis Star-Tribune
- read the bill text

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Hospital, family tussle over bills for dead patient

Wed, 07 May 2008 06:59:55 -0400

Here's the kind of story that gives hospital collections departments a bad name. It seems that due to internal communication problems, a Seattle-based healthcare provider continued to bill the family of a deceased cancer patient for a service taking place four months after the patient died. Somehow, the Seattle Cancer Care Alliance ended up doing a donor search for a bone marrow transplant for Melanie Smailus despite the fact that she was deceased. Since SCCA's collections department didn't have a policy in place to address charges incurred after death, workers continued to pursue the "estate of Melanie Smailus," in this case her husband Thomas Smailus, sending him at least three bills.

Though Thomas Smailus called repeatedly to question the charge, apparently the collections folks had no power to address the issue. However, when SCCA was contacted by a reporter, the institution finally wrote off the $2,700 charge and instituted a policy not to bill estates for the cost of services rendered after a patient's death.

To learn more about this case:
- read this Seattle Post-Intelligencer article

Insurer troubles could mean more bad debt for providers

Wed, 30 Apr 2008 06:59:58 -0400

In recent weeks, health insurers have started announcing financial results, and the news hasn't been good. WellPoint, for example, saw profits fall 25 percent, and UnitedHealth Group recently lowered its 2008 profit outlook by 40 cents per share. With insurers feeling financial pain, they're likely to raise premiums next year. In response, companies are likely to ask employees to carry more healthcare costs, industry watchers say. The net effect of all of this buck-passing is that with consumers facing higher bills, providers are likely to face high levels of bad debt, financial analysts predict. That's the case, in part, because consumers will be facing not only higher bills, but also a tougher economy and challenging job market, both of which further limit their ability to pay down medical debt. Add that to confusion over the use of the National Provider Identifier on Medicare claims--which could slow payments substantially--and 2009 is shaping up to be a very difficult year for providers, especially hospitals, healthcare analysts warn.

To learn more about this trend:
- read this InsideARM piece

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Trend: Hospitals requiring upfront cash payments before treatment

Wed, 30 Apr 2008 06:59:56 -0400

Of late, a growing number of hospitals have been insisting on cash payments before they offer high-ticket services to non-emergency patients if they're not sure they'll get paid. While such practices may not generate the best PR, it's a matter of survival, hospitals say. Even though the current slate of health reform schemes insure all citizens, it seems unlikely to address the problem of collecting payments for costly procedures. For example, Massachusetts plans include many high-deductible options, which still leaves hospitals deep in the red if patients don't pay their share.

Hospitals are being sapped by care for growing numbers of uninsured patients, and say that unless they get tough on patients with some means, some of them simply won't survive. For example, both HCA and LifePoint hospitals saw profits drop substantially during the first quarter of this year, largely due to jumps in bad debt expense--including lower collections on patient accounts. Uncompensated care has been flattening hospitals nationwide, with the burden climbing 44 percent in 2006, to $31.2 billion, from $21.6 billion in 2000. Such debt is helping to push hospital margins well below the the 3 to 5 percent considered appropriate, and sometimes destroys them entirely.

That being said, collecting cash aggressively can rebound when not-for-profits are involved. For example, this week the Wall Street Journal brought some unflattering attention to the M.D. Anderson Cancer Center, which in late 2006 asked a leukemia patient for $105,000 up front because it wasn't satisfied with her insurance coverage. And with federal legislators like Sen. Chuck Grassley questioning not-for-profit hospitals' right to their tax exemptions, coming across as too money-driven has its perils.

To learn more about this trend:
- read this Kaiser Daily Health Policy Report item

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Case study: FL hospitals offer online payments

Wed, 30 Apr 2008 06:59:54 -0400

A group of Jacksonville, FL-area hospital systems have begun letting patients pay their bills online in an effort to save time and money. The hospitals involved include St. Vincent's Medical Center, Orange Park Medical Center and Memorial Hospital of Jacksonville. In doing this, the hospitals are on the cutting edge, as only 16 percent of U.S. hospitals provide this option, according to the American Hospital Association. Still, hospitals stand to benefit substantially. Transitioning from paper processes to electronic ones could save the industry $35 billion and about 2.5 billion pieces of paper each year, according to the Healthcare Financial Management Association.

One early adopter of this approach is St. Vincent's, which uses ExpressBill Online by Emdeon Business Services to handle the payments. It began offering web payments with Emdeon in 2003, after having been a longer-term user of the vendor's statement processing software. To pay using the web, St. Vincent's patients simply enroll online, then choose a payment source (checking account or credit card).

To learn more about online bill payment:
- read this Jacksonville Business Journal article

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Study: Better records could boost self-pay collections

Wed, 16 Apr 2008 06:59:55 -0400

Struggling to manage your bad debt load? You're not alone--but some of the pain may not be necessary. According to a new study, a good percentage of the self-pay accounts hospitals write off could probably have been collected upon if hospitals tightened their financial screening procedures. The study, which was done by Nashville, TN-based vendor nTelagent, analyzed receivables between 90 and 180 days old from January 2007 to January 2008. They drew the records from 40 providers, some of which were existing clients.

Researchers found that 30 percent of the self-pay accounts were written off as bad debt because patient's incomes and net worths weren't obtained or verified. However, when nTelagent did the research, it found that more than 16 percent of the patients being studied could be classified as having high income and/or high net worth, while another 33 percent had moderate household income or net worth. nTelagent suggests that all of these accounts could have been re-billed or outsourced to collections. Meanwhile, another 17 percent of written-off accounts might have qualified for government assistance or charity care programs, the vendor reported.

To learn more about the study:
- read this InsideARM piece

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