SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O’Hanlon Health Consulting Business for Health Business Skills for Private Medical Practices Module 16: Manage Payments and Collections

A Quick Start Welcome! While you are waiting for the class to begin, please take the Pre-Test and make sure your name is on it before you hand it to the facilitator. While you are waiting for the class to begin, please take the Pre-Test and make sure your name is on it before you hand it to the facilitator. Thank you!. 2Business Skills for Private Medical Practices

Agenda Welcome Reasons Why Medical Practices Lose Money Steps for Managing Payments and Collections Upfront Payment and Collections Policies Staff Training Patient Education Insurance Claims Managing Payments and Collections Summary and Evaluation Close 3Business Skills for Private Medical Practices

Learning Objectives During this session, you will: 1.discuss why private medical practices lose money; 2.identify the steps involved in effectively managing payments and collections; 3.determine the key components of an upfront payments and collections policy; 4Business Skills for Private Medical Practices

Learning Objectives 4.explain the staff training necessary to implement the policy; 5.propose how to educate patients regarding their financial responsibilities; 6.assess the value of a financial assistance program; 5Business Skills for Private Medical Practices

Learning Objectives 7.review how well your practice handles the steps involved in managing insurance claims; 8.propose how to handle payments and collections issues; 9.describe the next step; and 10.state your key take-away from this session. 6Business Skills for Private Medical Practices

Introduction You will have 1 minute to introduce yourself: 1.Your name 2.Your position 3.Your business 4. How long you have been in business 7Business Skills for Private Medical Practices

Reasons Why Medical Practices Lose Money Business Skills for Private Medical Practices 8

When Costs Are Out of Control LuKiMa Outpatient Center: What are the main sources of costs that LuKiMa Outpatient Center needs to control? Business Skills for Private Medical Practices9

LuKiMa Outpatient Center Main Sources of Costs: 1.Poor financial controls 2.Poor stock controls 3.Failure to collect upfront payments 4.Insufficient/lack of appropriate documentation 5.Unauthorized services performed Business Skills for Private Medical Practices10

Individual Assessment Put a star next to reasons that are true for your practice: 1.Inadequate Internal Controls Process 2.Failure to Collect Upfront Payments 3.Insufficient or Lack of Appropriate Documentation 4. Missed Charges on Patient Account 11Business Skills for Private Medical Practices

Individual Assessment 5.Outdated Fee Schedule 6.Gaps in the Schedule Due to Missed Appointments 7.Lack of Appeals for Denied Claims 8.Unauthorized Procedures and Services Performed 9.Outdated Managed Care Contracts 10.Inaccurate or Incomplete Coding 12Business Skills for Private Medical Practices

Recognizing What You Can Change 1.What are the top three reasons? 2.Of these reasons, which are under your control? 3.Which of the reasons could you take action to immediately address? 4.What could you do? 13Business Skills for Private Medical Practices

Steps for Managing Payments and Collections Business Skills for Private Medical Practices 14

Steps for Effective Payments and Collections Management 1.Develop an upfront payments and collections policy 2.Train staff 3.Educate patients about their financial responsibilities 4.Offer financial assistance 5.Manage insurance claims 15Business Skills for Private Medical Practices

Upfront Payments and Collections Policies Business Skills for Private Medical Practices 16

Analyzing Upfront Payments and Collections Policies: Example A 1.What do you like about the policy? 2.What is missing from the policy? 17Business Skills for Private Medical Practices

Analyzing Upfront Payments and Collections Policies: Example B 1.What do you like about the policy? 2.What is missing from the policy? 18Business Skills for Private Medical Practices

Upfront Payment Policy Components  When payment is due  Who is responsible for payment  How co-pays and deductibles will be handled  What forms of payment are accepted 19Business Skills for Private Medical Practices

Upfront Payment Policy Components  What happens if nonpayment occurs  What happens if appointments are missed or cancelled  How an inability to pay for service can be handled 20Business Skills for Private Medical Practices

Staff Training Business Skills for Private Medical Practices 21

Training Your Staff Create a humorous 2-minute skit: What you DO and DO NOT want your staff to do or say in collections situations. 22Business Skills for Private Medical Practices

Patient Education Business Skills for Private Medical Practices 23

Educating Your Patients About Their Financial Responsibility 1.What changes would you make to adapt this policy to your practice? 1.How would you be sure that your patients know and understand the policy? 24Business Skills for Private Medical Practices

Sample Payment Policy 1.Insurance 2.Co-payments 3.Non-covered services 4.Proof of insurance 25Business Skills for Private Medical Practices 5.Claims submission 6.Coverage changes 7.Nonpayment 8.Missed appointments

Reception Room Notification  You have 5 minutes to create a notice to hang in your reception area to educate patients about the key terms of your payments and collections policy.  Tape it on the wall.  Read everyone else’s notifications. 26Business Skills for Private Medical Practices

Financial Assistance Business Skills for Private Medical Practices 27

Offering Financial Assistance to Needy Patients 1.How can a medical practice offer financial assistance to needy patients? 1.How could these financial assistance options be designed and implemented so they do not have a negative impact on the medical practice’s profitability? 28Business Skills for Private Medical Practices

Insurance Claims Business Skills for Private Medical Practices 29

Collecting Payment from Insurance 30Business Skills for Private Medical Practices

Sample Medical Practice Claims Management Review Cycle 31Business Skills for Private Medical Practices 1.Where does your practice struggle the most in this cycle? 1.What can you do to make your claims management process more efficient?

Sample Claims Management Review Cycle 32Business Skills for Private Medical Practices

Sample Claims Management Review Cycle 33Business Skills for Private Medical Practices

Steps in the Medical Practice Claims Management Review Cycle 34Business Skills for Private Medical Practices  Registration  Clinical Documentation  Checkout  Coding  Billing  Health Insurer  Collections

Managing Payments and Collections Business Skills for Private Medical Practices 35

Case: Takala Nursing Home Ltd. 1.Which steps in the medical practice claims management review cycle were manipulated by the accountant and administrator? 2.What actions should the receiver manager take to ensure that such manipulation does not occur in the future? Business Skills for Private Medical Practices36

Steps in the Medical Practice Claims Management Review Cycle 37Business Skills for Private Medical Practices  Registration  Clinical Documentation  Checkout  Coding  Billing  Health Insurer  Collections

Summary and Evaluation Business Skills for Private Medical Practices 38

Evaluation Sheet 39Business Skills for Private Medical Practices

The Next Step 1.Ensure your payments and collections policy is complete 2.Train staff 3.Educate patients about their financial responsibilities 4.Consider offering financial assistance 5.Manage insurance claims 40Business Skills for Private Medical Practices

Let’s See How Much You’ve Learned Please take the Post-Test. We will compare it to your Pre-Test to see how much you’ve learned in this session. Thank you. Business Skills for Private Medical Practices41

My Key Take-Away 42Business Skills for Private Medical Practices