How we increased our point of service collections on elective surgery.

o Patient Access staff saw a large potential for up front collections from surgical patients. o We were trying to increase customer service by creating price transparency. o As an attempt to help decrease calls to billing post procedure with concerns or anger about the cost. o We wanted to create a policy that would allow us to meet the benchmark of collecting 1-1.5% of net revenue in POS collections, which would allow us to fall in the 95 th percentile for point of service collections. This policy allowed us to reach this benchmark within the first year of implementation.

o A PI team was created to brainstorm ideas on how to increase point of service collections from our surgical patients. o The PI team designed a Surgical Financial Worksheet for the offices to use to help determine down payments. o The PT team crafted a Deposit Matrix. The team included members of Patient Access, Patient Financial Services, and our CRO. Eventually, staff members from the physician group were added to the team. o A policy was written outlining the requirements and for how to handle patients who were unable to pay.

All of our physician offices with providers performing surgical procedures at Otsego Memorial Hospital (OMH). This included: General Surgery, N’Orthopedics, OB, and Urology. Providers with privileges, but are not employed by OMH are not required to fill out surgical financial worksheets. However, their patients are still required to make a down payment on the day of the procedure. Last, but not least, and most importantly our patients having elective surgical procedures.

After the provider determines the patient requires surgery the patient meets with a surgery scheduler. The surgery scheduler goes over all the information about the surgery process with the patient. They verify the patient’s current benefit balances at this time. The scheduler fills out the Surgical Financial Worksheet and goes over required down payments with the patient. If the patient is able to make the required down payment for their elective surgery, they are scheduled. A copy of the Surgical Financial Worksheet is sent to the Patient Access Department pre-admission testing Specialist.

o The patient is scheduled for surgery by the OR scheduler and given a pre-admission testing appointment by Central Scheduling. o The patient calls or comes in to pre-register for surgery. At this time the pre-admission testing Specialist collects all required down payments. o If the patient expresses wanting to pay on the date of surgery we will work with the patient, especially, if they have a good payment history with OMH. o If the patient expresses to the office that they are unable to pay anything down on the date of service, or are a self-pay. The patient is required to contact the CAC/ Financial Advocate prior to being scheduled. o The CAC/ Financial Advocate will speak with the patient and see if there is alternate funding available to help pay the patient’s liability. Such as, Health Department funds, Medicaid, Hospital grants, and lastly the Hospital’s charity program.

o The CAC/ Financial Advocate is responsible for helping the patient apply for any alternate funding programs if the patient wishes. o The Financial Advocate will go over the patient’s payment history and discuss any bad debt appearing on file associated with the patient. o Once the patient has been financial cleared by the Financial Advocate the Advocate will contact the physician office letting the scheduler know the patient can be scheduled for surgery. o The patient is given a final estimate of procedure cost, including the physician fee cost, at their pre-admission testing appointment. Our Patient Access staff generate this estimate using Emdeon’s pre-estimation tool.

Deductible, Coinsurance, Patient Balance $1,000- 1,999 $2,000- 2,999 $3,000- 3,999 $4,000- 4,999 $5,000- 5,999 $6,000- 6,999 Down Payment $1,000$1,500$2,000$2,500$3,000$3,500 Balances greater than $1,000 according to the following schedule: *Balances below $1, must pay 100% down.

o Patient Access staff had 100% buy-in from the beginning. However, it was difficult in some of the offices to gain staff buy-in. o Due to the fact we had already rolled out a POS collection initiative on all other outpatient testing many of our patients were aware of our up front collections policy. However, these procedures had much greater costs associated with them than most testing they were familiar with. o Many patients were very happy to have an estimate up front. This helped them to avoid ‘sticker’ shock when opening their first bill from their surgical procedure. o Patients were also able to ask questions up front if they did not understand how the procedure would be applied to their insurance. If they like we provide them with the CPT code(s) for their procedure so they can call their insurance company up front to verify benefits with them as well, if they wish.

o This policy, along with our outpatient up front collection policy, has helped reduced calls to billing with complaints such as, “If I had known how much this procedure/ test was going to cost, I never would have had it done!” Or, “No one told me my insurance was not going to cover this!” o Last year alone, we reduced our bad debt by approximately 25%. o Every year since implementing this policy our POS collections have increased significantly. For example, our POS collections in February 2015 were $83,000. This year they were $97,000, a 16.9% increase.

Candace Marcotte, CAC/ Financial Advocate Otsego Memorial Hospital Kim Jones, CAC/ Pre-admission Testing Specialist Otsego Memorial Hospital