The 3 P's to Perfect Your Pre-Encounter

The Problem Double-digit denial rates Cash flow Patient billing responsibility Most providers are facing double-digit denial rates, which is impacting cash flow. Nearly every provider is dealing with cash flow problems today. Patients don’t know what they owe.

The Opportunity = 3 Ps Process = Cut denial rates by half (was 10% now 5.7% soon to be 3.0%) Patient = Better understanding Working with Cone Health Network who cut their denial rates from 10% to 5.7% and on pace to bring that down to 3% The second piece in the puzzle is the patient’s responsibility. Cone had a goal of increasing cash flow to $100k per month and within 3 months they beat that by 33% and brought in $400k. Payment = Boost cash flow $100k/month

Highlights Defining the bottom line Centralization of scheduling: the key to success Defining where you are and where you will go Develop and deploying a process Training Tracking, measuring, and evaluating the success

The $6 Million QuestionTM On a scale of 0 to 10, how well do you communicate your patients’ payment responsibility?

John Cook Why should you listen to me? Served as Revenue Cycle Director for 22 years Pro Recovery, Inc. = Worked with more than 100+ hospitals on improving their revenue cycle Reducing AR days from over 100 to 55 days Advising and mentoring hospital managers National HFMA Yerger Award for Outstanding Performance in Education

Lesson #1: Define your bottom line. Define why you are implementing a pre-encounter process. What efficiencies do you want to realize?

Here is what your colleagues said Consistency To create efficiencies to promote patient satisfaction and financial accuracy by education patients prior to service To educate the patient, financially and clinically Customer service Reduce errors / streamline and improve the patient experience Pre-financial screening Patient Friendly!! Financial clearance and education Get it right the first time Scheduling Customer service and collection of money Obtain authorization Implement a new program Source: Answers given by attendees of NCHFMA Roundtable Discussion on Pre-Admission Procedures and Best Practices, July, 2012

Bottom Line: 5 Key Elements Cleaner claims Patient payment issues Communication of payment expectations Asking for payment upfront Service excellence Gathering accurate and up to date information is the single most critical piece of the patient admission process: The result will be cleaner claims which will result in less denials and faster turnaround. This is the high dollar piece. Financial clearance for patient: Determine any patient issues and challenges they may have in paying their bill. This is the opportunity to offer other options such as Medicaid, assistance in applying for insurance through the Affordable Care Act, clearing up any past due accounts, or determining possible charity care or financial assistance. Communication of expectations: This is the opportunity to provide the patient with estimates and potential balances after insurance pays. Providing expectations will assist the patient in planning for these expenses. Pre-Service collection: Simply stated, asking for money up-front (i.e. deductibles, co-pays, past due debts, deposits). Service Excellence: Make the difference. Create the first impression Denial rate, speed of approval, how much do you convert into cash. Each one have an example of how to track that.

Lesson #2: Centralize Scheduling The foundation of a successful pre-encounter process Scheduling is a patient access function One calendar One location Everyone on the same page The foundation of a successful pre-encounter process: Bring it all under one roof. Scheduling is a patient access function. Own it. One calendar for all procedures: Scheduling calendars must be a part of the overall software package with the ability to create a work file for patient access representative to work from. One location: A Team Everyone on the same page: Playing by the same rules, seeking consistent information.  

Lesson #3: Define where you are and where you need to go Rate your responses on a scale of 0 to 10, 0 = extremely poor; 10 = extremely well. ____ Overall, how would you rate your pre-encounter program? ____ How would you rate the information you get from patients? ____ How would you rate your clean claims? ____ How would you rate your scheduling software? ____ How would you rate your scheduling process? ____ How would you rate your insurance eligibility capabilities? ____ How would you rate your ability to estimate charges? ____ How would you rate your ability to refer uninsured patients to their payment options? ____How would you rate your current collection policies and procedures?

Lesson #4: Develop and Deploy a Process Act Centralize scheduling Secure technology Establish a plan and timelines Complete buy-in   Act on your assessment. This is the starting point Taking the action needed to centralize scheduling Secure up to data technology Establish the plan and timelines Complete “buy in”: Support of administration, support of nursing, support of all departments involved (surgery, radiology, outpatient surgery, etc.)

Lesson #5: Train, Inspire, Create Create passion Ask for money Create service excellence Communicate expectations Create passion for the role, Train staff how to ask for money Train staff how to relate to patient and create service excellence Train staff to communicate expectations Example: Ken’s overall bottom line wasn’t not necessarily to get the co-pay but to communicate the patient’s payment responsibility. The cost of the procedure is ________ and your insurance will likely cover __________ and therefore your balance will be _________. If there are any issues with you paying that amount we would like

Lesson #6: Track, Measure, and Celebrate the Success Reduction in AR days Increase in clean claims Increase in point of service collection Increase in patient satisfaction scores

A Successful Process: Cone Health High denial rates Boost cash flow Training Reduce denial rates to 3% Increase cash flow by $100,000 per month through pre-service Epic system lacked in estimation Estimation package purchased New policy and procedure approved by Administration Awareness of problem: High denial rates and the need to boost cash flow Determination of the bottom line Review of current Pre-Encounter and Pre-Admission process Goals and Timelines Centralization of scheduling Review of current in-house software capabilities Review of technology Purchase and installation of estimation software New policy and process buy in Setting up separate Pre-Service Center off campus Creating the environment Training

Results: Cone Health Reduction of denials to 5.8% from 10% Pre-Service collections at $400,000 average of $133,000 per month

Summary Questions Where are you in this process? What is your biggest obstacle? What are your failures? What are your successes?  Ask the question, what has been stopping you. What is the wall that you are going to hit. Who do you need to convenience. Other departments? What suggestions from you who have dealt with this? Get the roundtable going. Audience interaction.

Now ask yourself the $6 Million QuestionTM If you put in place just a few of these ideas… How well could you communicate your patients’ payment responsibility?

Quick Start Consultations Available from John Cook at no cost Contact Information jcook@prorecoveryinc.com 828-773-4466 (Cell) 866-907-8023

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