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Hospitals looking for creative options to assist patients during job transitions may want to consider paying healthcare insurance continuation premiums. Under COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985), workers can continue their employer-provided health insurance?assuming they were enrolled?for 18 to 36 months, as long as they pay the premiums. They must enroll in the program within 60 days of layoff, termination, or another qualifying event. The U.S. Department of Labor’s “Frequently Asked Questions: COBRA Continuation Health Coverage” includes additional information on eligibility and qualifying events. “When a financial counselor is discussing payment options with a patient, the counselor may uncover the fact that the patient was recently unemployed,” says Christine Fontaine, CHFP, CPAM, vice president, revenue cycle solutions, OptumInsight. “This could launch a screening process in which the counselor determines if the patient is eligible for COBRA, has no other existing insurance, and is able to make the premium payments. COBRA premiums are very expensive, and some patients may not be able to afford to make them. Depending on the results of the screening and the reasons for the patient’s hospital visit, it may make sense for the hospital to pay the patient’s COBRA premium for a month or two.” This strategy could be appropriate if the patient’s treatment involves high-cost drugs, such as chemotherapy drugs or infused antibiotics. Lengthy inpatient stays may also warrant this approach. “Hospitals need to weigh the cost of the treatment with the cost of paying the COBRA premium,” says Kristen Shoup, MBA, RHIA, manager, revenue cycle, Wooster Community Hospital, Wooster, Ohio. “A patient admission is going to have a much heftier price tag than a COBRA payment or two.”
There are several benefits to paying a patient’s COBRA premiums. “First, it ensures the patient has adequate insurance coverage for the services the hospital provides,” says HFMA’s Suzanne Lestina, FHFMA, CPC, director, revenue cycle MAP. “It also serves as a community service because patients receive complete coverage for all their health care, such as services provided by physicians or rehabilitation facilities?in addition to the hospital.” Paying a COBRA premium can also enhance patient satisfaction and build loyalty. It can solve the patient’s short-term insurance needs, while supporting continuity of coverage for patients, which is helpful should they find new employment and want to go on a new employer’s health plan. “Enrolling in COBRA can be confusing and intimidating, and some patients avoid it until there is an emergency,” says Shoup. “Hospitals that agree to not only pay the premium for a short term, but help the patient understand and navigate the enrollment process can engender patient goodwill while receiving reimbursement for services. Streamlining the COBRA process for patients can also possibly encourage them to make future payments on their own.”
Before committing to paying patients’ COBRA premiums, hospitals should develop a formal policy that addresses the topic. “Policies should be vetted by your legal department,” says Fontaine. “Although paying COBRA payments is legal and acceptable, organizations should define the process and make sure they follow the policy they have in place.” Access related tool: Sample Policy for Paying Patients' COBRA Premiums Keep in mind that paying a patient’s COBRA premium is a temporary solution because the coverage will only last as long as the premiums are paid. “If a patient re-enters the hospital six months after the initial visit and has not maintained the premium payments, there could be a lapse in coverage,” says Shoup. “Plus, when the 18 to 36 month timeframe elapses, the patient may be without insurance if he or she has not found employment.” To address coverage issues over the long term, it may be beneficial for the hospital to seek additional options for the patient, such as state and federal insurance programs, including Medicaid.
Identifying potential sources of insurance, such as COBRA, is more than just a good idea; it is becoming necessary in the new healthcare environment. The Affordable Care Act requires hospitals to get involved in researching insurance options, says Lestina. “For example, the legislation requires hospitals to fully explore all possible third-party reimbursement vehicles and document this effort before starting the collections process.” Determining whether patients are eligible to extend their healthcare coverage under COBRA is one option. It can help ensure that patients receive necessary care and that the hospital limits bad debt from unreimbursed care.
Kathleen B. Vega is a freelance healthcare writer and editor who contributes regularly to HFMA Forums (Kathleen@kbvega.com). Interviewed for this article: Christine Fontaine, CHFP, CPAM, is vice president, revenue cycle solutions, OptumInsight, Baltimore, and a member of HFMA’s Maryland Chapter (firstname.lastname@example.org). Kristen Shoup, MBA, RHIA, is manager, revenue cycle for Wooster Community Hospital, Wooster, Ohio, and a member of HFMA’s Northeast Ohio Chapter (email@example.com). Suzanne Lestina, FHFMA, CPC, is director, Revenue Cycle MAP, HFMA (slestina@HFMA.org).
In this Business Profile, Shawn Yates, director of healthcare product management at Ontario Systems, discusses the growing challenge of managing self-pay accounts and provides insight on how providers can successfully collect patient payments.
In this business profile, Cathy Smith, leader of the revenue transformation consulting practice at The Claro Group discusses how the organization helps hospitals and medical groups reimagine their revenue cycle.
In this business profile, Deloitte & Touche LLP executives Anne Phelps, principal and U.S. healthcare regulatory leader, and Daniel Esquibel, senior manager, explain ways health systems, health plans, and physician practices can prepare for MACRA.
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Drive down costs while improving quality in a reform environment.
Receive expert insights and how-to action to achieve and maintain peak revenue cycle performance.
Access expert insights on financial forecasting/planning, strategic partnerships, capital allocation, and more.
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