Browse by Topic
More than 40,000 members value HFMA's thought leadership and practical strategies. HFMA is where you need to be.
Get acquainted with the
healthcare finance industry's leading professional association. Find out why our
members rely on HFMA as their go-to source for insight and
Members have many
options for helping them advance their careers. Conferences, seminars,
eLearning, certification, and more -- our education and events will keep you
Connect the dots on today's big issues, explore collaborations, get career-boosting tips, and network with colleagues nationwide at the leading finance conference. Save $100 off the full conference rate when you register by May 8.
Real-time presentations with nationally recognized experts, networking opportunities, and industry solutions—no travel required!
Learn about timely healthcare finance topics and earn CPEs. Most live webinars are free for HFMA members and $99 for non-members. View the latest schedule.
If you're a subscriber to any of our three newsletters, you have access to online education. Learn more or subscribe.
Get the perspectives of leading healthcare finance professionals on today's hottest issues.
Information about leading vendors helps your buying decisions.
Forum members can network during live webinars or access a library of past webinars on topics such as bundled payment, charity care, and ICD-10.
An ever-expanding collection of spreadsheets, policies, job
descriptions, checklists, and more that you can adopt and adapt.
Forum members can submit vexing questions to a panel of experts
using our Ask the Expert service.
Your source for employment solutions.
Find new employment opportunities or
reach out to qualified candidates.
Distinguish yourself as a
leader among your peers and advance your career by earning certification in our
healthcare finance programs.
Get an objective third-party evaluation of products and services used in the healthcare finance workplace.
MAP App is a web-based application that helps organizations improve revenue cycle performance based on industry-standard metrics called MAP Keys.
Find suppliers and products in this comprehensive vendor directory for healthcare finance professionals.
Guidance for understanding and communicating about the price of health care.
Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
Unless you’re a coin collector or a big fan of Thomas Jefferson, you’d never trade a half-dollar for a nickel coin. But that’s exactly what many hospital business office directors are doing by prematurely sending motor vehicle accident claims to either health insurers or a self-pay vendor.
Business office directors tend to live by the motto, “Days outstanding means everything.” Many of them receive bonuses based on how aggressively they whittle down the hospital’s average days outstanding. For accident claims, it is common for them to take the fastest (and easiest) path to revenue by pushing these claims directly to either health insurance or self-pay, instead of performing the complex work required to get fully paid from property and casualty (P&C) insurance carriers. And for those willing to do the work to file no-fault and liability claims with P&C carriers, many still become nervous at the 120-day mark and downright panicky when aging reaches the 180-day threshold.
What business office directors should keep in mind is that reimbursement for accident claims is a niche unto itself—and that there are two great reasons to go beyond 180 days: significantly greater reimbursement and higher patient satisfaction. Moreover, a hospital can achieve both without adding a single new patient or increasing the number of procedures performed.
Every year—regardless of whether the economy is up or down—about 1.5 to 2 percent of a hospital’s gross revenue comes from motor vehicle accidents treated in the emergency department. (ED) You can understand why hospitals shy away from aggressively working these accident claims. Without an experienced partner, it can be a workflow nightmare: interviewing accident victims, tracking down police reports, dealing with multiple P&C insurers for both no-fault and liability coverage, and so forth. If the injured patient has health insurance, some hospitals simply direct the bill in that direction. If the patient is uninsured, they often send it straight to a collection agency. But in their haste to get the claim off their days outstanding list, they may be leaving a lot of money on the table.
For claims involving medically uninsured patients, the average reimbursement rate from a self-pay collection agency is typically 5 to 10 percent. But if business office directors are patient, they can often get 50 cents on the dollar on these specialty claims. The extra money comes from two places.
Roughly two-thirds of the additional revenue comes from no-fault insurance (Med-Pay or PIP), which has the dual advantage of lowering the patient’s co-payments and deductibles while dramatically increasing the hospital’s reimbursement rate.
About one-third of the extra revenue comes from lien protection in cases where an uninsured victim was not “at fault” and has a financial settlement pending. By placing a lien on the future settlement, the hospital is guaranteed to receive their fair share before the patient receives the settlement check—and the hospital avoids the negative publicity of pushing an accident victim through a self-pay collection process.
For no-fault claims, it typically takes about 60 days to receive reimbursement. And for liability claims, it typically takes about 250 days to receive reimbursement from the patient’s settlement—and reluctance to wait this long can significantly hurt the hospital’s revenue stream. Some business office directors get so concerned at the 180-day mark that they remove the lien and send the claim to a collection agency. They could be missing out on a big chunk of additional income by not waiting those additional 70 days.
Days outstanding is a vital metric for any hospital, but it’s a mistake for business office directors to use only that single yardstick. Pushing claims too quickly to either health insurance or self-pay will definitely lower days outstanding, but the hospital gets significantly lower reimbursement.
The old adage “haste makes waste” comes to mind here. No one would hurriedly swap a half-dollar for a nickel. But that’s exactly what hospital business office directors are doing when they race to get auto accident claims off the books. It’s much smarter to find an accident claims management partner with the expertise and patience to help achieve maximum reimbursement.
Lyle Beasley is president of Medical Reimbursements of America, Brentwood, Tenn.
Publication Date: Friday, December 20, 2013
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
©2015 Copyright Healthcare Financial Management Association
HFMA.org is best viewed using IE9 or the latest versions of Chrome, Firefox, and Safari.
Join HFMA today and enjoy: