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Patients at El Camino Hospital, a two-campus health system serving Silicon Valley, used to struggle to understand how their hospital bills correlated with their insurance benefits and their year-to-date out-of-pocket spending.
No more. In early 2013, El Camino began providing patients with online statements that include all bills from all healthcare providers—even those not associated with El Camino—fully reconciled with patients’ insurance benefits and adjusted to reflect patients’ deductible balances. The result: Patients pay their bills more quickly. In addition, El Camino experienced the following improvements within the first six months of launching the billing system:
Judi Ashline, El Camino’s director of patient financial services when the new billing system launched, says combining information from multiple sources into the easy-to-understand statement (see the exhibit below) is a patient-friendly service that benefits the health system. “Even though I am a healthcare professional, sometimes I even get a little confused about my own bills,” she says. “This really brings clarity around a process that is very confusing.”
As patients’ out-of-pocket responsibilities have increased in recent years, El Camino patients often struggle to understand exactly what is expected of them. Matching billing statements against an insurer’s explanation of benefits is daunting, especially when multiple providers are involved.
Ashline offers an emergency department (ED) visit as an example of how even a brief encounter with the healthcare system can turn into a confusing financial situation for patients. “After an ED visit, the patient gets a facility bill and an ED physician bill and, if there are X-rays, there will be a bill from the radiologist, and there may be a bill from a pathologist for some of the blood tests we do,” she says. “If the patient is getting four bills and then four separate explanations from the insurance company, it gets a little hairy.”
Typical patient behavior is to wait until all statements arrive, stare at the confusing paperwork for a while, and then call the health system for help, Ashline says. Patient financial services representatives field the same questions repeatedly: “Why am I getting this bill from an El Camino ED physician?” “What’s a radiologist?” “Who are these people?”
That is why El Camino’s interim CFO, Ned Borgstrom, was willing to try a patient-payment technology, suggested by the health system’s CIO, which offered a new way of communicating patients’ financial responsibilities. “I was intrigued with the fact that maybe we could improve patient satisfaction by giving patients bills that they could understand,” he says.
Participating in the online service is optional. Patients who prefer to receive regular paper bills, which are not consolidated with insurance benefits, simply do not sign up for the service.
Those El Camino patients who do want to sign up start by going to the health system’s website to set up a password-protected account with the vendor that developed the online payment service. Patients provide the names of their health, dental, drug, and vision insurance plans, plus their log-in information to their online accounts for those plans. After the insurance accounts are linked, the technology pulls claims from the insurers’ websites daily and presents the information on a dashboard so patients can see all their healthcare bills, regardless of the provider.
The dashboard explains every line of the statements, including why coinsurance applies to certain bills, why a copayment is required for others, and why some expenses listed on the bills do not have to be paid. Insurance claims are pulled each day so patients’ deductible balances and out-of-pocket spending tallies are current. Patients can also see the deductible status and spending breakdown by family member, as well as total year-to-date healthcare spending by provider.
Patients who sign up for the insurance-reconciled online statements and other information provided on the patient-engagement platform receive an email message when an El Camino bill is owed. Patients can pay their bills directly on the website. “We are getting paid quicker because patients understand their liability,” Ashline says. “Many patients pay as soon as they get that email, so we don’t need to send multiple statements to them, which is fabulous from our perspective.”
El Camino and its patients—even those who choose not to sign up for online access to consolidated bills—receive several other benefits from the new approach:
Improved customer support. Some patients who sign up for this service prefer not to go online to see their hospital bills, electing instead for regular paper bills. However, when patients call to ask questions about paper statements, patient financial services staff can send the patients their online consolidated bills by email to ensure they are viewing the same information. “We say ‘Hang on a sec, let me email you something so that you and I are looking at the exact same thing,’” Ashline says. “Then we can walk through it line by line so that we are not talking about apples and oranges. Customers respond really well to it, and our employees really like it.”
Payment plans. Patients can set up payment arrangements online, creating orders for payments to be made automatically every month. Conversely, patients can opt to be notified each month when payments are due and then use the website to make payments.
Patient eligibility and cost estimates. Because patient financial services staff have access to patients’ insurance information, they use the web tool to verify insurance coverage for specific tests and procedures. They can also provide cost estimates that reflect patients’ real-time deductible balances.
The easy-to-understand bills have reduced El Camino’s revenue cycle workload. “We reduced staff by a half-FTE in the customer service area, and we have reduced our overall talk time on the phone with our patients by an average of approximately 20 percent,” Ashline says.
One surprise area of savings: reduced fees for collecting past-due accounts. El Camino does no in-house collecting; after three statements, patient bills are referred to an agency for “soft” collections. About six months after adopting the new online billing approach, the agency called Ashline to find out why the volume of accounts had fallen by nearly 50 percent.“The reason is because people are paying their bills more quickly, so we save the collection fees,” she says.
Ashline shared the following tips from her hospital’s experience to date.
Email addresses are essential. Before launching the new online approach, El Camino had not collected patient email addresses, which are needed so that auto-generated email messages can notify patients when their bills are due. Thus, Ashline encourages hospitals that may want to adopt a similar approach to start collecting email addresses now. That will allow them to notify their patients about the service and how to sign up, independent of a medical encounter.
Old technology may impede savings. El Camino’s computer system is currently set to send three statements and “turning off” that function has been a technical challenge. “We are working to fix that, and considering that it costs us $1.50 per statement, eliminating the extra statements will be a significant savings,” Ashline says. “We are finding that for many patients, we do not need to send three statements because they pay when they get the emails.”
One thing that has not been a challenge: Getting patients to try the portal. “It has not been difficult to convince patients to use the portal. Maybe that is because we are in the very tech-savvy Silicon Valley,” Ashline says. “We are just keeping up with today’s technology.”
Lola Butcher is a freelance writer and editor based in Missouri.
Ned Borgstrom is interim CFO, El Camino Hospital, Mountain View, Calif.
Judi Ashline was previously director of patient financial services at Camino Hospital, Mountain View, Calif.
Publication Date: Friday, January 17, 2014
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.
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.
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.
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.
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.
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.
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
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In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
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.
In this business profile, sponsored by SSI, Jay Colfer, vice president of sales and marketing, shares how patient access solutions are reversing the trend toward increased bad debt resulting from the rise in high-deductible consumer health plans.
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.
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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.
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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.
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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.
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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.
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