Browse by Topic
Learn more about the healthcare finance industry's leading professional association. Find out why our members rely on HFMA as their go-to source for insight and information.
Members have many options for helping them advance their careers. Conferences, seminars, eLearning, certification, and more -- our education and events will keep you motivated.
Focus on the essentials. Develop strategies that deliver results. Redefine the boundaries of your success. Find out what’s driving innovation at ANI. Register by 5/6, save $100.
Earn the credentials that distinguish you as a leader in the healthcare industry. CHFP. CRCR. FHFMA. CSBI. CSPPM. CSMC. CSAF. Get certified today. Learn more.
Learn about timely healthcare industry topics and earn CPEs with HFMA live and on-demand webinars. View the latest schedule.
Our newsletters offer targeted articles with
technical how-to details and thought-provoking insights from healthcare finance
leaders and industry experts.
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 ICD-10 implementation, CMS audits, bundled payment, charity care, KPIs, and more.
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.
When Centra Health, a three-hospital system serving central and southern Virginia, introduced a 10 percent pre-pay discount on the out-of-pocket responsibility for insured patients in 2010, its point-of-service (POS) collections jumped $50,000 in the first month.
“That particular year we had been averaging around $275,000 a month in point-of-service payments. When we offered the pre-pay discount, we jumped to more than $300,000 every month, and we have never gone below that since,” says Melissa Viohl, director of patient access at Centra.
In fact, monthly point-of-service collections are averaging $545,000 in 2014, up from an average of $500,000 each month in 2013.
Since Centra introduced its pre-pay discount program for insured patients four years ago, it has become so well-known that many patients ask for the discount before the preregistration staff member has a chance to offer it. “People want it,” Viohl says. “These days money is tight across the board, and even if it only equates to a $40 discount, they want it.”
Wooster Community Hospital in Wooster, Ohio, has also seen POS collections increase steadily since it began offering early-pay discounts on insured patients’ out-of-pocket charges in 2009. Wooster offers a 15 percent discount to patients who pay on the day of service and a 10 percent discount if the patient pays within 30 days.
“Many patients want to take advantage of the discount because they already know they are going to have to pay their out-of-pocket charges anyway,” says Kristen Shoup, Wooster’s director of revenue cycle.
Neither Centra nor Wooster have payer contracts that prohibit pre-pay discounts for patients’ out-of-pocket responsibilities, but not every health system is so lucky. “Some payers have taken the position that if a provider discounts to the patient, then the payer is liable for less because of the discount,” says Sandra Wolfskill, HFMA’s director of healthcare finance policy, revenue cycle MAP. “My advice to any provider is to have your legal department look at your payer contracts before you start giving discounts and go with that legal advice.”
Both Centra and Wooster introduced the discounts for insured patients as part of a broader program that includes deeper discounts for true, uninsured self-pay patients. Wooster offers self-pay patients a 25 percent prompt-pay discount; Centra offers 30 percent off chargemaster prices plus a 10 percent prompt-pay discount. As a result, both providers have been able to ease the financial burden for patients, encourage quicker payments, and improve efficiency in the revenue cycle.
“If your goal is to drive down bad debt expense and drive down your cost to collect, the most efficient way to collect out-of-pocket payments is when the patient is in your facility,” Shoup says. “That’s when they have the highest motivation to pay because right then and there your services are important to them.”
Wooster settled on its strategy—15 percent discount on day of service; 10 percent discount if paid within 30 days—after considering two factors:
Chargemaster prices in comparison to competitors. Wooster has been nationally recognized for its low chargemaster prices on some common procedures, so it does not need a deep discount to position itself as the lowest-cost option.
A desire to incentivize early payments. Wooster’s 15 percent discount on the day of service makes it easy for patients to choose to pay even if they must use a credit card. “We want to offer enough of a discount to make it worth it for people to pay at or near the time of service,” Shoup says.
Centra opted for a 10 percent discount after its revenue cycle director researched the discount policies of other hospitals in the region, as well as some providers in other states. The goal was to find the balance between early, no-cost collection and loss of potential revenue. “I would urge others to start small,” Viohl says. “I think 10 percent is enough of an incentive.”
Centra extends the pre-pay discount for five days after service to meet the HFMA MAP standard that says money collected within five days of discharge counts as POS cash. This patient-friendly policy gives patients a chance to move money from one account to another or make other arrangements to be sure the money is available for payment.
Related tool: Pre-Pay Discount and Cost Estimate Scripts
Communicating the idea of a pre-pay discount to patients is easy; communicating the exact amount of the discount can be tricky. Here’s how Centra and Wooster handle this challenge.
Centra’s approach. An automated tool calculates estimates of the patients’ full out-of-pocket responsibilities and the 10 percent discount on those amounts. Preregistration staff, who register about 85 percent of all patients, offer the discount during a telephone call and payment is accepted at that time, on the day of service, or within five days after discharge.
If the actual charge is higher or lower than the estimate, the discount must be recalculated, and patient accounts staff make a manual adjustment. “It creates a little bit of work, from a systems standpoint, on the back end,” Viohl says.
Centra has never advertised its discount policy. However, after four years of offering discounts as part of preregistrars’ scripted telephone conversations with scheduled patients, the practice is well known among its patient base.
Wooster’s approach. Wooster is currently implementing a financial clearance software suite that will automate out-of-pocket estimates. However, for nearly five years, registration staff have been calculating out-of-pocket estimates and discounts manually when patients arrive for service.
“Of course, it’s easy to calculate straight copays for visits,” Shoup says. Beyond that, registration staff match the order for services that the patient is to receive against a price list of commonly ordered services to estimate the patient’s responsibility and the applicable discount. If services are more complicated, revenue cycle staff look up chargemaster prices to provide an estimate. “We do a lot manually at the drop of a hat when patients come in because we want them to receive their discounts,” she says.
Wooster does not advertise its discount for out-of-pocket charges, but it is offered to every insured patient who receives an estimate before a service is performed.
Although pre-pay discounts offer benefits to both providers and patients, there are a few factors providers should be aware of as they develop their policies.
Research competitor policies and prices. “You definitely have to know your marketplace,” Shoup says. “We hear a lot of patients say, ‘Such-and-such hospital is offering a bigger discount.’” She refers those patients to Wooster’s website, which illustrates how its prices are lower than its competitors’ prices. That allows her to make the point that a small discount off a lower price still means a smaller out-of-pocket responsibility to the patient.
Prepare for credit balances and refunds. Providers that don’t have a way to accurately estimate patient payments should prepare to manage credit balances in accounts receivable and to promptly process patient refunds if patients have overpaid. “Until the final bill is satisfied, the 10 percent pre-pay discount hits your accounts receivable as a credit balance,” Viohl says.
Of course, when a patient’s actual responsibility is less than was collected upfront, a refund must be made. “You need to make sure that you have a process in place in which you refund quickly—otherwise, this becomes a source of patient dissatisfaction,” she says.
Develop a clear policy for offering pre-pay discounts. Centra’s policy is to offer a pre-pay discount to any patient who receives an estimate. But that is not always possible when patients arrive in the emergency department (ED) because their treatments must supersede any financial discussions.
If a patient asks for a discount after the five-day window in Centra’s policy, staff verify (through the ED registrars’ notes) that no discount was offered at the time of service, and then offer a 5 percent discount. “We don’t offer it—you have to ask for it,” Viohl says. “We review it on a case-by-case basis. We have to be careful or everybody will call in saying ‘Nobody offered it to me.’ We actually had that issue when we first started the pre-pay discounts, so we’ve altered our policy to cover various scenarios.”
At Wooster, the discount window ends at 30 days after service, by which time the first billing statement should have been received. If a patient calls to ask for a discount, insisting that the billing statement did not arrive, the hospital re-sends the statement. “We honor that because we want to give them the benefit of the doubt,” Shoup says. “But we do want to be paid on that first statement, and that way everybody wins. We get our money collected faster, and the patient gets a little bit of a discount off of their out-of-pocket.”
As patients’ out-of-pocket expenses rise, revenue cycle staff will find themselves counseling patients who may be surprised by their financial responsibilities. Estimates of patient costs and pre-pay discounts can help patients prepare to meet their financial responsibilities and ease the burden of higher copayments and deductibles.
Lola Butcher is a freelance writer and editor based in Missouri.
Kristen Shoup is manager of revenue cycle, Wooster Community Hospital, Wooster, Ohio, and a member of HFMA’s Northeast Ohio Chapter.
Melissa Viohl is director of patient access, Centra Health, Lynchburg, Va., and a member of HFMA’s Virginia-Washington D.C. Chapter.
Publication Date: Wednesday, May 07, 2014
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.
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, 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.
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.
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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.
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
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.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
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.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
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.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
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.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
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.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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.
HFMA's print, email, online, and mobile opportunities provide you maximum reach and impact. We will work with you to build a plan that meets your needs. Contact a sales rep.
HFMA offers online, email, and print opportunities to help you recruit the most talented healthcare finance professionals. Place your classified ads today.
Drive down costs while improving quality in a reform environment.
Stay informed about new directions in healthcare finance. Share tools and strategies for improving performance. Be an active participant in your profession. Together, we’ll reshape the business and practice of healthcare. Join us.
Copyright 2016, Healthcare Financial Management Association.
Join HFMA today and enjoy: