In this Business Profile, Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.

Steve ScibettaTell me a little bit about your organization.

Ontario Systems is an experienced receivables management company, which delivers a combination of software and expert services that empower organizations to secure more cash and decrease their cost to collect. Through our strategic revenue cycle management product—Artiva HC™—healthcare providers can seize revenue opportunities, speed cash flow, reduce days in AR, and optimize patient payment. While three of the top 6 largest U.S. health systems use the Artiva HC product, our solutions scale to the regional health system level as well.

What are some of the biggest challenges you see affecting healthcare organizations?

Today's healthcare finance leaders are facing an increasingly challenging reimbursement environment as patient responsibility grows and payer requirements intensify, resulting in climbing accounts receivable volumes.

High-deductible health plans (HDHPs), for example, require patients to pay more out-of-pocket. When individuals have HDHPs, they are more likely to carry a balance, which requires organizational intervention to resolve. Depending on the patient, this may involve setting payment expectations, establishing payment plans, providing charity care, and so on. The risk within a provider's self-pay portfolio has increased as volume has grown.

Amidst increasing patient payment, last December the IRS introduced the final regulations that non-profit hospitals need to meet in order to maintain their 501(r) status. Three of the rules pertain to patient billing and collections and specify the options available to these consumers. One area in particular requires hospitals to make reasonable efforts to determine if a patient is eligible for financial assistance before the institution takes certain collection actions.

Another regulation that affects patient collections is the Telephone Consumer Protection Act (TCPA), which applies to phone calls made to mobile devices. In the context of this regulation, providers must be intentional when they connect with patients to communicate financial responsibilities.

Regarding payer reimbursement, the launch of ICD-10 in October will increase claim denials, expand days in AR, slow cash flow, and perhaps even restrict revenue in the near term.

How does Ontario Systems help address these challenges?

The Artiva HC product includes a number of feature sets that improve a healthcare provider's revenue cycle operations in response to the abovementioned issues. One of the product's key benefits is high-yield aggregation, meaning it manages accounts receivable from the health system's various facilities and practices within one system that standardizes workflow for every account and reinforces repeatable processes, thereby driving the best outcomes. This is especially important when an organization has legacy systems or when it has recently gone through a merger or acquisition and is blending disparate systems. With an aggregation strategy, differing hosts feed into Artiva HC enabling it to deliver comprehensive and consistent reports that highlight actionable data.

We also focus on the "front end" as a feeder into the patient and payer reimbursement process. The Artiva HC product orchestrates specific steps in pre-registration that help providers standardize patient access, verify insurance, set patient payment expectations, and thus gain the financially cleared patient.

Another area of focus is claim denial management. The Artiva HC product will assess the claim remittance advice for a root cause and respond with automated workflow that alerts the appropriate team or skill set to appeal the denial—for example alerting the right personnel to respond to the need for additional medical information. By automating the denial management process and moving claims seamlessly through the workflow, a provider will manage today's denial volume and be poised to respond to any uptick in denials from ICD-10.

To enable a highly-effective patient collection process, Ontario Systems leverages communication methods that are very familiar to patients, the phone and the Internet. The Artiva HC product allows our clients to execute calling campaigns with patients while also intelligently routing any calls the patient makes in response We also offer options that turn the business office into a 24/7 operation by empowering the patient to self-serve via our inbound IVR and our online automated portal. Your patient connectedness strategy should provide the patient options that fit their communication preferences while also complying with important regulations, such as TCPA.

Ontario Systems also leverages data analytics to identify process improvement opportunities through trended real-time data that highlights staff productivity, payer activity, payment trends, and other important KPIs. With this data in hand, the provider can undertake process improvements and monitor the results. We employ a disciplined, closed-loop change management strategy, setting up potential improvements, testing them, training them, and then rolling them out to production.

What are some key considerations for healthcare leaders when choosing an accounts receivable product?

A vital consideration is how the system responds to the real challenges faced by today's healthcare finance leaders. Artiva HC augments a hospital's patient accounting and practice management systems with an accounts receivable competence that reduces costs, increases efficiency, and thus improves the bottom line. By offering solutions in the areas of pre-registration, payer follow-up and denials management, and patient liabilities, we deploy a comprehensive approach that moves key financial indicators in the right direction and most importantly, brings cash in the door.

Another consideration is how the system interacts with patients as consumers. We feel it's important to embrace a customer service mindset and consequently empower hospital staff with information regarding the patient bill. With this in hand, the customer service representative can knowledgeably discuss the bill, including how it rolls to the patient balance, what the co-pay is, and how much the payer has already paid. The representative can also quickly see whether the patient needs financial assistance or a payment plan or whether the individual is ready to make a full payment via credit card.

As healthcare providers implement your products, what advice do you offer so they can best set themselves up for success?

When providers implement our products, a key strategic asset is the existence or formation of a steering committee that provides guidance to the mutual implementation teams. Our consultants will indeed recommend practices and standards, but at the end of the day, we want to make sure we align with the vision and strategy of the steering committee. The steering committee should have clear decision rights regarding system goals and the implementation timeline. With this alignment, our consultants can better keep the project on track and ensure that the benefits of the initiative are realized.

Are there any educational materials you would like to share to help healthcare providers in these efforts?

On our website, we have two areas that are especially worth visiting. The InfoHub is where we post eBooks, success stories, data sheets, replays of our webinars, and more. (We hold approximately 10 to 12 webinars a year on various compliance, accounts receivable, and healthcare topics.) Alongside our InfoHub is a robust blog community where subject matter experts from accounts receivable, IT security, compliance and other aspects of the healthcare industry share valuable information.

Finally, if you'd like to learn more about any of the topics mentioned above, please contact me and we can dig deeper!

HFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. Business Profiles are funded through advertising with leading solution providers. Learn more.

OntarioSystemsContent for this Business Profile is supplied by Ontario Systems. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.

Publication Date: Sunday, November 01, 2015