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In this Business Profile, Jay Colfer, vice president of sales and marketing at The SSI Group shares how patient access solutions are reversing the trend towards increased bad debt resulting from the rise in high-deductible consumer health plans.

Jay ColferTell me a bit about your organization.

SSI offers a single-source revenue cycle solution, which brings together front-end systems that support everything from patient access to claims processing, as well as back-end functions, such as denial management, contract management, auditing, and analytics. We’ve been a trusted partner in health care for more than 27 years, and many industry leaders are familiar with our deep expertise in claims management and billing. In fact, we process more than 350 million transactions and over $1 trillion in electronic claims revenue for providers annually, serving 2,400 clients nationwide. SSI’s certified clearinghouse has 800 direct payer connections, including Medicare and Medicaid. This depth of experience has allowed us to remain on the forefront of revenue cycle technology, even as the industry focus has shifted from back-end to front-end operations.

In your experience, what’s keeping healthcare finance executives up at night?

Patient access issues, for one thing. Finance leaders are feeling squeezed due to decreasing payer reimbursement and increasing patient out-of-pocket costs. Some believe they are essentially being asked to solve the problem of uncompensated care as bad debt rises.

Once the burden of employers and payers, the financial responsibility for healthcare costs has shifted to patients through the rise of high-deductible health plans. In 2015, 24 percent of patients were enrolled in employer-based plans.a When you add those enrolled in the Affordable Care Act’s insurance exchanges, which mandate coverage, self-pay has become the third largest payer behind Medicare and Medicaid.

This shift in responsibility has important consequences for both reimbursement and the quality of the patient experience. An organization must determine patients’ financial responsibility at the point-of-service, such as when patients arrive for treatment, so they don’t feel blindsided by a bill later, and the organization can collect as much as possible up front. It is essential to be proactive because back-end recovery rates are traditionally low. In fact, in a poll of attendees at HFMA’s Annual National Institute a few years ago, 29 percent said they were only able to collect 15 to 30 percent of patient responsibility on the back-end.b That’s a serious problem.

How do SSI solutions help reverse this trend?

SSI’s patient access solution provides real-time, actionable information to guide staff to the most effective up-front collections approach, based on patients’ unique financial circumstances. This integrated solution helps organizations shift from handling patient payments in the billing office after discharge to collecting them at the point of care, enabling a constant flow of information between a hospital’s systems and staff communicating with patients. More specifically, the tool prevents registration errors by ensuring consistency in the selection of insurance codes and benefit information; validating patient demographics; and verifying eligibility. It also limits back-end denials by providing automated authorizations and pre-certifications. The tool guides staff through the pre-service cost estimation process; determines a patient’s propensity to pay; accepts real-time point- of-service payments; and steers staff through the financial screening process to identify Medicaid and charity care program eligibility. By using our solution, an organization can achieve a reliable, consistent, and compassionate patient access function while decreasing administrative costs and optimizing revenue.

What should organizations focus on as they consider different suppliers for these types of solutions?

Consistency is important. As such, you should find out how long a potential vendor has been working in the area of revenue cycle management and then learn how outside organizations measure the company’s quality and service. For example, through KLAS Research — an organization that collects data from healthcare professionals regarding their use of applications and then analyzes the data to provide ratings of healthcare IT vendors—SSI has earned a consistently high score for the past five years.

I would also recommend working with a company that offers integrated front-end, middle, and back-end revenue cycle solutions. In talking with one new client recently, he said, “I currently deal with 25 different revenue cycle vendors for my organization.” Because SSI provides an integrated solution, organizations can limit the number of different vendors they use and experience increased continuity, efficiency, and scale.

What works best to ensure hospitals are realizing the maximum gains from their investment in your solutions?

The complexity of health care today demands custom, nuanced, and targeted patient access solutions that align to an organization’s vision. We work closely with clients to set appropriate benchmarks and goals based on industry standards and corporate objectives, verifying performance through targeted KPIs. It’s the best way to measure progress on a go-forward basis and objectively determine success.

We also encourage clients to become involved in industry groups and events to learn how peers are addressing challenges. In fact, every year, SSI offers four user group meetings. We recognize that people working on the front-end to improve patient access don’t always have the time or budget for travel, so each meeting is held in a different region of the United States. Our focus is to make it as convenient as possible to attend.

Patient Access

Finally, as organizations implement our patient access solution, it’s crucial to communicate with patients about the process. Explain to patients how you will work closely with them to identify comfortable payment options. These efforts should only improve—not detract from—patient satisfaction.

Are there any educational resources you’d like to share with readers?

SSI is currently planning educational opportunities via a spring webinar series. The series will address patient access, audit management, denial management and analytics. Registration details will be available here.

SSI is more than just claims. To learn more, click here.


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.

SSIContent for this Business Profile is supplied by SSI. 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.

Footnotes

a. 2015 Employer Health Benefits Survey, Kaiser Family Foundation

b. TransUnion Pulse Poll, 2011 HFMA Annual National Institute (ANI)

Publication Date: Friday, April 01, 2016