Tag: Patient Collections

As deductibles and premiums increase, more patients struggle to pay healthcare bills, and, in turn, the patient collections process becomes more and more daunting. Hospitals and clinics are now relying on debt collection agencies more than ever. At Experian Health, we estimate a 119 percent increase in this specific outsourcing over a four-year period, from 2014 to 2018. A third-party debt collection agency is attractive for many reasons. For one, it frees up your healthcare practice’s valuable resources. Also, patients with delinquent bills typically respond well to a debt collector’s call. However, using a debt collection agency does not relieve all concerns because you must consider vicarious liability. By law, your hospital or clinic can be held responsible for the debt collection agency’s actions when it acts on your behalf. To keep your healthcare practice out of legal trouble and clear of costly fines, ensure the debt collection agencies that you hire comply with relevant laws and regulations. Also, consider using tools to make sense of these complex requirements. Do You Know the Laws Controlling Debt Collection? The legal requirements governing debt collection are varied and frequently evolving. It can take a lot of work to keep up with them, but there’s a tool to help you. We’ll describe this tool in just a moment, but first, let’s review a sample of federal debt collection laws and regulations to make sure you’re up-to-date: The Fair Debt Collection Practices Act (FDCPA) limits the behavior and actions of collectors who attempt to collect debts on behalf of another person or entity. This federal law aims to eliminate “abusive, deceptive, and unfair debt collection practices.” The Telephone Consumer Protection Act (TCPA) governs interactions between businesses and their customers, including healthcare providers and their patients. In many cases, this federal law requires consent before a provider can communicate with a patient’s mobile device through automated dialing systems, such as auto-texting or “robocall” systems. The Fair Credit Reporting Act (FCRA) regulates the collection, dissemination, and use of consumer information, including credit information. The Gramm-Leach-Bliley Act (GLBA) requires institutions to explain their information-sharing practices to customers and any available opt-out provisions. IRS Code 501(r) is a federal regulation enacted by the Affordable Care Act. It mandates certain financial assistance practices in order for an organization to maintain a nonprofit 501(c)(3) status. A key provision holds many hospitals and healthcare systems accountable for the acts of their debt collection agencies. The Electronic Fund Transfer Act (EFTA) establishes the rights and liabilities of consumers in electronic fund transfer activities, as well as the responsibilities of all parties. The Truth in Lending Act (TILA) requires disclosures about lending terms and the costs associated with borrowing.  

Jason Considine, Senior Vice President, Patient Collections & Engagement, with Experian Health, sat down with Joe Lavelle from IntrepidNOW at HIMSS17 to talk patient engagement. Excerpt: "I think hospitals have spent tons of money really customizing the clinical experience for the patient over the last really 10 years and if you go into any hospital large hospital in America today, you’re going to feel like your care has been customized for you. But when you exit the care delivery mechanism and you get into the billing process, I still see providers treating patients kind of in a one size fits all method, and that’s where I see a lot of patient engagement changing from a financial perspective is using the power of information like what Experian has. We know what a patient’s financial disposition is, whether they can pay their bill or not, whether they qualify for the hospital’s financial assistance mechanism or not, and we can be more proactive in building that relationship and sending them offers to pay their bill and customize those types of engagements more appropriately for that you unique patient’s needs. We are the Best in KLAS vendor for patient access solutions, the eCare NEXT products suite. We are very focused on taking those tools that have been adopted by providers across the United States and making them patient facing. And so we have portals that can be accessed from any mobile device and from a desktop or laptop, and give the patient the ability to shop for care using self-service estimates. Pay their bill online and set up new payment plans and really communicate with their providers in the mechanism in vehicles in which they want to do it." Listen to the full podcast Learn about our Collections and Patient Engagement solutions.

Meet Joe—a patient who is walking into a healthcare office, terrified of the news he might hear. He is confused and overwhelmed, not sure of where to turn for help. Joe isn’t entering a doctor’s exam room – he is actually walking into a hospital’s patient registration area, waiting to receive information about how much his procedure is going to cost. Although anxious about the procedure, Joe is even more concerned about its impact on the family budget, unsure of his insurance co-payment or what will be covered. He’s worried that he can’t afford to pay a large bill in one payment. His interactions with the registration staff over the next few minutes will set the stage for the remainder of his experience with the hospital. Now, let’s say the hospital realizes the value of having caring and compassionate financial conversations with patients at the start of the patient visit. Patient access staff quickly become the patient’s advocate while also improving the organization’s ability to collect from the patient and payer. In this instance, leveraging a data-driven approach allows staff to verify Joe’s identity and insurance coverage as well as provide an accurate estimate of his payment responsibility. The staff even can review data to assess his ability to pay and evaluate various payment plan and/or financial assistance options. Even after Joe is discharged, the hospital continues to employ a patient-centered approach to collections, using patient financial data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. Joe’s financial data places his in the “most likely to pay” segment, indicating that he would not receive a payment follow up call until (for example) day 75 instead of the traditional call on day 45. This not only saves staff time and increases successful collections, it also preserves Joe’s satisfaction by eliminating unnecessary phone calls when he is likely to pay. Joe expected the hospital’s clinical staff to be responsive to his medical needs. When he found that the revenue cycle team was equally attentive to his financial needs, his satisfaction with the entire experience grew exponentially. It was fueled by a positive encounter that eased his mind about payment and allowed his to focus on his health. Using this proactive, personalized approach, the revenue cycle team had a major impact on both Joe’s experience and the bottom line. What is your healthcare organization doing to enhance the patient experience? Comment below to share some of your best practices.

There aren’t too many situations in which an individual purchases a product or service, but is NOT asked to pay for it right away. Healthcare, however, is somewhat unique in that regard, often avoiding a retail-based experience where patients receive service, but pay quite some time later, whether in full or the balance. Not surprisingly, this approach often times adversely impacts healthcare organizations in many ways. Best-case scenario, patient payments, while unpredictable, are received, but not in a timely manner and after a good deal of effort on the collections staff’s part. Worst-case scenario, the organization is left holding the proverbial bag, forced to write off bad debt, when payment could have been received if handled differently. In between, there are poor cash collections, increased revenue cycle costs and lower patient satisfaction. Organizations can avoid this perfect storm with a more precise approach to optimizing patient revenue. By leveraging tools that empower and improve upfront financial counseling communication, healthcare organizations stay one step ahead by accurately predicting patient responsibility payments and enhancing pre-service collections. When fueled by data and analytics, these tools offer a powerful two-pronged approach to minimizing risk and driving revenue: Avoid patient payment delays. Without knowing what insurance companies allow, many providers postpone collections until payer reimbursement is received. Healthcare organizations should instead have access to the latest contract terms, payment rules and fee schedules in order to identify patient and payer responsibility much earlier in the revenue cycle. Increase time-of-service collections. By proactively using patient payment data and current payer contract terms to calculate the amount owed by the patient at the time of service, organizations can effectively collect either a portion or all of that payment upfront. In the end, data-driven estimates of patient payment responsibility allow healthcare organizations to capture more revenue at the right time and boost cash flow. An added bonus is enhanced patient satisfaction because there are no confusing bills or ongoing collections calls, enabling a more personal experience for the patient. Hospitals have an opportunity to use data and analytics to improve the revenue stream and patient satisfaction. Learn about how Experian Healthcare Patient Responsibility Pricer can improve your collections on the front end of the revenue cycle and enhance the overall the patient experience.

Americans who do not currently receive health insurance through their employers or a government program such as Medicaid or Medicare are now required to obtain insurance coverage or pay a penalty tax per the Affordable Care Act’s individual health insurance coverage mandate. These consumers can go to newly created health insurance exchanges (HIX) — offered through the state or federal government, depending on where an individual lives — to enroll in a private insurance plan. It’s definitely a patient-driven process. So, how can healthcare organizations help? They can take advantage of this opportunity to improve the patient experience by connecting patients with much-needed insurance, while simultaneously mitigating patient payment risk. Today’s patients want to be armed with as much information as possible. With this new initiative, healthcare providers can help patients navigate the various options offered through the exchanges by calculating how much patients might spend on insurance and by providing a comparison of plan benefits. However, it’s important for healthcare organizations to take this process a step further by screening patients to determine if they qualify for federal subsidies and beginning the enrollment process. Assisting patients in this way not only improves the patient experience, but also benefits the hospital by getting more patients enrolled with insurance, ultimately leading to higher reimbursement for services provided. That leads to the next likely question: how can healthcare organizations successfully aid in this process? Solutions powered by data and analytics are the key. By using a data-driven approach to HIX screening and enrollment, an organization can identify patients that meet the income criteria for subsidy payments and tax credits, and automate the enrollment process by prepopulating the state’s HIX application form. In much the same way that data is used to screen for various financial assistance programs such as Medicaid or charity care, HIX screening uses key information about a patient’s unique financial situation to accurately determine if the patient qualifies for subsidies to help them pay for their insurance. Interested in learning how you can improve the patient experience when it comes to insurance coverage? Check out our newest product, HIX Screening and Enrollment, and see how it can help support your patients as they begin to navigate the new aspects of healthcare reform.

We live in a choice-based society. Every day we are at liberty to make a myriad of choices. like where we live, where our kids go to school, what to eat, whether to exercise, which car we drive or what movie to see. This era of consumerism also means we have choices for healthcare. And since patients now have greater financial responsibility for their healthcare, they are becoming more selective about where they go to receive medical attention, looking not only for high quality but also positive, cost-effective and informative interactions. As patients become choosier, healthcare organizations must improve their commitment to being good stewards of the care experience. To help make things more manageable, many healthcare organizations are turning or already have turned to payment plans to become more patient centric. To that end, industry estimates point to around payment plans being leveraged for one in five outstanding patient accounts, and use of these tools has grown by more than 50 percent in some organizations. While this information may not be news to you, the crux of this approach is that all too often payment plans take “a one size fits all” approach, following a generic formula for all patients without regard to payment history, demographic information or other key financial data. The result? Default rates between 40-60 percent, defeating the overarching goal of reducing patient bad debt. All is not lost! With a data-driven approach to developing patient payment plans, healthcare organizations avoid the common pitfall with a win-win for both patient and organization. By using technology to analyze key information about a patient’s financial situation, an organization can accurately anticipate a patient’s propensity to pay. The technology can then review this information, along with other financial data and organizational policies — such as minimum payment amounts — and generate personalized payment plans that offer optimal terms and amounts. Taking a data-driven approach is a way to extend your organization’s commitment to compassionate care to the billing and collections process. Embracing this method allows business office staff to be responsive to the patient’s unique financial situation, just as the clinical staff is responsive to a patient’s medical status. Leveraging data to develop the optimal patient payment plan helps set the stage for a positive interaction, boosting patient satisfaction and ensuring patients choose your organization as their long-term healthcare destination. Not only does this improve the patient experience, but healthcare organizations are also better able to collect optimal payment in a timely fashion, knowing what each patient can safely afford. Want to learn more about how to develop personalized payment plans that meet the unique needs of patients? We’d be happy to help. Check out our latest product addition, Payment Plan Advisor℠.