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Customizing Your Patient Responsibility Revenue Cycle

Many healthcare providers choose to work with vendors like Etactics so they can focus on providing quality care to their patients. Several of our previous blog posts have discussed the need for vendors to be interoperable. This is a very important quality to note when choosing a vendor. However, this does not mean that an outside company can always do a better job than your current billing staff, specifically when it comes to collections. Today we will discuss key considerations to decide if using an early out vendor is right for you.

Patient responsibility is becoming a larger component of the revenue cycle due to higher-deductible plans and higher co-pays on the rise.  As these plans change, patient confusion may increase causing a need for increased customer service. At the same time these inbound calls are increasing, providers still need to win the race against time to collect from patients who are not actively communicating. The U.S. Department of Commerce shows several studies that the longer you wait to make contact with the patient or customer, the average amount collected becomes less and less with time.

Outsourcing
With this need for billing staff to be both reactive and proactive, providers are looking to outsource these patient collection efforts. Many early-out or collection companies will take your patient balance accounts typically on day 1 or day 60. These companies will send statements and letters on your behalf and can even brand it as your health system, but then list their own contact information to coordinate payment and communication. The advantage of this is it still looks like your organization to the patient, but the early-out or collection company is handling the customer service calls. This can lower workload greatly depending on when you choose to outsource accounts.

However, there are a few disadvantages to consider with outsourcing this entire part of your revenue cycle. It can be hard to budget for this cost because most collection companies will keep a portion of what they collect from patients, so this can vary. There is also the issue of customer service and bi-directional communication. Many companies can tout first class service, and even provide recordings when requested, however they do not know your patients and your health system like you do. Will these outside companies handle every situation and communicate according to your business rules? With more and more patients shopping around for their healthcare, patient loyalty is becoming increasingly important.

Insourcing
Rather than budget to outsource this entire process, maybe you spend the money to hire and train your internal staff. This allows you to maintain control of the communication regarding patient collections. An internal staff is more likely to be able to gather information and make decisions regarding patient accounts in a more timely matter. This can lead to higher quality customer service, and provide the opportunity to continually improve.

While this all sounds nice, many health systems are not able to readily hire additional staff. This can lead to increased stress on your current staff. Not to mention accounts and cash falling through the cracks due to this increased workload.

A Hybrid Model
If neither of those plans sounds like a good fit for your health system, you may want to consider doing both. Etactics currently partners with a few quality early-out vendors to provide a comprehensive solution.

For example, we recently sat down with our customer the Patient-Centered Collaborative Network (PCCN) to document their success story. They started the billing process in-house, then brought in their early-out partner.

PCCN uses a solution from Etactics called IntelliStatements™. IntelliStatements is a suite of tools and services designed to optimize the management of the self-pay revenue cycle. IntelliStatements can automate patient communication such as statements, letters, and phone calls, while also changing the content of these communications.

PCCN serves a physician group of over 400 multi-specialty providers. A decision was made by the client to employ the services of an early-out company. Their goal was to maximize the efficiency of the self-pay revenue cycle, and continue to focus on their excellence in billing and other core competencies.

Another goal of the client was to bill based on encounter, so that previous patient balances were not wrapped into new visits. However, their practice management software could not break down patient accounts by the encounter. As a result of the desired workflow between these two entities, who had historically enjoyed a successful business relationship, could not be achieved.

Etactics was consulted regarding the workflow problem and was able to program a solution using only the regular statement file from the practice management system. IntelliStatements was programmed to detect the age of the encounter and automatically deploy the appropriate communication based on the combined best practice rules of our client and the early-out service provider.

This graphic illustrates the best practice workflow deployed by IntellStatements. While Etactics prints and mails all statements, the contact info and other messaging on the statement appears to come from the practice at first and is then flipped to the early-out service. The communications highlighted in green indicate that the statement was sent from the client. The communications in orange indicate that the statement was sent from the early-out.

The first event is the patient visit or encounter, followed by a first statement from the practice reading ‘payment due now’. Here the patient can either pay in full or set up a payment plan. If the patient does not setup a payment plan OR if they setup a payment plan, but then miss a payment, that is when the account is managed by the early-out company. If the patient continues to miss payments the early-out company will send statements, but ramp-up the messaging on the statement each time.

All statements ask the patient to pay in full or call to set up a payment plan. If the patient receives any of the statements in orange, their payment plan will be managed by the early out company. The patient may then continue to make payments.

However, if a payment is missed or if the patient receives all four statements without any communication or payment to the practice, the encounter is flagged, Etactics stops mailing statements, and sends a report listing suppressed encounters to all stakeholders.

This handoff of collection responsibilities is completely seamless for our customer and their early-out partner, and uniform for the patient, both thanks to IntelliStatements. As a result, IntelliStatements optimized and automated this workflow, allowing all parties to focus on their core competencies.

In Conclusion
While not all health systems will have a patient collections revenue cycle quite as complex, we encourage you to find a solution to make it work for your organization. The solution is not always one or the other, and a good vendor will be inter-operable and not force you into a box. No one knows your health system and your patients like you do.