Ten Strategies for Capturing All Reimbursements

Capture all relevant patient data prior to service
Fortunately most providers have recognized the need for collecting critical patient data up front. In any situation short of an emergency, proactive treatment should not be issued before a defined set of information is gathered and validated.

• Avoid fraud and identity theft.Confirm patient demographic information such as a social security number and an address to be certain they are who they say they are. Verify patient identity by reviewing photo identification for every patient. Theft and fraud is generally more prevalent during difficult economic times, and hospitals are likely targets for criminals seeking free care. The Federal Trade Commission's Red Flag Edits compliance enforcement deadline for having identity theft-related processes in place is May, so providers are now actually mandated to address these issues. It can also eliminate or reduce unnecessary administrative work.
• Verify real-time insurance eligibility for all patients.Make certain that every patient who presents as having insurance has his or her coverage validated. Gather up-to-date co-pay and deductible information during scheduling and pre-registration and verify again during registration or at the point of service. A patient whose eligibility has changed due to a recent job loss, for example, may not be inclined to divulge the most accurate information, and even with COBRA coverage, benefits can change.
• Audit registrations for quality assurance. Inaccurate information should be flagged and corrected before services are rendered and certainly before a claim is submitted to avoid unnecessary work and costly mistakes on the back end.

Tap into up-front revenue streams
The information described above can be leveraged to increase proactive front-end collections from insured and uninsured patients.

• Provide patient payment estimates. Reconcile charge master data with contracted rates and patient benefits to arrive at an accurate up-front price estimate. Consistent price transparency will have a substantial impact on the bottom line and on patient satisfaction.
• Implement policies and processes for discount and charity care. Enable front-end personnel to make educated decisions on the spot about whether patients qualify for free or discounted care based on credit scores and other information.
• Increase collection points. Accept patient payments in the form of cash, checks, and credit cards at locations throughout the facility. Offer convenience in the form of interest-free medical finance cards or payment plans with automatic recurring deductions. West Virginia University Hospitals nearly doubled its point-of-service collections in three years following the installation of credit card processing systems in its hospital and physician clinics.
• Set the proper expectations with patients. Uninsured and insured patients presenting in non-emergent situations should expect to pay for at least some portion of treatment. With accurate information, training, tools, and scripting front-end personnel should be comfortable and confident asking for payment. Patients will become accustomed to the policy and cash collections will rise.

By applying these best practices healthcare providers can mitigate the impact of a recession and protect their long-term financial outlook. No hospital or other healthcare facility can carry out its mission of patient care if it becomes financially insolvent.