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3 Ways Tech Can Help Hospitals Collect

 |  By gshaw@healthleadersmedia.com  
   September 20, 2011

The way Americans pay for healthcare services is changing—and as a result healthcare providers will be forced to take on new or expanded roles as benefits educators and administrators, financial counselors, creditors, and collectors.

HealthLeaders recently convened a panel of experts in Boston to discuss how healthcare organizations can adapt to the new landscape. We talked about a range of topics—from patient financing to outsourcing collections to honoring your mission and protecting your brand while you mind your bottom line.

One theme that emerged during the discussion: Technology can help healthcare organizations with many of the collections issues they face.  Panelists discussed three ways technology can enhance the collections process.

1. Educating patients

Insurance models are becoming more and more complex—high deductible plans, co-pays, co-insurance, and different tiers of coverage can confound patients. So who will be responsible for education? And how can technology help?

"It's challenging from a patient education perspective: telling patients why they owe more money than in the past, interpreting new rules, helping patients into the right programs, and helping them understand those programs," said Thomas Yoesle, chief operating officer patient financial services at Orlando Health.

"Technology can play a huge role in helping consumers understand their plans, their benefits, and the amount they must pay out of pocket," added Deborah Lelinski, Director Product Management at Ontario Systems, which sponsored the roundtable event. "Right now, it's very difficult to realistically predict the cost of service when the complexity leads us to answer with 'It depends.' "

Meanwhile, online education has its benefits, but face-to-face interactions might be important as well, Yoesle said. "As much as I want to push this education and information to the Web, I think we'll start hosting workshops and using kiosks to answer questions about benefits and plans and then push those FAQs to the Web."

Richard O'Donnell, vice president of payer strategies and contracting at Trinity Health also noted that insurance exchanges could take on the role of interpreting benefit design.

Even so, said Timothy Reiner, vice president of revenue management at Adventist Health System, "we're still going to have to engage the patient in different ways once those exchanges become more prevalent in the various states in 2014. It may be online portals or other strategies. There is a lot we don't know, but clearly one of the tenets of meaningful use is to engage the patient more online in their care—including their financial responsibility."

2. Estimating payments

When you walk out of a dentist's office, the person at the front desk has a pretty good idea what you'll owe—and it's rare a patient walks out the door without paying at least part of it.

So why not in hospitals and physician's offices?

"Estimating benefits is something that we've struggled with from the Stone Age," Reiner said. "As a provider, you've got to decide whether to invest in additional technology beyond just pushing a button and sending a transaction to the payer or screen scraping [capturing computer screenshots and putting them into a database]. We should be so much better than this."

"We need what I would call real-time patient liability estimators—complete interconnectedness between health plans and the clearinghouses and the providers," O'Donnell said. "Patients should be able to log onto a portal to determine their unmet liability, he said, even if that means adding disclaimers that it might not be 100% up-to-date." It's so much better than having someone asking 20 questions to identify your possible out-of-pocket liability that may still be inaccurate."

3. Securing payments

At a hotel, your bill is computed before you check out—usually they've slipped it under your door in the night. And there's no walking out the door without settling up. So how can technology help hospitals catch up to dentists and hoteliers?

"As we move toward more EMRs, documentation will drive the charges," Reiner said. "If you're documenting a level 3 evaluation and management visit, you know that by the time the patient is ready to walk out the door. That claim could be adjudicated, as with the pharmacy model, and you would know your co-pay is $35. There's no reason that episodic physician visits can't be done like that.

Inpatients are a little different, but the only reason that it can't be done is because the payers don't offer it and there's not a singular work flow for it."

But what about the risk that physicians will miss a charge if they don't properly document the visit?

Reiner says he's willing to take it. "If we made a charge capture error, we'll take our lumps. It would be better to miss a charge but get the payment at time of service."

Read more highlights from this lively discussion (including answers to the burning question, "Will that be cash or credit?") in The New Rules of Revenue Cycle: Adapting in an Era of Change.

See Also:
Special Report: The Future-Proof Revenue Cycle
Self-Pay and the Bottom Line

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