4 Ways to Turbocharge Self-Pay Management
For hospitals, especially those that have relied on paperwork or lower quality software systems, a great self-pay patient management software can be a game changer for efficiency, productivity and bottom line.
Bluemark's MAPS Solution helps providers to accurately and efficiently assess the uninsured or underinsured, properly qualify them for appropriate assistance programs, and provide complete enrollment support in a single technology platform. Here are the four main ways MAPS works to make you and your team's jobs easier.
1. Workflows backed by automation
Everything starts with the initial enrollment screening. But once you have information on the patient, next steps aren't always easy to identify. There are multiple options for assistance programs, and each one has complex eligibility requirements. MAPS software will take patient information and automatically search all available programs to identify viable options for which the patient qualifies. Once a program is selected, the patient is automatically placed in a workflow that breaks down the full enrollment process step by step.
For example, if MAPS recognizes the patient qualifies for Medicaid, the software will determine what information is required by the state agency to evaluate and enroll that patient in the program. This means staff only needs to gather what's required and not waste time on getting proof of information that ultimately will not be needed.
MAPS also saves the patient's information for later and pulls it into the workflow as required, meaning it's not necessary to start every screening from scratch if a patient comes back to your hospital in the near future. Rather than regathering each piece of information, you can quickly confirm it remains accurate before moving forward.
2. AI and machine learning
When a patient account enters an enrollment workflow, there is also an element of intelligence included with MAPS. The software analyzes the information provided by the patient and customizes the workflow based on that data. For example, if a patient indicates they are not a United States citizen, it often means the financial assistance program will have different requirements than those of U.S. citizens.
By using algorithms, business rules and pre-installed elements of artificial intelligence, MAPS is capable of understanding and processing patient information and making any needed changes to the established workflow. This does not just apply to the beginning of the enrollment process, either. If a piece of information changes midway through, MAPS will make needed adjustments as you go.
At the end of the day, MAPS is designed to optimize your pathway from assistance program eligibility identification to enrollment. It gets you from an outstanding account with lost revenue to a closed account in as few steps and as streamlined as possible.
3. Electronic application submission
Another key feature from a process optimization standpoint is electronic submission of the final application for assistance. MAPS uses proprietary Exchange functionality, allowing staff to share information from the MAPS solution with state-based Medicaid application submission portals.
This electronic submission feature is key to so many customers due to its time saving ability. Traditionally, hospital staff submit a paper application or enter the patient's information into the outside party's portal on their behalf. But MAPS interfaces with third party submission portals, allowing you to track your progress and eliminate duplicate entry data. To share information, simply open the third party portal in one browser tab and MAPS in another.
4. Patient portal technology
A patient portal is the ultimate way to optimize communication between patients and financial assistance staff. A portal takes advantage of electronic communications tools and places them all in one spot, which is convenient for both parties.
With a patient portal, staff is not forced to rely on hand-delivered documentation or forms sent through snail mail. Rather, patients are directed to a portal where they can login, validate their identity and scan and upload documentation on the spot. They can also fill out forms and communicate with staff via text messages and email. This is just another way Bluemark's MAPS software optimizes communication and streamlines the enrollment process using technology.
What does optimized self-pay management look like?
If these features sound beneficial to you, you may be wondering what exactly will they deliver? Electronic submission will surely save time, but can you quantify the results that come with implementing MAPS?
Bluemark has examined MAPS outcomes using a combination of client polling, time studies, detailed time recording and reported data analysis. Improvements can be challenging to quantify due to limited or inaccurate information available about providers' prior, sometimes manual processes. It is also difficult to isolate all variables when looking at the overall program enrollment results due to seasonal and economic factors that greatly impact the population seeking assistance.
That being said, after analyzing data from real-life client experiences, we can reasonably conclude that MAPS delivers a 25-30% increase in efficiency as well as a significant increase in ROI. For one client, this came to a 5x increase in ROI, or $1 million in annual cost savings.
Real client experiences with MAPS
As a policy, we are precluded from sharing specific details regarding client experiences, as this information is proprietary to each customer. To provide concrete context for savings, we have grouped clients together to provide data on expected results depending on the nature of the customer.
• Large Distributed Health Systems
MAPS has been implemented at several large health systems across the country. Typically, at initial go-live clients are able to reduce their staff headcount by up to 10%, and then plan to reduce staff headcount by another 10% within the first 12 months. Given the typical sizes of their staff, these reductions can result in savings between $300,000 and $600,000 annually. This will be close to a three times return on their MAPS investment.
• Urban Region Health Systems
The MAPS solution has also been implemented in a number of urban regional health systems. Based on the efficiency improvements with MAPS, these clients have been able to increase the number of open accounts that each financial counselor can manage at one time. Generally, each financial counselor can manage 15% to 25% more active cases. With MAPS, these clients can avoid adding additional financial counseling resources while processing more accounts. The cost savings is estimated to be $250,000, a 2.5 times return on their MAPS investment.
Schedule your free, no-commitment MAPS demo
MAPS brings together all of the functionality needed to convert the self-pay patient population into either reimbursement generating programs or financial assistance in the most effective and efficient manner possible. The suite of functionality includes tools for patient outreach and engagement, core assistance program eligibility and enrollment processing, and patient financial services management tools and reporting.
Backed by strong relationships with our clients and partners, Bluemark offers mature SaaS solutions that are time-tested and positioned to evolve with the healthcare market. Through our engaged community of users, we stay connected to the challenges that impact our clients and continue to enhance our solutions to meet changing industry needs.
Click here to schedule your free, no-commitment demo of the MAPS software and understand how it can best work with your hospital's current systems.
Managing the Different Types of Healthcare Audits
In the healthcare space, audits often play a crucial role in measuring compliance and patient satisfaction. However, audits also put a hospital or health system at risk by increasing exposure to financial losses. The first step to mastering audits is understanding that there are several types, each of which requires a different response from your team.
What is the purpose of a healthcare audit?
The purpose of an internal healthcare audit is to develop and follow an official process to assess, analyze and improve patient care and internal processes. The purpose of an external audit is usually to ensure all parties were paid fairly and accurately in the insurance claims process.
What are the different types of healthcare audits?
There are two main types of healthcare audits that providers face: internal and external. External audits can be broken down further into government and commercial insurance audits. From there, government audits can be broken down even further into Medicare, or Recovery Audits and Medicaid audits.
Audit Response teams that understand the ins and outs of each type of audit are better prepared and positioned to decrease financial exposure by efficiently managing the audit response and appeals process.
Internal auditing in healthcare
The first major type of healthcare audit is an internal audit which takes place entirely inside the hospital facility. Hospitals can commission an internal examination of its finances for several reasons, usually to identify potential audit exposure and to proactively address issues that may result in an audit down the road.
The process usually starts by selecting several subsets of claims inside the organization to see if they are at risk of being audited from a compliance standpoint. For example, a hospital may be concerned paperwork is not being coded correctly. If this is the case, auditors in or outside of the organization may pull a group of codes and analyze from for accuracy. Hospitals can also audit their preauthorization forms and cases. Is staff making sure the correct preauthorization is used for specific types of care?
If several errors are found, the hospital knows it must put together a team to organize and check codes on internal paperwork. It may be tedious, but putting in the work in advance prevents the negative consequences that can occur if an external party decides to audit that hospital's coding.
Not all internal audits need to be finance-related either. Hospitals can audit standards of care to ensure they fall in line with what has been established by official boards. Any process or element of the organization can be audited to search for means of improvement.
External auditing in healthcare
An external healthcare audit is an examination of a hospital's finances or processes conducted at the will of an outside party. This outside party is usually either the government or a commercial insurance company looking to ensure correct payments were provided to thehospital for past cases.
• Government healthcare audits
The government provides reimbursement for healthcare services on both a state and federal level following both state and federal guidelines, depending on the type of assistance. There are two main types of government healthcare audits.
The government provides reimbursement for healthcare services on both a state and federal level following both state and federal guidelines, depending on the type of assistance. There are two main types of government healthcare audits.
The first type of government healthcare audit is evaluating Medicare claims and reimbursement. Medicare is one of the biggest hospital payors, making up around 40% of the payor mix. Medicare audits are usually conducted by federal government employees or third-party recovery audit contractors.
The second type of government healthcare audit is focussed on Medicaid. Medicaid audits are more often conducted by contractors, but can be done by state government employees. Whoever conducts the audit must have acute knowledge of the state's laws as Medicaid laws vary from state to state.
Oftentimes contractors will be specialized to audit within a specific state. They can also specialize in auditing a specialized medical subject matter, looking only at cases within thatsubject matter.
Medicaid audit activity varies depending on several factors. Sometimes the state's Medicaid office doesn't employ audit contractors for a period of time, meaning the hospitals within that state experience a short break in Medicaid audits. But trust us - that break doesn't last forever!
• Commercial insurance healthcare audits
While the government may ebb and flow its audit activity, commercial insurance companies are a different story. Companies, especially larger ones like United Healthcare, Etna, Blue Cross Blue Shield, etc., can and will audit.
When a hospital establishes its contract with the insurance company in addition to negotiating the reimbursement rates it will also establish parameters around what can be audited and how the hospital can respond to that audit. Insurance companies will then audit certain groups of claims based upon these parameters.
Insurance company audits also differ from government audits in that government audits are based upon laws and regulations, where as reimbursement contracts can be negotiated between the hospital and insurance providers.
Healthcare audits vs. claims denials
In the world of audits, the hospital has already been reimbursed and auditors are searching for misaligned reimbursements indicating overpayment or underpayment of claims. But denials are a different ballgame. Audits and denials are related, but the concepts have several key differences.
First, while audits look at groups of cases, denials are on a claim-by-claim basis, not a group. Second, audits take place after the hospital has already been reimbursed. Denials mean the insurance company never paid in the first place and the hospital never saw the revenue. A denial can also be generally defined as the audit result while the audit is the initial examination.
While denials do not come into play with internal audits, they exist across the entire external side of healthcare audits. Insurance companies review and deny claims for several reasons. When a denial occurs, the hospital must go through the denial appeal process to receive reimbursement.
How do hospitals handle healthcare audits?
Traditionally, audits and denials are often complex, involving stacks of meticulously gathered paperwork painstakingly submitted to an outside agency. It's a balance of keeping up with deadlines while ensuring accuracy in file submission.
Because of the complexities, it's understandable that teams tasked with handling audit response are focused mainly on handling short-term responsibilities. This gets the job done, but at the cost of overlooking the ideal long term goal: better, more efficient management of audits and denials. Providers should focus on creating a large-scale system dedicated to improved audit and denials management. All teams should work on the same system and be trained in best practices for faster workflows and low rate of error.
The best healthcare audit tools
Oftentimes the best solution for this problem is software-based, providing configurable tools your team can use to bring all audit response workflows into one database. An ideal software should have the following characteristics:
- Automation: Manual tools are subject to human error and require tedious data entry tasks. An integrated system designed for automation eliminates the need for manual process.
- Standardized workflows: The software should be customizable to your hospital's technical capability and internal audit and denials process. When it comes to health system audit management, there is no
- Real-time work lists: Team members should know who is assigned to work on which task and when. This information should update in real time so team members can better meet deadlines, understand priorities and remain respectful of others' workloads.
- Data integrity: One of the main perks of software as a solution to audit management is greater confidence in data provided to outside auditors. Whereas data may need to be triple and even quadruple checked in past processes, a quality software will provide peace of mind that the right numbers are delivered to the right people, saving both timeand effort.
Creating a single platform and unified, technology-based response to audit management may be the solution your hospital system has been searching for. No matter which type of healthcare audit your team is up against, you will be better prepared to respond quickly and accurately with the right tools under your belt.
Blueway Tracker is a configurable software bringing a comprehensive audit management and response process under one department and one solution. Schedule your free software demo and an expert software specialist will show how Blueway Tracker can decrease your audit exposure and increase your productivity this year.
Click here to schedule your free software demo.
Guidelines for Better Managing Self-Pay Patient Populations in 2021
In the coming months and years, wise hospitals will recognize and prepare for an inevitable increase in self-pay patients. The COVID-19 pandemic has resulted in millions of Americans losing their jobs and, consequently, health insurance. But regardless of insurance status or ability to pay, sick and injured patients will end up in your emergency department.
Once the vaccine is available and hospitals resume regular patient volumes, the number of self-pay patients will only increase even further. What can a financially savvy health system do to prepare for this increase. These five guidelines will help you better manage the influx and convert self-pay patient accounts to revenue through proactive financial assistance in 2021.
1. Revamp coverage discovery
The first step in increasing your efficiency with self-pay patients is to identify just who these self-pay patients are. You may think this is a fairly basic concept, but many accounts end up in the patient registration metaphorical abyss as staff work to determine if they have insurance at all, what insurance they have, etc. Sometimes patients are tagged as self-pay but really do have insurance, sometimes patients have insurance but are labeled as self-pay.
Revamp your registration process to better identify coverage sooner in the process rather than later. Establish a process to verify that self-pay patient accounts truly do not have any type of insurance before they reach Patient Financial Services. It may help to create a task force dedicated to identifying current processes, seeking out efficiencies and implementing them within your organization.
2. Establish a relationship with your self-pay population
In a hospital setting, there is generally a relationship, whether positive or negative, between a patient and provider due to care. A patient interacts regularly with the doctors and nurses assigned to their case and the longer the hospital visit, the better chance of a positive rapport.
However, there does not usually exist a relationship between that same patient and the financial services department. Even though the department's job is to help the patient, patients usually blur the line between financial services and collections or billing. Patient financial services exist as a resource to help patients, but the department is constantly combating distrust and lack of direct contact with the patient to establish any sort of relationship.
Work to identify and implement measures to proactively establish a relationship with your patient population as a whole. If this task seems Herculean, start with just the self-pay patients. How can you improve outreach and engagement for a more positive relationship and a better chance of enrolling the patient in a financial assistance program?
3. Always check patient history
There's never a need to reinvent the wheel, so to speak. If a patient has previously been approved for financial assistance within your organization, you may not need to re-enroll or re-screen for eligibility.
First, establish a policy for previously approved patients. Many hospitals state that financial assistance approvals are good for a certain amount of time, usually 90 days, six months or one year. This will save you valuable time and effort. You may still have to update a few pieces of key information to validate that they're in the same circumstances as when they were approved, but this is still much easier than completely re-screening.
On a related note, patients are often going to come back to your hospital for further care, especially if you work in a community hospital. If someone comes to you four times in one year but they weren't approved for financial assistance until the last time, you miss out on that revenue. If you catch these patients on their first visit, they'll have coverage for the subsequent instances of care.
Even if that patient specifically does not return, their family may have a need for care. For financial assistance programs like Medicaid, you will typically enroll a full family for assistance. Covering the original patient on their first visit means you have covered their full family for the foreseeable future.
To make this self-pay patient guideline as simple as possible to execute, ensure you have a system for tracking financial assistance approval for individuals and families that all relevant personnel can access. Consider creating an audit process wherein staff checks previous approvals on all accounts with a high balance because of co-pay or high deductible plans. Get any previously approved accounts settled quickly.
4. Tie accounts together throughout your system
When a patient is admitted to the ER, they may experience any number of treatments. They may be referred, get tested, get X-rayed, get lab work done, etc. When examined individually, each one of these instances alone may not appear to be worth a lot of effort in terms of resolving the account or finding reimbursement.
However, when you start pulling all care actions together, you may start to see that it is worth the time and effort to proactively assist this patient in settling their account. Consider this example:
This patient stayed in the hospital for 10 days after being admitted to the emergency room. They received several different services over the course of the stay from departments in house, including radiology, physical and occupational therapy, lab work and more. If this self-pay patient relapses or returns for another visit within a few months, they may even double this bill by experiencing these services again. Without a way to pull all services and visits together into one account, you lose the full picture of the patient's circumstances and hinder your team's ability to proactively help.
Having a way to pull together the patient's data or information and gain a broader view of their big picture financial situation can completely change the way you approach the account. This is especially true if your health system is expansive and covers several different care departments under one roof.
5. Leverage available self-pay management technology
Perhaps the most important guideline of all in better managing self-pay patients is investing in the proper technology that makes it easy for all team members to implement points 1-4. Any system that deserves your time and money should be one that can aggregate patient accounts, check for patient history and cover and make outreach and engagement easy for both parties.
Automation that utilizes rules and established workflows to move accounts through a system should be a huge part of your processes going into 2021. This concept is not in line with artificial intelligence per se, but the right technology has a level of intelligence built into it that dynamically changes the workflow based on inputs. For example, if a patient indicates that they are not a U.S. citizen, a workflow can and should automatically adjust which programs the patient is eligible for.
In addition, investing in technology can give you the ability to collect, analyze and report on self-pay patient data all in one place. Then you can better identify problems, opportunities for improvement, results, effectiveness and more.
If you're in need of software to automate your interactions with self-pay patients, Bluemark's MAPS program was developed specifically to address the concerns addressed in this article. MAPS makes it simple to identify, screen and interact with self-pay patients in need of financial assistance.
The Bluemark team is filled with experts who have years of experience within self-pay management. We would be happy to have a conversation about ideas and best practices to improve your process. Click here to contact Bluemark.