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PFS OUTREACH MAY 2021

Patient outreach is the process of establishing a financial relationship with your self-pay patient population. It works to position financial counselors as a resource to help patients with medical expenses the same way nurses, doctors and specialists assist with medical care. At the very least, outreach involves getting patient contact information and permission to contact them in the future regarding their medical payments.

The goal of patient outreach is to make contact with a patient as early as possible to facilitate future communication regarding the patient's account. The process must be done efficiently, but with immense tact for best results in establishing strong relationships. Each hospital or health system has established procedures and etiquette for outreach, but as with every process, there's always room for a little improvement!

Why is patient outreach important?

Building a relationship with your self-pay patient population is a key principle of success in healthcare finance. There are many misconceptions around medical financial assistance, and outreach can help demystify the process by educating patients.

One such misconception is the potentially negative stigma around Medicaid and charity care as a welfare program in the eyes of many patients. The Affordable Care Act attempted to destigmatize healthcare assistance programs by redefining programs like Medicaid as simply a subsidized program that covers medical costs for individuals and families. Outreach education continues with this repositioning by showing patients that Medicaid is simply a subsidized program based upon your family circumstances at the time of care.

Another misconception is that financial counseling is closely associated or overlapped with the collections department. Patients often falsely believe that anyone who contacts them in regard to medical payments is seeking to collect money. While hospitals may have financial counselors involved in collecting deductibles and copays, collections is generally not a task charged to the financial assistance department.

Finally, this is not necessarily a misconception, but another aspect of financial assistance patients don't often realize and may need educated on is that financial assistance is a win for both the hospital and the patient. The hospital's expenses are covered, as are the patients. Additionally, when one family member is enrolled in Medicaid, their entire family is typically enrolled and they may be eligible for coverage on future visits.

When is the best time to reach out to patients?

There are two times to reach out to patients: Either when they are still on hospital grounds or once they've gone home. Both circumstances require different outreach methods.

• Outreach while on hospital grounds

Ideally, patients should be approached for financial assistance enrollment as early as possible. However, there are certain sensitivities around the logistics of approaching a patient's bedside which must be considered when initiating the relationship.

To ensure your staff speaks to the patient without being insensitive, you may want to make financial assistance part of the discharge checklist. If a patient is set to leave, either assign a staff member to check in with them and start the enrollment process, or ask the patient to check in with the financial counseling office prior to leaving.

• Outreach from home

If you are unable to reach out to a patient while they are still in the hospital, you must move on to option two and attempt to contact them at home. This option is less ideal as you may be confused for collections or your outreach attempts ignored more easily than if you were at their bedside. But it is not impossible to establish a relationship after the patient's hospital visit.

There are two types of outreach at this point: direct and passive. Direct outreach is proactive and involves calling patients over the phone to engage them in the financial assistance enrollment process. Direct outreach works well for getting a patient's attention, but can be costly and time consuming. It is best to focus on high-dollar accounts first when making phone calls for outreach.

PFS OUTREACH MAY 2021

The second type of outreach is passive, which involves including information on medical bills or other correspondence directing the patient to the financial assistance office for help covering their payments. In this case, impetus is on the patient to reach out, not your staff. This method is not as effective and can be easily ignored, but it does allow you to target a larger number of accounts at once.

What are some best practices for patient outreach?

Outreach is a nuanced process that tends to be highly specific to the hospital or health system in which it takes place. However, there are several key best practices that can be followed universally.

PFS OUTREACH MAY 2021

1. Account for your patient population's evolving demographics.

Part of the population is still comfortable answering the phone or responding to persistent (not annoying!) voicemail messages. That part of the population tends to be older, and only makes up a portion of patients today.

Younger generations tend to prefer self-service tools that allow them to engage in the financial assistance process on their terms, when they want and in their desired communications channel. Instead of operating only through phone calls, branch out into using emails and texts in your outreach process to keep up with evolving demographics.

2. Make use of technology.

Even if the majority of your patient population is older or has been responding fairly well to phone calls for years, you may be able to capture and engage several other patients through emails and texts.

Technology doesn't just give you the means to send email and text communication. It also:

  • Facilitates the use of electronic tools like program screening microapps
  • Allows for self-service portals that can initiate the engagement process more effectively
  • Automates workflows for increased time management
  • Increases security for sensitive information communicated electronically.

Some processes have been done by hand for so long you may no longer notice. If snail mail, phone calls and manual spreadsheets are just the way you've always done it, it doesn't hurt to take a peek behind the curtain and explore the possibility of a tech upgrade in your outreach process.

3. Give patients freedom of choice.

Once you've found the channel in which a patient is most comfortable engaging with, let them choose how they wish to communicate after first contact. Provide 2-4 options and points of access and make note of which one they specify is best for connecting. From there, you can also ask which times of day they prefer to be contacted.

Not only does this increase the likelihood of regular patient response, it puts them behind the driver's seat and gives them some control over the situation. Freedom of choice is an underused tactic for patient cooperation that can set a solid foundation for the future of the relationship.

4. Prioritize education in your outreach.

This one is huge. Patients must understand the role you're playing is to help them, not send them to collections or ask for money. Be aware of phrasing, and know what conversation openers tend to elicit a positive response from patients. Then, train your employees on what words and phrases work and don't work.

The goal is to provide education without coming off as insincere or giving the patient a reason to cut off contact before the relationship is even established.

5. Always track outreach efforts.

Remember, a huge part of financial assistance write-offs are dependent upon demonstrating effective, proactive outreach activity. The best way to do this is to use a software or other electronic system that can track your team's efforts and ensure they are compliant with your internal rules as well as external tax regulations.

Many hospitals underestimate the value of tracking outreach internally, but this data is invaluable. Knowing how often people in different age groups respond to certain outreach efforts can help manage your staff's time and better segment calling lists. You can also track metrics to help determine the best times to call and how to open the conversation. When it comes to outreach, hard data is the best teacher.

Technology to improve patient outreach

Take your patient outreach process online with the MAPS-clear patient portal. This standalone portal works as a web-based application that supports proactive patient outreach activities, remote financial counseling, and new contactless engagement initiatives.

Learn more about Bluemark's MAPS-clear solution here.



Are Microapps Right For Your Organization?

PFS MICROAPPS APR 2021

While technology has proven time and again to be an aid to the healthcare space, it is possible to have too much of a good thing. Investing in a multi-use software tool that streamlines dozens of tasks has its merits, but sometimes, especially in smaller organizations, lack of use cases becomes a serious financial problem.

You wouldn't use industrial strength adhesive to wrap a Christmas present when a little clear tape will do the trick, so why invest in a full software package to assist solely with something simple like patient document submission?

Enter micro-applications, or microapps, a more palatable solution for healthcare finance professionals who may not have the necessary time, attention and resources for a massive IT solution. Is a microapp-based strategy a viable short-term solution for improving your organization's efficiency?

PFS MICROAPPS APR 2021

What is a microapp?

In a broad context, a microapp is a small, software-based solution designed to address one specific problem or
use case.

Microapps can be free or paid. Facebook Messenger is an example of a free microapp designed specifically to allow Facebook users to message each other and communicate with Business Pages. Hangouts is Google's similar microapp designed only for chat-based communication between Google users.

Paid microapps usually follow a tiered pricing model with a basic version of the software available for free use. For example, HubSpot's Customer Relationship Management tool is free to use with limited features, but paying more money brings more enhancements on top of the free-use features. Same with applications such as Mailchimp, Vimeo and Slack.

How are microapps used in healthcare?

The current landscape of microapps in the healthcare space is fairly limited. Most of the microapps are provided by non-profit organizations, governmental agencies and payers. These applications focus on problems such as program screening, payment estimation and auxiliary functions.

In terms of specific examples, Kaiser has many individual tools that can be considered microapps. Even a payor document submission portal can be considered a microapp as it is designed specifically to accomplish one job in
one use.

The healthcare IT vendor community has been slow to embrace the microapp model as solution providers tend to focus on providing larger tools that do more. This focus is clearly due to the hospital mantra that we have all heard many times, "one system, one platform, no auxiliary projects." We agree with this in-concept, however, it is clear that (when done correctly!) there is a place in the industry for purpose-built microapps.

Why use a microapp?

Think of full-service healthcare software packages like a Swiss Army Knife. There's a tool for every task you need completed all in one neat little gadget. But a microapp is a flathead screwdriver, robust and designed for one job only. It's possible to invest in a Swiss Army Knife to place a screw, but it's more money only to use a small screwdriver attached to a bevy of other tools. The one-job flathead screwdriver would serve you much better in this particular use case.

Big solutions are for big problems - they require big commitments, significant investments, and buy-in from several team members. But sometimes being business savvy means recognizing when a problem is small and needs a small solution, like a microapp.

Larger organizations may need to use a microapp's features multiple times per day across hundreds of users. In this case, it makes sense to invest in a higher price tier. But smaller organizations may only need to use an app's functionality 1-3 times per month, or even less. In this case, it makes sense to stick with base-level free or low cost options.

Translated into the healthcare space, large healthcare systems with thousands of employees and moving pieces often need to invest in complex IT systems to streamline operations. But using microapps provide an alternate model for solving specific problems within the healthcare revenue cycle at a lower cost.

Pros and cons of microapps

Like every solution, microapps have their good points and sticking points. Your business's final decision simply depends on whether the pros outweigh the cons.

PFS MICROAPPS APR 2021

There are several pros to cultivating an arsenal of microapps as day-to-day tools, including:

  • Lower cost - A small, free or low-cost solution saves money and increases ROI.
  • Ease of access - Remember, small problems sometimes need small solutions. It's easy to create an account and use a free tool as opposed to gathering the full team to make the decision on investing in a full healthcare software package.
  • Limited resource allocation - Microapps can be used without taxing resources like labor and capital.
  • Ease of management - One small tool is easily managed when compared to a large software solution.
  • Purpose-built - Like the flathead screwdriver, microapps are built to excel at one objective only, making them, quite literally, the perfect tool for the job.

However, despite the multitude of good points, using microapps is not a perfect solution for every organization. Microapps come with several cons, including:

  • Lack of integration - Microapps are not customizable, nor are they designed with your organization in mind. It can be frustrating to use a solution that isn't integrated into your current software platforms.
  • Turnover risk - If one employee had access to all microapps in use, and something happens to their position, suddenly the rest of the team may be locked out of microapps or worse, not know which tools were being used in the first place.
  • Compliance risk - Not all microapps were built with HIPAA or healthcare compliance in mind. It's important to be extra vigilant when using a generic solution capable of working across industries where privacy is not as big a concern.
  • Fragmentation concerns - Unless employees communicate extensively, they may not know who is working in one app vs. another or understand the process. Without regulation, your organization risks fragmentation and mismanagement.

When to move beyond microapps

It's fully possible to use an army of free or low-cost microapps to make your job easier without investing in a software solution. Think of the applications on your cell phone. You have probably created a portfolio of microapps that you open in specific cases. All these apps function independently, and you did not invest time, effort or money in gathering the tools you need for everyday life. The same is possible in a professional healthcare finance setting.

However, microapps tend to work best in smaller organizations with fewer audits, patients and activity. Larger organizations or those on the rise may find microapps chaotic with few benefits. At what point is it time to leave microapps behind and invest in larger, multi-purpose, all-in-one tools?

If you're seeing fragmentation, process breakdowns or a lack of communication amongst team members, your organization probably has a bigger need for software to keep employees pointed in the right direction.

Microapps are also a simple solution designed to address a simple problem. If you find yourself facing multiple challenges within a process, that is likely the point at which you want to look into a system-wide approach to improvement rather than finding one solution for each challenge.

A one-off problem you encounter every few weeks or months calls for a microapp first. But a problem or process core to your job needs a bigger investment as you must rely on it weekly, even daily. Small solutions make your bottom line appear healthy, but always work smarter, not harder, and invest in a big solution when your problems outgrow what microapps can provide.

Are microapps right for your organization? At Bluemark, we hope to have some exciting products in this space launching in 2021. Stay tuned, and please contact us with any questions about microapps vs. large-scale technology-based solutions in the healthcare space.



Don't Panic: How to Navigate the Healthcare Insurance Audit Process

A&C AUDIT APR 2021

The best way to be prepared for a healthcare insurance audit is to understand the healthcare insurance process front and back. From the initial inquiry all the way to the appeals process, here's what you and your team need to know before an auditor comes knocking.

Who conducts audits?

Audits are conducted by a payor. The payor could be Medicare, Medicaid or a commercial insurance company. Medicare and Medicaid audits are conducted by third-party contractors. Commercial insurance audits can be conducted by a third-party contractor or an employee of that insurance company.

What triggers an audit?

Audits are a regular part of working in healthcare and with health insurance. If transactions are occurring between a hospital and an insurance company or government medical care coverage program, audits are guaranteed.

The timing of an audit is dependent entirely upon the insurance company, Medicare or Medicaid. If the payor wishes to conduct an audit, the hospital must comply. To trigger the start of an audit, the payor will usually send an official letter of intent to audit and request documentation.

What are auditors looking for?

Auditors are looking for instances of over or underpayments in an insurance transaction while using established policies and procedures as a guide for rooting out miscalculations, errors and even fraud.

Oftentimes health systems believe audits are working against them, with intent to take back payments. However, audits are designed to double check work on both sides of the transaction, meaning there is a chance the hospital can receive money back from an error on behalf of the payor.

How to prepare for a health insurance audit

The best way to respond to a health insurance audit is to prepare in advance. Knowing what you're up against is key to navigating such a deadline-driven, paperwork-heavy process. There are several tactics you can use in your training
and education.

A&C AUDIT APR 2021

• Read up on the audit process

The first way to prepare is reading resources like this article and others across the web. Credible sources can provide authentic accounts of what to expect based on their own experiences. Sources like Becker's Hospital Review and RAC Monitor are excellent for keeping up with breaking news and developments in the audit space.

• Consult colleagues in other departments

Speaking with colleagues in the industry at conferences, networking events or even in online forums and groups can also be helpful. Ask about their experiences with audits in their organization and how they handled any roadblocks. Everyone has a story about an audit that went wrong! Swapping stories gives you a chance to learn from their mistakes.

• Try a mock audit

Because audits are best learned by doing, rather than reading, some teams also choose to conduct mock audits, especially during new employee onboarding. These fake audits help identify weak spots early on and allow for course correction prior to the real deal.

How do I respond to a health insurance audit?

No two audits are exactly alike, but each one generally follows a similar process, starting with the audit request and progressing through to the decision to appeal the results. When responding to a health insurance audit, stick to the following basic process.

Part 1: IMMEDIATE RESPONSE

There are two parts to the audit process, each with its own set of steps. The first part, the immediate response, happens right after the audit process is triggered by the payor. When boiled down, it is comprised of four simple steps:

A&C AUDIT APR 2021

1. Receive the Additional Document Request (ADR)

The hospital receives an official ADR from the payor, whether it be a Medicare or Medicaid audit contractor or employee of a commercial health insurance company. A typical ADR will list out the claims to be audited and the process for response, usually submitting medical records or documentation. At this point, the audit has begun and every action you take is considered time sensitive.

2. Collect documentation

To collect required documentation, you will need to work with your health information management (HIM) department, the group within the hospital that manages medical records. Alert them to the audit and detail which medical records you need pulled. You will also want to pull associated documentation like physicians notes to be thorough.

3. Review collected documentation

Once you have all your required medical records, conduct a final review to double check your work. Verify the documents delivered by HIM correspond with the ADR from the payor. If you have the time and manpower, enlist another team member to triple check your work.

4. Submit all documentation

Finally, submit all documentation to officially respond to the audit. Because this process is deadline driven, the most important thing to remember is that you must respond within a certain time, or you may automatically forfeit the audit's monetary amount in question.

With Medicare and Medicaid audits, the Centers for Medicare and Medicaid Services (CMS) provides a standard number of days to submit needed materials. With commercial insurance audits, the number of days you have to respond to an audit depends on the requirements in the payor agreement.

The audit management team must adhere to a strict timeline and make sure all employees participating in the audit response are adhering to deadlines. More missed audit deadlines means increased audit exposure and a lower bottom line.

PART TWO: MONITORING RESULTS

Collecting and submitting documentation is considered the immediate response to the audit. The second part is monitoring the response from the result of the audit. The result of the audit dictates how far into the process you will get in Part Two.

A&C AUDIT APR 2021

1. Receive audit results

Audit results usually come in the same form of communication as the ADR, oftentimes an official letter. The audit may find no discrepancies in the process and conclude that the transaction was processed correctly. If this is the case, the healthcare audit process ends here.

However, the audit may also uncover a discrepancy in the transaction in the form of over or under payment. If this is the case, the amount owed to you or that you owe will be reflected in your next payment by the specific payor.

It can sometimes be tricky to find or even notice these adjustments, especially in larger health systems that are sending batches of claims on a regular basis. However, it's critical to track audit exposure. Letting too many audit results get away from you can make it difficult to understand the true financial impact audits have on your organization.

2. Decide whether to appeal results

If you were found to have been overpaid on an audit and emphatically disagree with the results, you are able to appeal the decision. Often this means you believe the hospital provided care at established levels with the correct treatments and filed all the appropriate paperwork. If you think this is true and your audit did not work out in your favor, you may wish to appeal.

On the government side of things, with Medicare and Medicaid audits, there are levels of appeal built into the audit process. Commercial insurance audit appeals are conducted by pre-set provisions in the payor agreement that lays out the agreed audit process.

Deciding whether or not to appeal can be difficult. Work with your internal team to determine your case and decide whether or not it's worth investing the time and effort to appeal. Think about how big the pool of audited claims is, what was the financial impact of the audit and how strongly you feel your position is justified.

3. If appealing, repeat Immediate Response process

At its lowest levels, appealing essentially involves repeating Steps 1-4 in Part One, above, from filing the appeal to re-submitting documentation and appeal paperwork. Like the original audit, the appeal will be time-bound and require its own set of paperwork.

At this point, you will once again have to wait on audit results. If the results turn in your favor, the process ends. If the results remain the same and you continue to feel strongly that they should be different, you can appeal to higher and higher levels, until you start to invest money in appealing to different courts of law. Remember, the decision to appeal remains entirely up to you and your organization.

Leveraging reporting to improve the audit process

Once you've been around the block a few times and have successfully navigated healthcare audits, you should always leverage available data to improve your internal audit response process and decisions to appeal in the future.

For example, knowing you have a certain success rate with one type of appeal and have a good chance at getting the result overturned is a better business decision than investing the time and effort just to hope the audit results work out in your favor the second time. Good, hard data can be key in determining your appeals strategy moving forward.

Data on lost audits and audit exposure can also help you determine root causes within your organization. Do you have a consistently audited problem with preauthorization, coding or standard of care? What steps can you take now to prevent audit exposure in the future?

A&C AUDIT APR 2021

Bluemark's Blueway Tracker software is your best defense against insurance audits, providing project management, automation, critical deadline alerts and comprehensive reporting. Take your audit response to the next level with a technological solution that saves time, money and effort.

Learn more about Blueway Tracker, now with Full Cycle esMD, and how it can work to transform your audit response process here.