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OCHIN Billing Workshop II

Jessie Janota, Tech Lead, Revenue Cycle Team OCHIN

Jane Speyer, Senior Billing Manager, OCHIN

T.J. Bauer, Enterprise Account Executive,

TeleVox Software, Inc.

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Recap from Friday’s Session

• Charge Router functionality– Router Review– Charge Handler Functions

• Billing WQ Routing and Automatic Activities– Automated Credit Matching– Auto Follow-up Activities

• Remittance Code Mapping

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Today’s Topics

• Optimizing Self Pay Collections• Automated Patient Notifications

– T.J. Bauer from Televox• Partnering with the Revenue Cycle Team

– JIRA Success– Billing and Claims JIRA meetings

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Self Pay Collections:Simplify and Optimize

Jane Speyer

Senior Billing Manager, OCHIN

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Optimize Self-Pay Collections

• Self Pay Aging Date• Account Workqueues: • Advantages of Drop Cycle Statements• Small Balance Write off and Statement

Suppression• Sending Accounts to a Collection Agency • Statement Intervention• Automate Patient Collection Calls

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Self-pay Collections

• Lots of variation between clinics • We have the ability to customize but what

seems to work best?• OCHIN continuously looks for ways to

optimize, automate and simplify the work • Here are our recommendations:

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Self Pay Aging Date

• There are 3 options for setting the self-pay aging date:– Service Date

• Reflects actual age of service• Patient can get a statement saying service is 60

days past due when it was just NRP’d to patient

– Post Date • Item doesn’t age until it is posted to self-pay

– Statement Date• Item ages when statement is accepted

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Account WQ Settings: The Basics

• No Rules Insurance WQ• Returned Mail WQ• Payment Plan WQ

– Can set up a insufficient payment WQ• Confidential, Contested and Hold

Statement WQ• Self Pay WQ – 30 days and older

– Can split by guarantor last name to split the workload between collectors

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Self-Pay over 30 days WQ

• This is where the bulk of your collection activity occurs

• Important Settings:– Exclude Account Status of

• Returned Mail• Hold Statements• Contested Accounts• Payment Plan

– Exclude Confidential Accounts– Self pay Aging of 30 days or more– One or more statements sent

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Drop Cycle Statements

• Accounts qualify for statements when charges drop to self-pay– Ensures that patients get a statement sooner

• Decision points– If patient incurs new charges, should they get

a new statement right away? – When should their next statement be sent?– When should you remove them from the

cycle?

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Drop Cycle Recommended Settings

• What to ask for when you request Drop Cycle:

• First week after you switch, you will have high volume of statements go out at once

• Prepare patients and customer service staff for change

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Statement Suppression

• Do you really want to send statements on low dollar accounts?– Cost of collecting isn’t worthwhile

• Consider suppressing statements for accounts under a certain amount– Industry recommendation is under $5.00

• You can also set up the system to automatically write off these low $ accounts at the time of statement processing

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Automatic Collection Workqueues

• If using a collection agency, make sending accounts to collections easy!– External Collection Workqueue can:

• Send a data file to your collection agency with new accounts to be added

• Send an update file with information about accounts removed from collections

• Send a payment file showing payments taken at clinic on accounts sent to collection agency

• Make sure your agency integrates with Epic– Professional Credit Services (PCS) is fully integrated

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External Collections WQ

• Accounts placed in External Collection WQ will be:– Written off to Collection Agency Bad Debt– Given an Account Status – your choice:

• Collections• Bad Debt• Cash at time of Service, etc.

– Will enter an Account Note (clinic can decide what it says)

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Statement Intervention

• Stops statements from going out• Useful when there is retroactive Sliding Scale

Discount eligibility– Programming point looks at charges that qualify for

slide, but no slide applied– Prevents statement from going out and drops it into a

Statement Intervention WQ– Allows you to correct error and if there is a balance,

account will qualify for next statement run if you use Drop Cycle

• Other uses?

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Televox

• Automatic Patient Balance Notification• OBS piloted this service at one of our

clinics:– Self pay collections increased $5,000/month

• This represented a 40% increase!

– In sample review of accounts that received a Televox call:• 41% made a payment• 16% called to report insurance or apply for Sliding

Scale Discount

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Patient Balance Notification

T.J. Bauer

Enterprise Account ExecutiveTeleVox Software, Inc.

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Benefits for OCHIN Members

Patient Balance NotificationsSimple Communications – Significant Results

Increase Self Pay Collections Maximize Resources

• Decreased A/R life• Increased focus on more severely

delinquent accounts• Reduce bad-debt write-offs• Identify need for assistance

• Effectively move from outbound to a mostly inbound call center

• Increase touches• Direct to on-line payments• Fewer statements

Strategy Options

• High balance vs. Low balance Logic

• Get paid after hours using Inbound Payment Options

• Voice tone changes based on account aging

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Patient Balance NotificationsSimple Communications – Significant Results

3 Strategies for Maximizing Results

1. Courtesy: Simple alert & offer of convenience2. Interactive: We’re here to help3. Final Notice: Action required

0-60 Days

Courtesy

Tone Neutral FirmFriendly

Call Back

Number or Live

Transfer

Live Transfer /

Pay-by-Phone

Call Attention /

Online Bill Pay

Day or Night Day or NightNight

Strategy

Time of Day

90-120 Days

Final Notice

60-90 Days

Interactive

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Patient Balance NotificationsSimple Communications – Significant Results

Patient Balance Strategy Scripts (No Payment Option)

“Hello, this is Central Health Clinic calling with an important message for (Patient Name). Did you check out our quick online bill pay option at www.yourportal.com? If you have recently mailed your payment, thank you. Please call us at 888-888-8888 if you have any questions about your bill. To replay this message, press 2.”

“Good evening. This is Central Health Clinic calling with important information about your outstanding balance. To speak with a staff member about your balance or make a payment, please press 1 now or call 888-888-8888 between the hours of 8:00 a.m. and 5:00 p.m. at your earliest convenience. Thank you for your attention to this important matter. To repeat this message, please press 2.”

“The Central Health Clinic has an important matter to discuss with you. You can reach us Monday through Friday from 8 a.m. to 5 p.m. by calling 888-888-8888. If you would like to speak to a representative at this time, please press 1. To repeat this message, please press 2.”

Interactive: We’re here to help

Final Notice: Action Required

Courtesy: Simple Alert and Offer of Convenience

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Patient Balance NotificationsSimple Communications – Significant Results

Outreach Sample: PaymentIVR (Outbound + Inbound)

Live Answer (Outbound Call):

“Hello, this is Central Health Clinic calling with an important message for <Sherrie>. If we have reached the correct party, press the 1 key now...

For right party verification, please verify we have reached the correct party by entering your date of birth (or SSN). Thank you! This is a courtesy call to advise your balance in the amount of <$250> is outstanding. Press the 2 key to speak to a member of our staff or press 9 now to make a payment via our automated payment attendant.

Answering Machine [With Inbound Call Option]:

Hello, this is Central Health Clinic calling with an important message regarding your account. For more details, please contact us at 800-555-5555 during regular business hours. [To make a payment after hours, please call <800-PAY-MENT> and enter the 5 digit PIN number of <12345>]. Thank you!

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Patient Balance NotificationsSimple Communications – Significant Results

Processing vs. Non-ProcessingAll IVR Messages

Non-Processed Method (PCI Vault Storage)

Payment Options

Enter CC Data

PCI VAULT Storage

Enter CC Data

Validated by

Processor

$ Deposited to customer

Payment Processed

Customer decrypts file

Customer Manually

processes payments

Data File Calls Delivered

Message Plays

RPVDOB/SSN

Enter into IVR

Press 9 toPay Now

Processed Method (Automated)

Payment Options

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Patient Balance NotificationsSimple Communications – Significant Results Case Studies

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Patient Balance NotificationsSimple Communications – Significant Results Case Studies

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Patient Balance NotificationsSimple Communications – Significant Results

Trust of the Industry• Serve over 140,000 providers• 750+ enterprise healthcare clients, including U.S.

News “Honor Roll Hospitals”• Recommended by over 100 industry partners,

including GE, Epic, Cerner, NextGen and Allscripts

Zero Risk• Proactive data security approach (external SSAE 16

and HIPAA audits)• Dual Data Center to ensure system resiliency• Trusted OCHIN partner for over 5 years

Commitment to Service• Implementations within 30 days• Over 80% of support issues resolved within 24 hours• Industry-leading 99.97% call completion rate

Why TeleVox?

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Partnering with the Revenue Cycle Team

Jane Speyer

Senior Billing Manager

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JIRA Secrets

• All these great improvements require a JIRA

• What can I do to get my JIRA’s worked faster?

• Chocolate might work, but these tips will work even better:

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JIRA Tips and Tricks

• When reporting a problem, always include multiple examples.– If it’s a claims issue, use invoice #, not account #, MRN or

patient or account name• When listing payors, include the payor ID (not the

name)– Find the payor ID by clicking on “Coverage Summary”

when in Account Maintenance• Check registration for User Errors for claim rejections• Claim Edit WQ Companion is truly a great

companion!

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JIRA Tips and Tricks

• Keep separate issues in separate JIRA’s– Can be confusing to follow and might lead to your

JIRA being closed without every issue being addressed.

– You can link JIRAs if information is related or relevant to the other issue you are reporting

• Only reopen the JIRA if the original resolution did not work– If a new issue or enhancement to the original issue is

needed, open a new JIRA– Link the closed JIRA if it’s relevant

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More Tips and Tricks

• Use CPT codes and ICD-9 codes or ranges of codes, not descriptions when requesting charge rules

• Avoid delays in requests for info by being as specific as possible in your first entry

• If asked for info, respond right away• You want your fix, and your analyst wants to

close the JIRA – Give them what they need so you both get what

you want!

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Billing/Claims Issues MeetingsMaking the most of them

• Get the right people in the room:– The biller who requested the JIRA– The person who enters them– The person with system knowledge

• This person may or may not be the site specialist

– This will allow your analyst to get the questions they have answered so they can implement the changes you need right away

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Billing/Claims Issues MeetingsMaking the most of them

• Prepare for the meeting by reviewing your JIRA list– Know going in, which JIRAs are most important to

you– Review JIRA’s to make sure your answered any

requests for info– Test early and often

• Or you might lose your build!• Pay attention to REL refresh dates

– Report that the Test is done so your fix can be moved into Production

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Billing/Claims Issues MeetingsMaking the most of them

• Use this time to ask your analysts about new problems that the system might be able to resolve for you – This is how system improvement happens– The Revenue Cycle Team needs to know

what areas in the Rev Cycle are inefficient, difficult, or repetitive

– Together you may be able to create an elegant solution to an inelegant workflow

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Questions?

• May we answer any questions?

• Thank you for your time!

• Please remember to complete your survey!