4 Noteworthy Point-of-Service Strategies We Learned in 2015

December 08, 2015 - Just as Ebenezer Scrooge from Dickens’ A Christmas Carol has money on his mind, so does the healthcare industry.

The importance of collecting money from a patient at or before point-of-service was a significant revenue cycle focus this year.

As 2015 comes to a close in coming weeks, here are 4 strategies we learned to strengthen complicated point-of-service tactics and make sure patients are able to quickly and effortlessly pay what is owed.

Trying to collect payment before the patient leaves is complicated

Most physician practices – 9 in 10, that is – believe collecting from a patient before he or she walks out the door is critical to revenue cycle success, according to an Avality Research Study.

“The conversation with the patient has to start early – at or before the point of service – if providers are to reduce the amount of bad debt they’re currently experiencing,” stated Russ Thomas, Availity’s CEO.

Despite this idea, the vast majority of healthcare providers struggle to immediately and expediently collect from patients. Over 85 percent of providers said collecting from patients once they walk away is a “difficult task.”

Hospitals reportedly collect from patients up front at an office or hospital around one-third of the time. This allegedly leaves a remaining 80 percent of patient-owed fees in limbo.

One primary challenge is patients are not always able to pay immediately. Over 40 percent of physician practices and over half of hospitals support payment plans, said Availity.

“Research has found that as many as two out of three bankruptcies involve illness, injury, significant uncovered medical bills or a combination of these factors and the fallout from them,” according to a report from PwC’s Health Research Institute.

Another struggle involves a high number of formerly uninsured patients walking in.

An “increased focus on insurance verification and an emphasis on point of service collections,” is critical, explained Dan Clark, McGladrey’s Director of Revenue Cycle, to RevCycleIntelligence.com.

Helping walk patients along once the revenue cycle process starts, he stated, means making sure protocols are in place to ensure needed information is collected as soon as possible.

As the role of patient responsibility changes, so must the importance of front-end collection.

“The front-end of the revenue cycle must be diligent with determining Medicaid eligibility and assist uninsured patients understand their coverage options with the insurance exchanges,” asserted Derek Bang, CPA, CGMA, Chief Innovation Officer at Crowe Horwath LLP, to RevCycleIntelligence.com.

“There must be greater focus on point-of-service cash collections, given the growing amount of patient responsibility for payment.”

Focus on attaining actionable data to stop leaving money on the table

A key focal point is to utilize truly actionable data from the moment point-of-service begins, said Carlos Olivares, CEO of Yakima Valley Farm Workers Clinic, to RevCycleIntelligence.com.

“We had a whole bunch of data systems that were floating all over our system and it was almost impossible to try to coordinate.”

It was not until Olivares analyzed data more closely that things suddenly began making sense.

“We were leaving a lot of money on the table. … There were a tremendous amount of resources that we were able to harness because of the data that we understood.”

“We don’t know what we don’t know. Most importantly, people who have not worked with data don’t know what the right question is.”

Smart technology may not yet be a smart option

Is technology the answer? Is the ability to track a patient with the swipe of a personalized electronic smart card at point-of-service an option worth considering?

Maybe not at this time, said a report from the Government Accountability Office and the Workgroup for Electronic Data Exchange.

Smart cards will cause interoperability hurdles and inconsistencies in provider record consistency, stated GAO. Claims processing systems are not currently designed to verify cards swiped at point-of-service. More work needs to be done when it comes to issuing provider cards and implementing criterions for use, added GAO.

“…Medicare providers are already investing resources, and facing IT challenges, to meet Medicare EHR Incentive Program requirements and to update their IT systems to adopt new billing codes,” GAO asserted.

Even if smart cards were able to be implemented seamlessly within hospitals and physicians offices, doing so is perhaps still too costly to prove beneficial.

“Practices that provide higher levels of identity authentication generally are more expensive and difficult to implement and maintain and may cause greater inconvenience to users than practices that provide lower levels of assurance.”

Despite revenue wrinkles that still need ironing out, GAO explained smart cards’ benefits to reimbursement are certainly tangible. 

“Using electronically readable cards to convey identity and insurance information to auto-populate and retrieve information from provider information technology (IT) systems could reduce reimbursement errors and improve medical record keeping.”

 “[The] next generation of health ID cards … will leverage mobile technology to streamline the patient check-in process by using applications rather than cards to provide benefit information and essential health records,” stated Devin Jopp, EdD, WEDI’s CEO.

High deductibles are complicating point-of-service efforts

“There continues to be a focus on reducing the overall costs to collect. CFOs tend to focus on how much their revenue cycle costs. While it’s important, I think it’s somewhat short-sighted. Just because it’s cheap doesn’t make it good,” explained Ben Colton, Senior Manager at ECG Management Consultants, to RevCycleIntelligence.com.

If high-deductibles continue to complicate point-of-service collection efforts, healthcare spending will soon top $10,000 per person.

“Unfortunately, what we’re finding is a lot of patients are still selecting high deductible plans which requires a significant amount of self-pay follow-up activity. … We’re going to continue to see some pressure on reimbursement and subsequently continued effort on reducing overall cost,” stated Colton.

“Where organizations need to focus is not just looking at opportunities for cost reduction but how to do so efficiently in a way where you’re also increasing your margins.”

Patients from urban areas who have significant outstanding balances used to make up around 20 percent of a total patient population, confirmed Mark Owen, Payor Logic’s Director of the Division of Emergency Medicine, to RevCycleIntelligence.com.

High deductibles may yield large balances for patients following a point-of-service, he stated. Owen predicted the number of patients with balances to soon exceed 50 percent of a patient population.