During the January 2018 American College of Emergency Physicians (ACEP) Reimbursement and Coding Conference in Nashville, three strategies were identified to improve self-pay and patient deducible revenues. This article will explore the 3 strategies and expand with a fourth.
There is no doubt that emergency medicine patient billing in hospitals and freestanding ERs presents some significant challenges. Physicians are under extreme pressure to provide high level safe emergent care while reducing wait times. As a result, paperwork and information intake often take a back seat to the treatment of life or death healthcare issues. Self-pay patients may be uninsured, underinsured or members of a high-deductible health plan (HDHP). Unless there are effective and streamlined up-front processes and a highly customized approach to emergency patient billing, self-pay revenue can be greatly reduced as it impacts optimal and timely reimbursement.
Three Self-Pay Emergency Medicine Billing Challenges
1. Laws require emergency medicine providers to stabilize and treat all patients regardless of their ability to pay. This law is known as The Emergency Medical Treatment and Labor Act (EMTALA), and was enacted in 1986. Because of this federal legislation, patients may not pay any part of their treatment fees up front.
2. Underpayment by healthcare payers is a common problem in emergency medicine billing. There are many reasons for this underpayment. State billing practices may vary considerably for out-of-network providers. Physicians may not be entitled to fair reimbursement when the facility is not contracted with the payer. Payers may down-code claims when there is a discrepancy between presenting symptoms and the final diagnosis and/or when the diagnosis is not deemed to be an emergency. It is not uncommon for commercial payers to request to pay rates equal to or lower than Medicare reimbursement rates for emergency medical care.
3. Lack of accurate and complete patient demographic information results in the practice’s inability to submit a clean claim. The primary reason for denied claims is faulty patient demographic data. Patient information is collected from patients and their families during times of extreme stress when patient care is of the utmost importance. Information problems range from incorrect addresses, phone numbers, social security numbers, and insurance claim information.
Four Management Billing Strategists to Enhance Self-Pay Revenue
Fortunately, four management strategies can help to overcome these challenges.
1. The first strategy is implementation of demographic verification technology and processes to assure that the bills are sent to the correct payer and address, even when the patient is the payer. Highly accurate consumer databases can be integrated with physician billing software and confirm patient identity upfront. An electronic search of the customer database verifies information including name, address, date of birth, and social security number. The result is a reduction in:
- Returned mail and billing costs.
- Claims rejections.
- Payment delays.
- HIPAA breach risk.
- Problems with statement delivery.
- Problems with insurance discovery.
2. The second strategy is real-time identification of billable insurance coverage for self-pay patients. Real-time insurance discovery eliminates manual steps and greatly increases workflow efficiency. Lists, batches, manual searching of websites and waiting for feedback along with duplicate data entry is virtually eliminated through this real-time technology solution. The result is a reduction of the needs for billing staff along with a significant boost in staff efficiency for insurance verification.
3. The third strategy is to use technology to proactively filter accounts and identify a patient’s propensity to pay. This allows staff to prioritize and focus collections on patients who are most able to pay. In the process, patients with a low propensity to pay can be quickly moved to a category of charitable care, Medicaid or write-offs. Staff efficiency is then enhanced by reducing the volume of accounts to process. It also reduces collection costs as there are fewer accounts sent to collection agencies.
4. The fourth strategy is the utilization of easy payment methods for patients such as re-occurring monthly payment plans that auto debit their bank account and payment methods allowing the patient to pay via their phone by taking a picture of their statement.
Cutting Loses and Maximizing Revenues and Cash flow in Emergency Medicine
Overcoming the challenges in collecting on self-pay accounts is of critical importance as the volume of self-pay patients is rapidly climbing. The answers to streamline billing operations, increase revenues and cash flow are highly dependent on technology driven medical billing strategies. These offer rapid demographic verification, billable insurance coverage identification, filtering of accounts based on a patient’s propensity to pay and making it easier on the patients to pay their bills monthly with re-occurring payment plans and paying via their cell phones.
Article By Rob Ross and David Windham, 360 Medical Billing Solutions Co-owners and VPs