Healthcare revenue cycle management

Our Corporate Headquarters:

1-800-383-6110

H & R Accounts, Inc.
7017 John Deere Pkwy
PO Box 672
Moline, IL 61265

 

January 15, 2010 -- The success of H & R Accounts, Inc.'s partnership with Mercy Medical Center in Cedar Rapids was highlighted in Revenue Cycle & Operations Management, a national industry publication. The article highlights the results of this cradle-to-grave self-pay management partnership.

 

The full article is reprinted with permission below:

Early-out Process, Centralized Scheduling Facilitate Handling of Self-pay Accounts

Faced with a dismal economy and a natural disaster that has driven up unemployment in its service area, Mercy Medical Center in Cedar Rapids, IA, has seen an increase in self-pay accounts. It has been able to manage this challenge by securing the assistance of an outside vendor to handle self-pay accounts and by implementing a centralized scheduling department to oversee authorizations, scheduling, and registrations.
•  The hospital saves at least $250,000 annually by plugging gaps

    in preauthorization process.
•  Bad debt is minimized with early-out process for self-pay accounts.
 

With double-digit unemployment gripping the country, most hospitals have seen the number of self-pay patients spike over the past year.  However, Mercy Medical Center in Cedar Rapids, IA, has not only had to deal with the impact of the sour economy, but also record flooding that destroyed businesses and forced more than 18,000 area residents from their homes in June 2008. 

 

“What we noticed is that over a two-month period, [our self-pay] charges went up by $10 million,” explains Shawn Steffen, senior director of revenue cycle for Mercy Medical Center. Since then, “we have been pretty much maintaining a 7% to 10% increase in self-pay business in our volume.” 

 

However, the hospital has been able to keep its bad debt average below 3% a month, which is at least two full percentage points below the national average, Steffen says. How? With an early-out process that transfers all self-pay accounts to an outside vendor as soon as they are identified during a preregistration process. “We go to an outside vendor expert who knows how to get people to pay in this market and how to work with them,” says Steffen. Currently, this handoff to the vendor is done electronically though the use of codes in Mercy Medical Center’s IT system. “During the night, the system compiles a daily listing of these [self-pay] accounts, and they are transmitted to our early-out vendor,” which is Moline, IL-based H&R Accounts, adds Steffen.

 

To improve the process further, the hospital is working with the vendor on a model that separates these early-out patients into four categories:
•  Medicaid-eligible patients that the hospital missed.  Their records can be

    returned to the hospital for processing;
•  patients that are eligible for charity care and can be removed from the

    bad-debt rolls;
•  self-pay patients who have a good record of paying;
•  self-pay patients who need encouragement and, therefore, should be

    the focus of extra effort.

Centralized scheduling delivers consistency
One initiative that has streamlined patient access and assisted in the appropriate identification of self-pay patients is the creation of a centralized scheduling department that handles preregistration, scheduling, and authorizations.
 

“We ended up with a staff of 18 people which includes six schedulers, six people doing preregistrations, four working on pre-authorizations,” plus a manager and an information technology staff person, says Steffen.
 

Most of the employees were reallocated from other departments, but Steffen did hire three new fulltime employees for the department at a cost of $90,000 per year. However, Steffen emphases that the hospital is seeing an excellent return on this investment. “We knew we were losing at least a quarter of a million dollars a year strictly to authorization problems that we were having, and we have not had any authorization losses since [central scheduling] was implemented in October of 2008,” he says.

The largest share of losses was from pre-authorizations not being verified prior to services being provided in the radiology department, explains Nicolette Woods, manager of central scheduling.  However, now the preauthorization team in central scheduling not only makes sure the preauthorization is in place prior to the service being provided, but it also verifies that the service that was provided is the same service that was preauthorized. “In some instances the radiologist will change the exam that was actually scheduled, says Woods.  “In these cases, we have 48 hours to secure a new preauthorization.”
 

There has been some resistance to centralized scheduling, mainly as a result of concerns that exams might not be scheduled correctly if they are not handled directly by the departments involved; however, Woods says most employees have been supportive and helpful.  Further, she emphasizes that the move has enabled the hospital to deliver more consistent service to patients. “All the departments that we schedule receive the same service,” she says. “We are able to provide a high level of customer service because all staff are trained with the same expectations.”

 

Sources/Resources
For more information about handling self-pay accounts or the transition to centralized scheduling, contact:
 

Shawn Steffen, Senior Director of Revenue Cycle

Mercy Medical Center, Cedar Rapids, IA

 

H&R Accounts, Moline, IL. Phone: (800) 383-6110

Web:  www.hraccounts.com

 

 

Special Reprint
Reprinted with permission of AHC Media LLC
P.O. Box 740056, Atlanta, GA 30374

For subscription information: (800) 688-2421