What are your outsourcing vendor’s 501(r) touch points?

Many health systems partner with an outsourcing vendor for their extended business office (EBO) functions. At THE HMC GROUP we do everything we can to make sure that we become a true satellite business office for the health system. So, that means we have to be in tune with all policies, procedures, mission, and values of the health system so that we can relay them to the patients seamlessly.
In future blog entries, I will talk about creating a comfort level for the patients during this time. However, let’s stick to 501(r) and how/where your early-out vendor’s touch points are while working with your patients. Most importantly, you want your EBO to mirror your 501(r) policies and your interpretations of the regulation:
As an early-out vendor and extended customer service call center, the HMC Group has a minimum of 4 touch points we use to advise the patient of the health system’s charity/financial assistance policies. We also alert the patient to what the future will hold should their bill time out with no payment (i.e., it may be turned over to a collection agency for activity).
1) Statements. Since the process involves customizing and sending of patient statements within the first 120 days of the patient balance, The HMC Group works with the health systems to establish bare minimum verbiage on each statement. This verbiage must express to the patient, at the very least, where or how they can retrieve and learn about getting/qualifying for financial assistance.

2) Inbound customer service message. We have dedicated phone lines for our health systems and their patients. This allows us to detail the hospitals 501(r) policies on the inbound phone message on where or how they can retrieve and learn about getting/qualifying for financial assistance.

3) Outbound customer service message. Whether we leave a manual message (i.e., live person) or a dialer/automated message, the thought process is the same as above (alert the patient where to get and qualify for financial assistance).

4) Live phone contact. We feel it is imperative that our team is trained on all of the policies, procedures, and details of the health systems we service. Right down to directions to the facility and where patients go at the hospital/facility to find out if they qualify for financial assistance. We relay this information to each patient during each live phone contact.

Your EBO is representing your organization and they should ensure your patients are treated well so they’ll return to you for future services.

When to let go?….A story of outsourcing your self-pay balances

In life and in our business settings we are always looking for that “best bang for our buck” type of deal. But I am of the belief you get what you pay for. This is especially true when it comes to a health system or physicians group outsourcing their self-pay balances (True Self-Pay or Residual Balances). I have been in this business for 18 years now, and have spoken to many wonderful people throughout many states about all of the different philosophies when it comes to this process.
The biggest hurdle that each of the business offices deal with is “when do I let go and utilize the EBO?” They struggle with cost, benefit, customer/patient satisfaction, staffing issues, and follow up. The world we live in today is one where each health system and physician/physician group is trying to cut cost while conducting internal processes with minimal resources.
For example, a health system must determine if they:
1) Have or want to have the staff internally to work accounts 30 or 45 days before sending to an early-out vendor
2) Want to absorb the cost for 1 or 2 patient statements and the cost of postage
3) Can contact every patient within this 30-45 day time frame to insure they have exhausted all efforts to recover as many dollars, and uncover/bill as much insurance as possible before sending accounts to the EBO
In most cases, the health system will check no to all of the above.
Sometimes I even hear the theory that the business office wants to get the “cream” in the door, and does not want to give a commission on the “cream” that is recovered with minimal effort or cost. That is fair enough, but what about the other 80-90% of the accounts that do not make a payment? What if you had someone reaching out to ALL patients early in the cycle to ensure that they are getting their statements timely, take a quick payment over the phone, uncover new/secondary insurance, qualify the patient for charity, set the patient up on a bank loan, or set the patient up on a payment plan all within the first 30 days? Instead of just sending one statement and counting on those “cream” dollars to come in-That 80-90% probably goes down to 50-60%.
However, business offices will still struggle with sending the account to the EBO at Day 1 of patient liability.
Those health systems or physicians groups that choose to hold or work accounts in house must be ready to face such challenges as:
1) How will your overall customer service be affected? The patient will have 2 entities in which to speak to resolve their balances. For example, an account is sent to an EBO at day 30, and then the EBO sends out a statement with a different phone number for contact. This same patient then comes in for new service and has a new bill. They then get a bill from your internal process, and maybe a phone call. This patient now has to speak and work with 2 different customer service call centers to try and resolve their balances. Not to mention trying to read 2 different statements
2) Does your internal department make outbound calls to ALL patients before they send accounts to the EBO? In most cases, to get to all your patients, you will have to have a predictive dialer or a large amount of FTEs to make outbound calls. It is best to try and give all of your patients the benefit of at least 1 phone attempt before they are sent to the early-out company if the business office is going to try and work accounts in house. That may be in the only way to get the “best bang for your buck.”
Finally, the going rate in 2015 for a Day 1 service has been adjusted down to the low single digits due to such a competitive market place. So, the cost would be minimal to recover more dollars quicker, alleviate costs, and alleviate workload immediately. If the comfort level is still not there, may I recommend a tiered fee structure whereas the fee goes up the older the account gets. This will create a smaller fee up front where there might be the cream accounts.
So that is the dilemma. After being in the industry for 18 years, I believe that the best bang for your buck happens when you work with a vendor to customize a dedicated Day 1 EBO that is tailored to your health system and patients. Unless your health system or physician group has a large call center and the technology, you are leaving dollars on the table not outsourcing at Day 1. You are also letting a chance to lower your A/R days slip away.
I know that you are probably saying to yourself….Of course he likes the Day 1 philosophy, he is on the vendor side. Again, that’s fair, but our company is in business because we have long tenured business partnerships. The main reason is that we concentrate on the patient experience and customer service. We believe that starts with getting all the accounts under one roof, and getting in touch with all the patients sooner rather than later.

Open lines of communication = a better patient experience and better cash flow

How do your hospital’s registration or billing departments communicate with patients when it comes to their insurances, financial assistance, payment policies, and what portion of the bill they may be responsible for? Are you are doing enough? What about your vendors? Folks like you Eligibility vendors, EBOs, and your collection agencies. What are their goals in communicating your policies, procedures, and values to your patients?
A good patient experience should not end at discharge. There are many opportunities to enhance the patient experience at every level. Yes, even in collections.
At The SOS GROUP we enhance the patient experience in both our early-out customer service call center and healthcare bad debt collections service center by working to create a comfort level for the patients. What do I mean by comfort level? Patients get calls from telemarketers, collection agencies, and other random places every day. How can we as the hospitals EBO or collection agency, increase our chances of getting them on the phone, let alone getting them to stay on the phone? This is where the rubber meets the road, and where recovery percentages and cash goals thrive or go to die.
We dedicate a team and phone lines to each of our health systems. At first we thought this may be difficult to do. But we have seen our results improve, and more importantly, an increase in customer service satisfaction. We believe it is because the patients have become comfortable with the people they are working with. Additionally, having dedicated phone lines has helped. These dedicated lines produce numbers like an average hold time of 59 seconds or less, and an abandonment rate of less than 5%. So, the patient is able to get a live person quicker which also helps this “comfort level.”
We have also found that if the patient is comfortable, the lines of communication are wide open. This is our chance to educate the patient on the charges, where to get a financial assistance application, what the payment plan parameters are, answer questions on insurances or Medicaid, and obtain new demographic or insurance information, etc. The patient is staying on the line with us! And we are assisting them on all options to get their balance resolved. That’s the goal.
This understanding enhances the patient experience and encourages the patient to return to your facility for future healthcare.
Communicating with your patient from beginning to end will help you not only achieve your cash goals, but create a happy patient.