Hospitals are increasingly focused on tracking financial data to determine where money is wasted and where costs can be cut. Here, Stephen Mooney, president of revenue cycle solutions at Conifer Health Solutions, discusses three of the most important statistics hospitals should track to ensure maximum profits.
1. Point-of-service cash collections. Point of service collections are defined as the collection of the portion of the bill that is the responsibility of the patient prior to the provision of service, which could mean payment is received before the procedure or on the day of the procedure. In order to note where your hospital is losing money, you need to know how much you collect from the patient on a monthly basis and how much of that is collected on point of service. Data on point-of-service cash collections should be reviewed monthly so your hospital can regularly examine and adjust its collections policy if necessary.
"There's a big initiative to contact a patient as soon as they are scheduled to find out if they are insured, who their insurance company is and whether their procedure is covered by insurance," Mr. Mooney says. "You want to determine the co-pay and deductible and call the patient beforehand to ask if they'd like to pay in advance or at the hospital." By calling the patient several days before the procedure, you set up an expectation that they will pay the claim when they arrive at the hospital, Mr. Mooney says.
2. Discharged not final billed claims. If your hospital has a claim that's been discharged and clear-coded but it hasn't arrived at the payor yet, there is something wrong with the claim that means it's not clearing the edits. If you aren't tracking DNFB claims, you won't be able to research why your hospital never received payment and how your billing department is submitting flawed claims. The status of DNFB claims should be reviewed every day to ensure billers and collectors know the status of the hospital's payments. Hospitals can also make sure they have a linkage to the payor, so that when the payor receives the file, they notify the hospital of the claim's status. Over-time statistics on DNFB claims can be reviewed less regularly — for example, every month — to get a "big picture" look at how many claims are being processed incorrectly.
Your hospital should also track claims that are hung up with the payor, Mr. Mooney says. "Once the bill has left the hospital, a lot of hospitals stop paying attention to it," he says. "I think we're going to see a lot more focus on those neglected claims."
3. Percentage of charity care. Tracking your hospital's percentage of charity care differs depending on non-profit or for-profit status. Non-profit hospitals have to provide a certain amount of charity care, and in order to qualify for funding, they must identify charity care cases and track the data. "It's very important for tax status to capture that population," Mr. Mooney says. "You want to triage the financial ability of a patient to pay as soon as possible. We have a tool that looks at every patient who comes through the doors of the hospital and looks at their credit report and looks at census bureau data and tries to figure out their propensity to pay."
If your hospital is for-profit, you should track your percentage of charity care and review it monthly to determine how you can route uninsured, non-emergency patients to other facilities. If your emergency department is frequently used to treat non-life-threatening situations, your hospital might talk to uninsured patients about using local clinics. For uninsured patients who are using the emergency room for real emergencies, your hospital can talk to patients about how to qualify for Medicaid. "A lot of patients who don't have insurance today use emergency rooms," Mr. Mooney says. "If it's an emergency, you can use a financial counselor once the patient is through the ER to talk about Medicaid, how to get food stamps in their community and how to improve their lifestyle in general."
Read more about Conifer Health Solutions.
1. Point-of-service cash collections. Point of service collections are defined as the collection of the portion of the bill that is the responsibility of the patient prior to the provision of service, which could mean payment is received before the procedure or on the day of the procedure. In order to note where your hospital is losing money, you need to know how much you collect from the patient on a monthly basis and how much of that is collected on point of service. Data on point-of-service cash collections should be reviewed monthly so your hospital can regularly examine and adjust its collections policy if necessary.
"There's a big initiative to contact a patient as soon as they are scheduled to find out if they are insured, who their insurance company is and whether their procedure is covered by insurance," Mr. Mooney says. "You want to determine the co-pay and deductible and call the patient beforehand to ask if they'd like to pay in advance or at the hospital." By calling the patient several days before the procedure, you set up an expectation that they will pay the claim when they arrive at the hospital, Mr. Mooney says.
2. Discharged not final billed claims. If your hospital has a claim that's been discharged and clear-coded but it hasn't arrived at the payor yet, there is something wrong with the claim that means it's not clearing the edits. If you aren't tracking DNFB claims, you won't be able to research why your hospital never received payment and how your billing department is submitting flawed claims. The status of DNFB claims should be reviewed every day to ensure billers and collectors know the status of the hospital's payments. Hospitals can also make sure they have a linkage to the payor, so that when the payor receives the file, they notify the hospital of the claim's status. Over-time statistics on DNFB claims can be reviewed less regularly — for example, every month — to get a "big picture" look at how many claims are being processed incorrectly.
Your hospital should also track claims that are hung up with the payor, Mr. Mooney says. "Once the bill has left the hospital, a lot of hospitals stop paying attention to it," he says. "I think we're going to see a lot more focus on those neglected claims."
3. Percentage of charity care. Tracking your hospital's percentage of charity care differs depending on non-profit or for-profit status. Non-profit hospitals have to provide a certain amount of charity care, and in order to qualify for funding, they must identify charity care cases and track the data. "It's very important for tax status to capture that population," Mr. Mooney says. "You want to triage the financial ability of a patient to pay as soon as possible. We have a tool that looks at every patient who comes through the doors of the hospital and looks at their credit report and looks at census bureau data and tries to figure out their propensity to pay."
If your hospital is for-profit, you should track your percentage of charity care and review it monthly to determine how you can route uninsured, non-emergency patients to other facilities. If your emergency department is frequently used to treat non-life-threatening situations, your hospital might talk to uninsured patients about using local clinics. For uninsured patients who are using the emergency room for real emergencies, your hospital can talk to patients about how to qualify for Medicaid. "A lot of patients who don't have insurance today use emergency rooms," Mr. Mooney says. "If it's an emergency, you can use a financial counselor once the patient is through the ER to talk about Medicaid, how to get food stamps in their community and how to improve their lifestyle in general."
Read more about Conifer Health Solutions.