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MC - HFMA

1/25/2016
by

David Hutchinson

on 24 February 2016

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Transcript of MC - HFMA


Unresponsive Patient Denials (UPD)
Evolution of Insurance
1900
*$100
$5
1900-1910
My Story
2004 - Managing Denials and Appeals
Monitoring denial volumes by payer

2007 - Create UPD program

2009 - First child born
Culture/mentality shift
Unions expand rapidly 2M-8M

Railroads begin offering medical plans
GM offers workplace injury coverage
1910-1920
$x2
Modern Medical school and Hospital taking shape (surgeries, x-rays, anesthesiology)
WWI - Aftermath
1920s
Hospitals focus on infant mortality (47%)
Baylor and the birth of Blue Cross (1934)
$6 for 14 days
1920s
1930s
Great Depression, empties hospitals. Blue Cross model adopted
Less than 10% of population covered
FDR, Social Security and foundation for Medicare
Unresponsive Patient Denials
Uncooperative Patients
Non Compliant Patients
Home Visit Program
Document Retrieval Program
ANSI Codes
HFMA AK-WA
February 24, 2016

UPD
Revenue
Aging
Patient
Satisfaction
Bad Debt
Reduction
Revenue
Aging
Bad Debt
Reduction
Patient
Satisfaction
Structural and Resource Allocation
75%
Target Resolution Rate
*Typically account for 18% - 29% of Denial Population
Additional Action Items
Review ANSI code denial volumes
Review accounts currently in Bad Debt to estimate current opportunities
Use bed size guide to provide rough estimate of resource needed
Develop training materials, or revisit existing ones as they surround:
HIPAA compliance
Electronic correspondence
Home visit policies
Skiptrace access/process
Identify timeframe or deadline for resolution
It's important that you don't "glut" the work queues of the team
Benefits of a Successful program
Dependent on facility size and volume of denials, a .5 to 1.5 day
decrease
in overall AR days
An increase in and acceleration of
revenue
Patient satisfaction with Billing Office
Position yourself as the patient's
advocate
Indirect improvement on HCAHPS, specifically questions 21, 23, 24)
Develop balance based checklist
Determine what actions will be taken and in what order based on the balance of the account
The single most important action item:

DO SOMETHING
1940s - 1950s
WWII leads to population and economic booms. Employer competition intensifies
"Fringe benefits" - like employer paid healthcare ruled tax free
1954 - Health insurance premiums considered tax deductible
63%
1960s - 1970s
Business offices focus on patient debts
"Great Society" programs introduced in 1965
Medicare, Medicaid - expansion of Social Security to include disabled
70% 80%
1960s - 1970s
70% 80%
1980s - 1990s
1982 - Introduction of UB82
1992 - Introduction of UB92
1999 - Trend in small employers dropping medical benefits gains steam
2000
Cost for employer plans rise by (230% by 2010)
2006, HDHP make up 4% of payer mix
2010 - 31% of covered population has a public coverage
Current
HDHP plans increase dramatically as percentage of payer mix (800%)
ACA passed, changing the nature and scope of health insurance plans
85% + of population has coverage
Pre-Existing exclusions eliminated
Coverage Payment
Sample Balance Based Checklist
Matt Cardon
mcardon@cardonoutreach.com
(801) 580-1034
Cory Mecham
cmecham@cardonoutreach.com
(208) 403-3300
Q&A
Full transcript