Collections rise by 25% — The reason? Bonuses
$500 quarterly incentive is possible
Collections surged by 25% the first year after a bonus program was implemented in 2010 at The University of Tennessee Medical Center in Knoxville. “We are on track to collect $3.8 million this year,” reports Brad Davenport, director of patient access.
Over the decade patient access employees had collected copays, collections typically increased 5% to 6% each year. However, the yearly increase was 8% to 9% for the second and third years after the incentive was added.
“All patient access employees are eligible for the bonus, because they all have a role to play,” says Davenport. “Insurance verification, preregistration, and preservice all have to flow together.”
Staff members are eligible to receive a $500 bonus quarterly if they meet both a collections goal for their area and additional criteria on these metrics, measured by the department’s recently implemented registration quality system:
• for scheduling areas: average hold time of less than 30 seconds, and abandoned call rate of 2% or less;
• for registration areas, including the emergency department: 98% of registrations error-free, and a duplicate medical record rate of less than 1%;
• for precertification and order management areas: less than nine preventable precertification-related denials per quarter, and less than 1.3% of scheduled patients delayed due to an order or precertification issue.
Anything collected up to five days after discharge counts toward the collection goal, such as if a patient calls to make a payment with a credit card, and prior balances also are counted. “A patient may come in for a scheduled service and owe balances on several prior visits. This gives staff an incentive to look for that,” says Davenport.
If areas haven’t met their goal for two or more quarters, “we put it out in front more,” says Davenport. “But at times, the ED has very high volume, and collections take a back seat. Sometimes you’ve just got to survive, and collections is usually the first thing to be pushed aside.”
Before the bonus program was rolled out, patient access leaders struggled to determine the amount of the collection goals because they wanted to make these challenging to meet, but not impossible, Davenport explains.
“We based the collection amounts mainly on our historical data of collections increasing by about 5-6% a year, and bumped that up a little bit,” he says. “But we found that for some areas, this wasn’t high enough to start with.”
ED had lower collection goal
A lower collection goal was set for the emergency department due to higher turnover, patients being unprepared to pay, and increased patient volumes, but this was increased gradually by 10% over six months, says Davenport. Of the $3.2 million collection goal the department set for this fiscal year, the ED collections goal is $540,000, and the goal for other point-of-service collections goal is $2.66 million.
To help staff collect, financial counselors were given the ability to approve prompt-pay discounts of 10% if patients cleared their balance on the spot.
The department is working to identify specific missed collection opportunities, such as the inability of staff to give accurate price estimates to patients, says Davenport. This process is done manually, but the department is looking into investing in a payment estimation system, which would allow staff to feel more confident in collecting the patient’s out-of-pocket responsibility, he says.
“We would be able to give patients something to show how the amount was arrived at,” Davenport says. “Some payers, though not all, allow you to do that on their web pages, but we haven’t been too successful with that.” This problem is primarily due to lack of accurate CPT codes at that time, he explains.
“Copays are simple to collect. There is not a whole lot of argument there. But on big accounts such as surgeries, staff may not feel comfortable presenting an estimate,” says Davenport. This situation often happens if the patient is sure they have met their deductible and staff members know the deductible they are seeing isn’t accurate, he adds.
Missed opportunities identified
The registration quality system will give patient access data on how many patient accounts converted to self-pay after insurance.
“This will help us determine the missed opportunities, so we can give better estimates,” Davenport says. “Then we can back track to see why that wasn’t collected on the front end.”
When the registration quality system is fully implemented, that situation will pave the way to offering employees an individual collection goal, he adds. There is some occasional grumbling about employees not pulling their fair share of collections, says Davenport, who adds that when the final payment is made, an adjustment is made for the employee’s productivity hours put in for that quarter. If an employee takes a week vacation during that time, for example, the commensurate amount is deducted from the bonus he or she receives.
“We have 130 edits currently. All registrars have their own worklist, so when they come in every day, they can see the registrations from the previous day that need a correction,” says Davenport. “We are now getting reports showing quality scores. We hope to give a report card to every employee.”
Collections surged by 25% the first year after a bonus program was implemented in 2010 at The University of Tennessee Medical Center in Knoxville.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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