CRCR ST
Dollars and Sense initiative (consistency, clarity, and transparency to patient financial
communications) - 3 healthcare revenue cycle initiatives - answer- Patient financial
communications best practices
- Best practices for price transparency
- Medical account resolution
Patient Financial Communications - ED - answerif patient is having a medical
emergency, financial conversation should occur during discharge. If it isn't an
emergency it can happen at registration or discharge
Patient Financial Communications - Advance of service - answerfinancial discussions
can occur via outbound, inbound contact, there should be reasonable attempt to have
the discussion as early possible before financial obligation has occurred.
Patient Financial Communications - Time of service (not ED) - answerfinancial
discussion can happen at registration or discharge so as not to disrupt the patient flow
Patient Financial Communications - Routine and complex scenarios - answerpatients
should be given the opportunity to request a patient advocate, family member, or other
designee to help
Patient Financial Communications - routine scenarios - answerRoutine: patients with
insurance and ability to pay, discussions should take place between patient/guarantor
and a properly trained provider rep
Patient Financial Communications - complex scenarios - answerComplex: uninsured,
underinsured patients a financial counselor/supervisor should be involved
Patient Share: - answer- Patients should be told about the types of service providers
(pathologists, radiologist, anesthesiologist, etc) who typically participate in the service.
Patients should receive written list of service provider types upon request. Should be
informed that actual costs may vary from estimates, depending on the actual services
performed or timing issues related to other payments that may affect their deductible.
,- Patients should be asked if they are interested in receiving information about payment
options or financial assistance programs.
- Discussion should not interfere with patient care, and should focus on patient
education
Financial Counseling - answer-Providers should have widely publicized toll-free number
for patients to call to receive assistance, and address concerns
-It is hard to focus on financial matters when urgent health matters happen at the same
time. It is important to make it convenient and the appropriate time.
-Provider should maintain a thread of pre-reg discussions and avoid repeated requests
for the same information
Prior Balances - answer- Providers should have clear policies on prior balance policies
that are available to the public. Providers should have technology that give financial
reps current info about patient financial obligations.
Balance Resolution - answer- Discussion should focus on amicable resolution. Balance
resolution discussion may occur concerning prior balances that are currently being
pursued for collection by the provider, a collection agency, etc
- Provider rep may discuss services that led to the prior balance, should provider write
list of services, dates of services. Should ask patient if they want to receive information
about payment options/financial assistance. They may also proactively attempt to
resolve prior balance through insurance/financial assistance programs.
- Once these steps have been completed, it is appropriate to ask the patient how they
would like to resolve the balance and inform them of any collection activity
The Provider - Patient Conversation - answerCompassion, Communication, Written
Follow-up
Compliance Framework - answer- Executive level metrics reporting - presented to
executive leadership annually
- Training Program - completed annually, and should cover best practices, financial
assistance policies, financing options, alternative options for the for the uninsured,
standard language to be used, laws and regulations (EMTALA, fair debt collections,
TCPA, etc)
- Process Compliance - annual observation, monitoring, tracking of results, should be
comprehensive and include all scenarios.
- Technology - should include eligibility verification, verification of existing prior balance,
estimated costs (PRE)
- Feedback process and response - solicit and receive input from stakeholders, ensure
patient complaints are resolved.
Charge Master - answerlists total charge, not net charges that reflect payers contractual
adjustment
, Price Transparency - answerReadily available information on the price of healthcare
services, that, together with other information, helps define the value of those services
and enables patients and other care purchasers to identify, compare, and choose
providers that offer the desired level of value.
Medical Account Resolution (Medical debt task force) - answer- Educate - educate
patients, and follow best practices
- Bills - clear, concise, correct and patient friendly
- Policies - establish policies, and make sure they are followed
- Consistency - from billing disputes to payment application
- Coordinate - avoid duplicate patient contacts
- Judgement - use good judgement and the best ways to communicate with patients
about bills
- Timing - set the account resolution clock when the first statement is sent to the patient
- Report and Track - report to credit bureaus when an account is resolved, track all
consumer complaints
OIG - answerOffice of Inspector General developed the Model Compliance Plan for
Clinical Laboratories in 1997, and the Compliance Program Guidance for Hospitals in
1998. These guidance documents all have the U.S. Sentencing Commission Guidelines
as their core.
Compliance & HIPAA Requirements Risk Areas - answer- "Upcoding" of MS-DRG
assignments
- Inaccurate or incorrect coding
- Bundling/unbundling of services
- Duplicate billing
- Billing for medically unnecessary services
- Waiving of deductibles to entice business
- Insufficient documentation
Essential Elements of a Corporate Compliance Program - answer- Have a plan
- Follow the plan (Corporate Compliance Program, know what happens if you don't
follow the plan)
- Review the Code of Conduct to verify you the follow the plan. Chief Compliance
Officer Role oversees the code of conduct.
FERA (Fraud Enforcement and Recovery Act) of 2009 amended the False Claims Act
(FCA) - answerClosure of loopholes, and to enhance the ability of the gov't,
whistleblowers and reporting individuals to identify and successfully pursue entities and
individuals who improperly receive gov't funds.
Corporate Compliance Policy (CCP) elements - answer- Transparent
- Clearly articulated
Dollars and Sense initiative (consistency, clarity, and transparency to patient financial
communications) - 3 healthcare revenue cycle initiatives - answer- Patient financial
communications best practices
- Best practices for price transparency
- Medical account resolution
Patient Financial Communications - ED - answerif patient is having a medical
emergency, financial conversation should occur during discharge. If it isn't an
emergency it can happen at registration or discharge
Patient Financial Communications - Advance of service - answerfinancial discussions
can occur via outbound, inbound contact, there should be reasonable attempt to have
the discussion as early possible before financial obligation has occurred.
Patient Financial Communications - Time of service (not ED) - answerfinancial
discussion can happen at registration or discharge so as not to disrupt the patient flow
Patient Financial Communications - Routine and complex scenarios - answerpatients
should be given the opportunity to request a patient advocate, family member, or other
designee to help
Patient Financial Communications - routine scenarios - answerRoutine: patients with
insurance and ability to pay, discussions should take place between patient/guarantor
and a properly trained provider rep
Patient Financial Communications - complex scenarios - answerComplex: uninsured,
underinsured patients a financial counselor/supervisor should be involved
Patient Share: - answer- Patients should be told about the types of service providers
(pathologists, radiologist, anesthesiologist, etc) who typically participate in the service.
Patients should receive written list of service provider types upon request. Should be
informed that actual costs may vary from estimates, depending on the actual services
performed or timing issues related to other payments that may affect their deductible.
,- Patients should be asked if they are interested in receiving information about payment
options or financial assistance programs.
- Discussion should not interfere with patient care, and should focus on patient
education
Financial Counseling - answer-Providers should have widely publicized toll-free number
for patients to call to receive assistance, and address concerns
-It is hard to focus on financial matters when urgent health matters happen at the same
time. It is important to make it convenient and the appropriate time.
-Provider should maintain a thread of pre-reg discussions and avoid repeated requests
for the same information
Prior Balances - answer- Providers should have clear policies on prior balance policies
that are available to the public. Providers should have technology that give financial
reps current info about patient financial obligations.
Balance Resolution - answer- Discussion should focus on amicable resolution. Balance
resolution discussion may occur concerning prior balances that are currently being
pursued for collection by the provider, a collection agency, etc
- Provider rep may discuss services that led to the prior balance, should provider write
list of services, dates of services. Should ask patient if they want to receive information
about payment options/financial assistance. They may also proactively attempt to
resolve prior balance through insurance/financial assistance programs.
- Once these steps have been completed, it is appropriate to ask the patient how they
would like to resolve the balance and inform them of any collection activity
The Provider - Patient Conversation - answerCompassion, Communication, Written
Follow-up
Compliance Framework - answer- Executive level metrics reporting - presented to
executive leadership annually
- Training Program - completed annually, and should cover best practices, financial
assistance policies, financing options, alternative options for the for the uninsured,
standard language to be used, laws and regulations (EMTALA, fair debt collections,
TCPA, etc)
- Process Compliance - annual observation, monitoring, tracking of results, should be
comprehensive and include all scenarios.
- Technology - should include eligibility verification, verification of existing prior balance,
estimated costs (PRE)
- Feedback process and response - solicit and receive input from stakeholders, ensure
patient complaints are resolved.
Charge Master - answerlists total charge, not net charges that reflect payers contractual
adjustment
, Price Transparency - answerReadily available information on the price of healthcare
services, that, together with other information, helps define the value of those services
and enables patients and other care purchasers to identify, compare, and choose
providers that offer the desired level of value.
Medical Account Resolution (Medical debt task force) - answer- Educate - educate
patients, and follow best practices
- Bills - clear, concise, correct and patient friendly
- Policies - establish policies, and make sure they are followed
- Consistency - from billing disputes to payment application
- Coordinate - avoid duplicate patient contacts
- Judgement - use good judgement and the best ways to communicate with patients
about bills
- Timing - set the account resolution clock when the first statement is sent to the patient
- Report and Track - report to credit bureaus when an account is resolved, track all
consumer complaints
OIG - answerOffice of Inspector General developed the Model Compliance Plan for
Clinical Laboratories in 1997, and the Compliance Program Guidance for Hospitals in
1998. These guidance documents all have the U.S. Sentencing Commission Guidelines
as their core.
Compliance & HIPAA Requirements Risk Areas - answer- "Upcoding" of MS-DRG
assignments
- Inaccurate or incorrect coding
- Bundling/unbundling of services
- Duplicate billing
- Billing for medically unnecessary services
- Waiving of deductibles to entice business
- Insufficient documentation
Essential Elements of a Corporate Compliance Program - answer- Have a plan
- Follow the plan (Corporate Compliance Program, know what happens if you don't
follow the plan)
- Review the Code of Conduct to verify you the follow the plan. Chief Compliance
Officer Role oversees the code of conduct.
FERA (Fraud Enforcement and Recovery Act) of 2009 amended the False Claims Act
(FCA) - answerClosure of loopholes, and to enhance the ability of the gov't,
whistleblowers and reporting individuals to identify and successfully pursue entities and
individuals who improperly receive gov't funds.
Corporate Compliance Policy (CCP) elements - answer- Transparent
- Clearly articulated
