1. Breakthrough Strategies
Leading Practice Self-Pay Solutions
Presented by: Phil C. Solomon
NC HFMA Chapter – March 17, 2009
Proprietary and Confidential
This information is not to be copied or otherwise utilized without the written consent of UCB, Inc.

2. Session Overview
Breakthrough Strategies
Learning Objectives:
Healthcare industry financial overview
Review the economic factors causing the rise
in self-pay
Identify new tools, technologies and strategies to
help you to address the increasing self-pay
patient population
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3. Session Overview
Breakthrough Strategies
“If you think you can…..
or if you think you can’t…..
you're right”
~ Henry Ford
Page  3

4. Question
Breakthrough Strategies
The new healthcare bill will
eliminate all self-pay accounts?
Chat
TRUE or FALSE?
Page  4

5. Answer
Breakthrough Strategies
Expect increase co-pays deductibles
Premiums increases
Patients look to reduce premiums
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6. Healthcare Industry Overview
Breakthrough Strategies
2009
U.S. $ 14.2 Trillion GDP
Gross Domestic Product (GDP)
consumption + investment + government spending + (exports – imports)
U.S. Healthcare $2.7 Trillion
UK Total GDP $2.67 Trillion
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7. Healthcare Industry Overview
Breakthrough Strategies
CMS Estimates by 2019…………
Page  7

8. Healthcare Industry Overview
Breakthrough Strategies
From 2006 to 2015
CMS estimates health spending
growth will exceed 7.2%
(three times faster than U.S. GDP)
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9. Self-Pay Drivers
Breakthrough Strategies
Sluggish economy creates loss of sales
Economic Crisis
Higher unemployment reduces taxes and
High Unemployment premiums to insurance companies
Government reduces subsidies-business’s
Government Cuts reduced ability to offer health care coverage
Government slows payments to Providers
Payment Slowdown
Increased premiums force patients to take
Costly Insurance more risk – higher deductibles & co-pays
Less available dollars and reduced borrowing
Capital Tightening power
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10. Self-Pay Factors
Breakthrough Strategies
Nationally, 17% of the population under 65 has
insurance – North Carolina 18% (source U.S. Census Bureau)
25 million adults under age 65 were
underinsured in 2008 (source Commonwealth Fund)
Underinsured population increased over 60%
from 2003 to 2009
Uninsured equals approximately
48 million Americans (source U.S. Census Bureau)
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11. Self-Pay Factors
Breakthrough Strategies
How large is 48 million…….
All Americans age 65 and older (35.9 million)
(source Center for American Progress)
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12. North Carolina Self-Pay Factors
Breakthrough Strategies
North Carolina
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13. North Carolina Self-Pay Factors
Breakthrough Strategies
North Carolina
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14. North Carolina Self-Pay Factors
Breakthrough Strategies
North Carolina
Page  14

15. North Carolina Self-Pay Factors
Breakthrough Strategies
North Carolina
Page  15

16. Self-Pay Factors
Breakthrough Strategies
Do More
with
Less
Page  16

17. Self-Pay Factors
Breakthrough Strategies
Distribution of Deductibles for Employee-Only PPO Coverage
48%
Source: Kaiser Family Foundation and Health Research & Educational Trust, 2000-2008 Survey of
Employer Health Benefits Report.
Page  17

18. Self-Pay Dilemma
Breakthrough Strategies
70% of Hospital Systems
Report Increase in Uninsured
Self-Pay Patients
(source HFMA View Live Poll June 2009)
Page  18

19. Self-Pay Dilemma
Breakthrough Strategies
The Good News:
An
The Healthcare Industry is Growing
Uncertain
Future
Page  19

20. Question
Breakthrough Strategies
What are the
solutions…
Page  20

21. Question
Breakthrough Strategies
What do
we focus
on first?
Page  21

22. No Risk – No Reward
Breakthrough Strategies
Don’t be afraid to try something new
Engage in pilot programs
Seek new technologies
Think “outside the box”
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23. No Stop Gap Band-Aid Solutions
Breakthrough Strategies
Page  23

24. Registration Challenges
Breakthrough Strategies
Registration input accuracy rate
(National Average 30%)
Incorrect insurance information
entered at pre/registration
Insurance eligibility and pre-cert
not verified at pre/registration
Costly to administer charity
No collection at POS - Co-pays or deductibles
Red Flag and acts of fraud
Page  24

25. Registration Cause-Effect
Breakthrough Strategies
Missed Medicaid/Medicare/Commercial
eligibility
Denials
Additional Rework
Excess Bad Debt
Missed Cobra 60 day rule
Increase in A/R – Days Chat
Other Registration Quality Effects?
Page  25

26. Registration Solutions
Breakthrough Strategies
Improve registration accuracy with real time
demographic validation
Enable POS collections by utilizing
patient payment estimation tools
Validate past due payment history with real time
systems – Ask for money pre & POS
Real time screen for charity – consumer behavior tools
Real time technologies identify COBRA – unemployed
Real time registration quality monitoring
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27. Registration Tracking
Breakthrough Strategies
Page  27

28. Eligibility Cascading Waterfall
Breakthrough Strategies
Real time eligibility check
Flat fee pricing
Waterfall cascade check:
Medicare/Medicaid
Commercial
Commercial propensity
Prime, second, tertiary
Patient historical data
Employer
Other demographics
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29. POS Collection
Breakthrough Strategies
Institute for Health Care Revenue Cycle Research - A Division of Zimmerman, LLC. National Pledge to Reform Uncompensated Care Reform Underway: Adopting Best Practices to Reduce
Uncompensated Care and Improve the Patient Experience. a special supplement to PATIENT PAYMENT BLUEPRINT™
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30. POS Collection Tools
Breakthrough Strategies
Page  30

31. POS Action Strategy
Breakthrough Strategies
Financial Assistance
You may qualify for Medicaid? Let me help you
You may qualify for our charity care program?
Let me help you
Patient Pay
Will you be paying cash, check or credit card?
Do you have a credit card on file with us?
Let me show you how you can take advantage
of our prompt payment and self-pay discount
Let’s set you up on a payment plan………..
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32. Self-Pay Processing Challenges
Breakthrough Strategies
Hard to identify potential charity account
Costly to process charity accounts
Lack of participation by patient
Issues in the ER
Systems lacking to track patient payment
history
Where is the money? – Who can pay?
Red Flags
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33. Self-Pay Cause-Effect
Breakthrough Strategies
Spend too much to give away free care
Patient apathy – learned behavior
Excessive mail returns
Excessive Bad Debt
Missed collection opportunity – vendors
lacking latest tools
Increase in A/R – Days Chat
Other Self-Pay Effects?
Page  33

34. Self-Pay Processing Solutions
Breakthrough Strategies
Use Self-pay modeling solutions
Automated charity screening
Screen all self-pay at POS and BAI
accounts
Real time systems assess a patient’s
financial situation
Use Medicaid Wizard Questionnaire to
determine eligibility
Adherence to Red Flag Policy with CRA
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35. Self-Pay Modeling Validation
Breakthrough Strategies
Without Self-Pay Modeling
Who should qualify for charity?
Who will pay their bill?
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36. Self-Pay Modeling Validation
Breakthrough Strategies
With Modeling & Analytics
Charity – High – Medium –their bill?– Unlikely– Need Data
Who will pay Low
Know how much they can pay
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37. Automated Charity Tools
Breakthrough Strategies
WHY?
Consistent fair evaluation
Unbiased and defensible
Tax-exempt - accurate classification and reporting
of community benefit for IRS Form 990
Cost reduction strategy
Scrutinize patients total financial profile
Guard against charity fraud
HFMA Statement 15 Section
3.7 supports credit validation
Page  37

38. Charity Processing
Breakthrough Strategies
Consider this:
“Manual Charity Processes = variable
interpretations and applications of policy”
Financial Financial Financial Financial Financial Financial
Counselor Counselor Counselor Counselor Counselor Counselor
Page  38

39. Charity Processing
Breakthrough Strategies
What does it cost to process a single
charity application?
Financial Financial Financial Financial Financial Financial
Counselor Counselor Counselor Counselor Counselor Counselor
Chat
Page  39
The Answer Is?

40. Best Payment Likelihood Model
Breakthrough Strategies
Customized Model Blending Patient Payment History
Actual Patient Payment History & Patterns
Similar Patient Profile History and Patterns
Generic Propensity of Payment Model, Including:
Credit Bureau Report
Demographic Profile
Non-Credit Lifestyle Profiling
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41. Segmented Collection Strategy
Breakthrough Strategies
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42. Work Flow Optimization
Breakthrough Strategies
Qualify &
Process
Maximum
Resources
Modified
Work Flow
Accelerate to
Bad debt
Skip Trace
& Process
Page  42

43. Red Flag Question
Breakthrough Strategies
What is a Red Flag Alert?
Notification of a possible terrorist threat
A continuous non paying patient
A warning from the government
An activity which indicates actual identity theft
An activity indicating the possibility of identity theft
Chat
Page  43 The Answer Is?

44. Answer
Breakthrough Strategies
A pattern, practice, or specific
activity that indicates the
possible existence of identity
theft
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45. What is a Red Flag?
Breakthrough Strategies
Red Flag Categories
 Alerts, notifications or warnings from a CRA
 Suspicious documents
 Suspicious personal identifying information
 Unusual use of, or suspicious activity relating to, the
covered account
 Notices from customer, victims of ID theft, law enforcement
authorities, or other persons regarding possible ID theft in
connection with covered accounts held by the organization
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46. Best Practice Self-Pay Modeling
Breakthrough Strategies
Patient Demographic Data
Zip+4 Census Data
Actual Collection Performance Validation
Patient Payment History – Custom Model
Financial Credit Bureau Data
Non-Credit Economic Data
Red Flag Alerts
Skip Trace Data Validation
Dual Validation Income Estimator
Charity Lifestyle Evaluation
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47. Other Collection Solutions
Breakthrough Strategies
Recourse – Non-recourse funding
Good or bad?
Healthcare Credit Cards
Personal lines of credit
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48. Self-Pay Bad Debt Challenges
Breakthrough Strategies
Cultural behavior and lack
of control slows placement
to agency
Stigma about placement –
conflict with mission
Myth - must use multiple
agencies to maximize performance
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49. Self-Pay Bad Debt Solutions
Breakthrough Strategies
With new processes, only “true” bad debt
accounts get placed
Know which accounts to write off sooner
with modeling
Analytics and segmentation minimizes
the need for champion vs. challenger
Minimize the need to work accounts too
long
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50. Self-Pay Bad Debt Strategies
Breakthrough Strategies
Lowest scored accounts average 50%
Reduce statement cost by accelerating placement
Low scored accounts – accelerate to collection
agency
Treat each segment similarly, accounts can be
reported on Medicare cost report sooner, leaving
“collectable” accounts with agency longer
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51. Question
Breakthrough Strategies
In order to meet Medicare cost
reporting guidelines, you are
required to work accounts
internally for 120 days?
Chat
TRUE or FALSE?
Page  51

52. Self-Pay Reporting Challenges
Breakthrough Strategies
HIS lacks self-pay focused tools
No real time collection statistics available
No patient payment analytics readily
available
Limited address validation reporting
Limited POS collection performance
tracking tools available
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53. Self-Pay Reporting Solutions
Breakthrough Strategies
New tools designed specifically
for Self-Pay
Provide instant feed
back to internal staff
Identify trends and
act rapidly for cost
containment
Leverage dashboards to track
performance
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54. Performance Real Time Dashboard
Breakthrough Strategies
Identify
Measure
Adjust
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55. Overall Benefits
Breakthrough Strategies
Collect 5% to 10% of total
self-pay inventory at POS
Reduce internal cost for
government eligibility
programs by 25%
Reduce charity administration costs by over 80%
Reclassify up to 20% of bad debt accounts as
charity
Reduce statement cost by 25%-70%
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56. Overall Benefits
Breakthrough Strategies
Reduce mail returns by over 40%
Improve liquidation by 25% to 40%
Add 10% to 15% in incremental
revenue through eligibility cascade
Accelerate Medicare cost reporting on bad debt
segmented accounts – allowing collectable
accounts to remain at agency longer
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57. Do You Have
Any Questions?
Thank you
Phil Solomon
Chief Client Officer
UCB, Inc.
404-849-8065
psolomon@ucbinc.com
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