Healthcare Providence to every citizen is the prime responsibility of medical care centers and other health departments working simultaneously. It is imperative for health care centers to educate and inform self-pay patients how to deal with insurance procedures. The medical institutes are devising strategies to collect cash from self-pay patients efficiently. Many of health care institutes help out self-pay patients to get insured but still many of self-pay patients do not get proper outlets or platforms to insure themselves. Healthcare centers like Sutter Healthcare are progressing and working on how to provide healthcare services to those who cannot afford or come forward to pay despite having resources.
The uninsured people and self-pay patients face difficulty in paying charges, but health care institutes are acknowledging the fact that 47 million of Americans are uninsured. The attempts are made by healthcare institutes to improve the point of collections and revenue cycle. Healthcare institutes are taking initiatives to help out self-pay patients who mainly are from working families who might have resources to pay for their health care.
The staff involved facilitating self-pay patients are termed as PFS staff, and health care centers participate in strengthening the staff, so appropriate services are provided to the patients. The paper reviews the case study of Margie Souza, health care factors that contribute to the betterment of the services provided by PFS staff, and Sutter healthcare initiatives towards the healthcare services to every citizen.
The PFS staff faces a lot of challenges in providing back end and front end services effectively. The revenue management cycle includes several of problems identified by Sutter health care (Maksy, 2013). PFS staff is not given authority or access to real-time information about key financial and operational indicators that serve as a hurdle to PFS staff to work effectively. The operational indicators include accounts receivable and cash collections. The collections collected from patients have to be improved proposed by many health institutes.
Medical institutes are taking initiatives to over the problems faced in collecting from patients. Sutter health care tends to cater the self-pay patients by empowering the PFS staff. PFS staff manages the cash collections and all account receivables, but their operation is limited when they are not given full access to the tools to carry out the task. Although Sutter health care came up with the project to facilitate the PFS staff which will assist in collecting from the patients efficiently without being limited.
The approach adopted by Sutter healthcare was supposed to help the PFS staff to collect from patients appropriately. Also, the Sutter health care tried to devise a strategy to focus on few key factors of cash collection procedure. The strategy included proper handling of gross A/R, cash collections, unbilled A/R days, billed A/R days, the percentage of A/R over 90,180,360 days, and major payer A/R days (Shwartz, Burgess, & Zhu, 2016). They have been working effortlessly towards the improvement of cash collections.
The strategy of empowering the PFS individuals and making them realize the responsibility of handling each account and collections. The PFS individuals are given a set of tools to handle the cash collections and account efficiently. Tools have been provided PFS people who allow them to prioritize the account work lists, sorting of accounts and ranking by work performance. Through these tools, PFS staff members get an idea where they stand and how could they improve the A/R days and cash collection goals. The problems occur when individual fails to provide timely reports on demand, also aging analysis, and A/R stratification.
There are various issues identified in medical institutes where staff members fail to do a proper check on A/R days and cash collections. Individuals might face difficulties in analyzing the self-pay patients because of several reasons including health insurance/claim number missing and duplicate medical record numbers (Shwartz, Burgess, & Zhu, 2016).
Lack of training of the receivable management has posed threats to the system and hindered the proper handling of accounts. The denial of health care claim by the staff members has been part of the problem in cash collections too. The issues can be handled effectively if the system of revenue cycle management is improved at an extreme level. Sutter Healthcare has taken the initiative that could improve the revenue cycle management to avoid any health care claim in the future. The strategies have been precisely crafted out to improve the receivables and cash collection procedures.
An efficient system with easy to handle cash collections goals is not only beneficial to the PFS staff but also the patients. The self-pay patients who interact with PFS staff demand to be catered adequately. The problem is in old accounting practices and not proper handling of revenue cycle management. Sutter Healthcare Institute has come up with strategies and solutions to such problems. The authority is given to PFS staff members to regulate the accounts they deal with and assist the patients claiming for services.
The comprehensive training granted to members could also solve the problems encountered. And the results have proved that due to the training of PFS staff members there has been an improvement in the way accounts are managed. The revenue cycle management has improved due to proper techniques employed by Sutter healthcare center. The concentration of PFS staff members over the accurate and complete information including cash up front has resulted in the claim that 80 million collections done are accurate. Sutter Healthcare has empowered and trained the PFS staff that as a result has shown a drastic change in improving the cash collection procedure.
There is an urgent need that every medical institute requires revising the strategies involved to handle accounting procedures involved (Pinder, Lloyd, Nafees, Elkin, & Marley, 2015). The self-pay patients interacting with PFS staff members do not want the denial of a claim if their medical history does not show any debt or other suspicious activity. Moreover, denial to such patients can result as a negative factor for the PFS staff.
With the advent of technology, institutes have to implement the innovative solutions to the problem of efficient cash collections. There are thirteen strategies proposed by the experts to speed up the collections without having an adverse impact on patients. Such strategies so far have shown improvement and promise to provide the better results.
The cause analysis of the denial of the claim done by patients can help the PFS staff to improve the cash collections procedure and avoid any such occurrence in the future. Denials are of different kinds such as formal denials, underpayments, backend identification errors, submission errors, and returned emails. PFS staff members have to devise a strategy to minimize the denials. Hence, keeping all these issues in mind there is dire need to deploy a handful of strategies to speed up the collections and reduce the problems occurred to both, i.e., PFS staff members and self-pay patients. The healthcare institutes need to update their A/R management software on a regular basis to avoid any mishap while cash collections.
The policies employed regarding billing dates and procedures need to be revised and reviewed. The innovative technology deployed by the Institute needs to be reviewed and fixed if it is not suiting the Institute. Most important of all make it easy for the self-pay patient to understand the cash collections procedure. Development of specific plan by the revenue management is a crucial step toward the improvement of cash collections. Proper training of all the PFS staff members by expert and careful evaluation of the policies employed by the Institute can improve the check in A/R days and cash collections.
The alternative solution that can be suggested to improve cash collections is the complete renewal of revenue management cycle and proper training of PFS staff members. An effective institute can increase the incentives to motivate the PFS staff members to deploy the proper strategies while managing the cash collections. However, Sutter healthcare had improved and given drastic results over the time when they started employing proper strategies. Strategies such as empowerment of PFS staff members (Shwartz, Burgess, & Zhu, 2016).
Even the PFS staff members reported the results achieved are due to the authority and ease gave to them while handling cash collections. Acceleration of cash collections in the proper way is an important strategy that should be employed by medical institutes. The immediate billing technique has shown positive results. The technique also builds the trust between the Institute and self-pay patient. The problems such as cash flow are declining, margins tightening, and bad debt increasing the medical institutes has to come up with a solution to address all such issues.
There are many solutions proposed by the financial management experts, but only a few have shown drastic results. The medical institutes looking forward to improving cash collections need to maintain convenient touch points with patients. For instance, make the experience of the patient doing business with the members pleasant and caring attitude would change the public relations built by the Institute. The institutes can improve the productivity if the patients are given the ease of dealing with insurance and other payment procedures.
Another technique which should be employed by the institutes is monitor all the pay contracts where one can check the reasons of self-pay patients denying too many claims and coming up with too many demands. Employ the Enterprise warehouse data to keep a track of data and tips to improve the performance and productivity. Mine the data properly while dealing with the self-pay patients. Flexibility and ability of revenue management cycle can improve the productivity of PFS staff members.
Suggestions from frontline can also improve the cash collections procedure. Important of all is that health care data should be trended and benchmarked appropriately to facilitate the cash collections process between PFS staff members and self-pay patients. The objective of medical institutes is to assist the patients while they claim for the health care services to be provided. The revenue cycle management plays an integral role in maintaining the relationship between an institute and patient.
At times the cash collections become a difficult task for PFS members to deal with meager resources and authority given (Maksy, 2013). Many institutes have developed an alternative solution to the problems occurred due to mismanagement. Solutions such as mentioned above like keeping track of proper information and benchmarking of healthcare data have shown results and improved the revenue cycle management efficiently.
Handling of revenue cycle management requires a lot of proficient management skills. Management skills with adequate solutions to the problems caused due to faulty cash collections procedures have shown the desired results. Technological superiority can help the medical institutes to improve the revenue management cycle.
The members involved in dealing directly with self-pay patients are required to have proper training. Software keeping track of revenues are required to be upgraded on a regular basis. Results such as an increase in self-pay patients coming forward to PFS staff members have been recorded over the time in the institutes who have successfully employed all the strategies.
The conclusion can be drawn easily on the basis of results shown by applying such strategies. An integral strategy suggested by experts to the medical institutes is analyzing the self-pay patient and checking the ability of patient whether he will be able to pay or not. Such analysis makes the whole procedure lot easier and gives you a proper picture of where the patient financially stands. Hence, such strategies and many others such useful strategies can easily improve the cash collections and accounts dealing. It is opinionated that if all these institutes focus on revenue cycle management and handle the self-pay patients’ queries efficiently, there will be an improvement in the productivity of institutes.
References
Maksy, M. M. (2013). Which Free Cash Flow Is Value Relevant? The Case of the Healthcare Industry. Journal of Accounting & Finance, 13(6), 107-117.
Pinder, B., Lloyd, A. J., Nafees, B., Elkin, E. P., & Marley, J. (2015). Patient preferences and willingness to pay for innovations in intermittent self-catheters. Patient Preference and Adherence, 9(1), 381-388.
Shwartz, M., Burgess, J. J., & Zhu, J. (2016). Innovative Applications of O.R.: A DEA based composite measure of quality and its associated data uncertainty interval for health care provider profiling and pay-for-performance. European Journal Of Operational Research, 253(2), 489-502.
