We’re not in Kansas

anymore!

Healthcare has changed and we need

courage, knowledge

and a big heart to survive the change!

How did we get here Toto?CMS MEDICARE Changes the rules to restore

$60 billion to the Medicare Trust Fund DRA – Deficit Reduction Act 2005

Created Medicaid Integrity Program (MIP) Dramatically Increased Resources of CMS

& HHS-OIG to Fight Medicaid Fraud Funding - $560M over 5 Years Medicare Contract Reform (MCR)

How did we get here Toto?Medicare Contract Reform (MCR)

POA’s – Present on Admission Indicators HAC’s – Hospital Acquired Conditions/Infections RAC’s – Recovery Audit Contractors MAC’s – Medicare Administrative Contractors

MS-DRG’s – from 500+ to 745 Adds Severity Levels DRG w/ no cc/mcc – $2500 DRG w/cc - $3500 DRG w/cc & mcc - $5000

How did we get here Toto? In Georgia – Bottom Lines began to shrink

due to: 2008 – Medicare Changes Bad Debt Rules

BCBS of GA– Ruled - No more bad debt write offs on active accts.

2009 – SHBP Plan Changes to High Deductibles

- CAHABA Part A – MAC on May 4th

- Medicaid Reimbursement cuts – 5% - Connolly RAC coming in August 09

Growing Uninsured For the sixth consecutive year, the number

of Americans living without health insurance has risen, according to new U.S. Census Bureau data. Approximately 2.2 million people were added to the uninsurance rolls in 2008.

Annual Census Bureau estimates released in August show 47 million people, or 15.8 percent of the U.S. population, are without health insurance

Growing Uninsured Rank   States  Amount  # 1   Texas: 825,635 # 2   Florida: 630,042 # 3   Pennsylvania: 408,822 # 4   California: 394,784 # 5   Georgia: 360,563 # 6   New Jersey: 291,238 # 7   Maryland: 263,616 # 8   Michigan: 258,653 # 9   Virginia: 245,525 # 10 North Carolina: 231,465 

Growing Underinsured DEFINITION

Having insufficient insurance coverage.

http://www.investorwords.com/5122/underinsured.html

Growing Underinsured "It's harder to define the underinsured," Collins said

of the The Commonwealth Fund, who defines underinsured as those who incur high out-of-pocket costs - excluding premiums - relative to their income, despite having coverage all year.

Using that measure in consumer surveys, Collins' firm estimates that 25 million adults under age 65 were underinsured in 2007.

More importantly, Collins pointed out that the number of underinsured increased 60% from 2003 to 2007. That compares with a 5.1% increase in the number of uninsured Americans - to about 46 million - over the same period, according to the U.S. Census Bureau.

"The 25 million [number] can still be an underestimate," Collins said.

Growing Underinsured What's also troubling, she said, is

that the ranks of the underinsured are spreading across income levels and have seen the most rapid increases lately in middle-income households earning between $40,000 to $60,000.

SHBP Changes New plans effective 1/1/2009 – SHBP

Offers only two options to new employees HDHP – High deductible Health Plan HRA – Health Reimbursement Account

HDHP with United & Cigna Single Deductible - $1150 FAMILY with 2 children - $2300

The Bad WitchRESULT:

Increasing Bad Debt and Uncollectible Self Pay Balances

So What Is the Answer? CHANGE!!

Remember the Definition of Insanity??

Doing the same thing over and over and expecting different results!

So What Is the Answer?

CHANGE!!

Remember the Definition of Insanity??

Doing the same thing over and over and expecting different results!

So What Needs to Change? Processes

Are your current processes effective?

How are you managing self pay?

Are you getting the same collections rate on 20% of your Self Pay A/R as you were when it was only 10%??

ExampleIn 2007 10% of $5 Million A/R = Self Pay

$500,000 sent to Early Out VendorCollections Rate – 10% = $50,000

In 200920% of $5 Million A/R = Self Pay

$1 Million sent to Early Out VendorCollections Rate – 10% = $100,000

$900,000 Written Off

End of Part OnePart Two

CMS has changed the meaning of the term - BAD DEBT - So now what do we call it? - The new definition is Early Out - Done the Right Way - Patty Rowland, DAS

End of Part TwoBREAK

Part Three

How Does the Hospital Manage the New Early Out Process to Increase Overall Collections? - Tracey Frederick at Southern Reg Med Center

Part FourSo How Do We Get Started?   Review Process Mapping Tool, Results

Tracking Tools, New Policies & Procedures, Benchmarks - Kathy Whitmire

The Good WitchGA HFMA

HomeTown HealthDAS

With the Solutions to help you make

the necessary changes!

Map Your Current ProcessesLEAN – Six Sigma

There has probably never been a process map developed where someone has not said, "Do we still do that?" or "Why does X happen there?" or "Why are we doing it that way?" or "I did not realize...."

Process Mapping Tools

New Policies & Procedures

Integrate Process changes into Policy & new procedure including:

-Screening for ability to pay or Credit score-Payment Arrangements on all balances

due with signed promissory note-Better Identification of Accounts

- Financial Class or Category-More Timely Placement -Monthly reporting on collections

BenchmarksEarly-out Vendor Benchmarks

Contingency rates range between 7% - 12% Recovery rates range between 8% - 25%.

Know your area.

Track / Trend data monthly

Create A Strategy for Success

Map Your Current ProcessesAnalyze your current resultsSet a goal for improvementCheck out new solutionsOutsource to a proven vendorTrack your Results!!

Best PracticesSuccess Stories & Best Practices

Questions & Answers

THANKS FOR BEING A PART OF TODAY’SMEETING!!!