According to the American Hospital Association, hospitals write off more than $38 billion in uncompensated care-based costs each year.[1]Whether from uninsured, under-insured, increasing self-pay, or reduced reimbursements—the hit to the bottom line is significant. Many turn to cost-cutting measures as a way to mitigate the damage. But a 2017 Advisory Board report found that the typical 350-bed hospital leaves around $22 million on the table by focusing on cutting costs, over-optimizing their revenue cycle.[2]One area, especially susceptible to revenue loss, is international claims. But it’s also an ideal opportunity for revenue recovery.
More than half of US tourists are without insurance. For those who are covered, the nuances of foreign insurance regulations can be quite complex. Of even great challenge is collecting self-pay balances. More forward-thinking hospitals are choosing to outsource international claims to industry experts who are adept at managing those complexities. This allows hospital staff to focus on core competencies of collecting from patients closer to home.
The following are five essential capabilities hospitals should look for when choosing an international claims outsourcer.
They understand each country’s unique medical coding requirements. There are tens of thousands of medical codes used by countries around the world. Terminology and descriptions vary—often substantially—from country to country.[3]The best partners will be those who are familiar with multiple coding systems and mapping. This can help facilitate faster claims processing.
They’re fluent in multiple languages and currencies. As self-pay increases in the US, hospitals are already struggling to get a handle on talking with patients about their financial responsibility. Now add additional layers of complexity from foreign languages, accents, and currencies, and those conversations become even more difficult. Hospitals should choose a partner with agents who understand not only the language and currency but also the varying cultural nuances of each country. For example, in some countries, a man will only talk with another man about matters such as finances. Each patient’s culture should be respected, and the conversation should be tailored to accommodate those cultural differences in order to provide the best financial experience.
They need to offer a variety of EDI interfaces. Payment adjudication systems vary from country to country. Look for a company that can accommodate multiple systems. This will streamline the process and shorten reimbursement time. It is also important that the outsourcer understands the complexity of collecting self-pay payments since patients often have to use multiple methods to pay a single bill. For example, when putting a large balance on credit, the patient may have to use more than one card due to balance limitations. The same is true for wire transfers. And those payment methodologies need to be integrated into the hospital’s RCM systems.
They need to provide reporting and analytics. Having full transparency into the claim lifecycle is hard enough with domestic claims. With international claims, the pursuit of visibility is even more challenging. The best outsourcers will be those that can provide historical data with qualitative and quantitative analytics so hospitals can identify the best collections opportunities. It also helps to identify closed international accounts that may be worth pursuing.
They need to embrace the importance of the patient financial experience. As patients have taken on more of their healthcare costs, they’ve come to expect the same quality in their financial engagements as they do in their clinical engagements. Just a handful of poor online reviews can damage a hospital’s brand reputation and future market share. And international patient reviews are no different. The best outsourcers are those that embrace your hospital’s culture and act as extensions of your hospital’s business office by treating your international patients with the utmost care.
Sunbelt Health Partners has more than 30 years of expertise in managing international claims and collections for some of the largest healthcare systems in the US and abroad. Our team of multilingual agents are experts in cultures around the world. They are cognizant of their role in representing our clients’ hospitals and the importance of delivering a positive patient financial experience.
Our specialists deliver superior collection results, often exceeding 94% with a significant percentage of claims paid above 70% of charges.
Sunbelt’s team of experts have acquired in-depth knowledge of international claims adjudication, including coding specifications and regulatory requirements. Our technology provides the highest level of security and compliance with HIPAA, HITECH, ISO, and international regulations. We also provide ongoing reporting with qualitative and quantitative data on claims, ongoing account statuses, and patient satisfaction.
In today’s more challenging financial ecosystem, hospitals cannot afford to leave money on the table. Partnering with Sunbelt Health Partners to manage international claims helps hospitals reduce costs, increase collections, and enhance the international patient financial experience.
[1]https://www.aha.org/system/files/2018-01/2017-uncompensated-care-factsheet.pdf
[2]https://www.advisory.com/research/financial-leadership-council/at-the-margins/2017/06/22-million-opportunity
[3]https://www.hddaccess.com/tips/mapping-between-the-code-systems-of-different-countries-a-case-study-cci-to-icd-10-pcs