Ten Guidelines for Choosing a Billing and Collections Partner

The holidays can wreak havoc on a hospital’s bottom line. The annual increase in ED visits means an increase in post-holiday self-pay collections. When the hospital bill arrives at the same time the credit card bills hit, collecting becomes that much more difficult. Many hospitals also see a rise in ED visits by those vacationing from other countries or visiting family during the holidays. These international claims add another level of complexity to the self-pay equation.

Many hospitals choose to be more proactive in addressing these issues by partnering with billing and collections experts to streamline the process for both domestic and foreign claims. Doing so helps remove the burden from the hospital while facilitating faster payer reimbursement and greater self-pay collections.

But choosing a billing and collections partner can be challenging. Hospitals need a solution that fits within existing workflows and is flexible enough to ebb and flow with seasonal spikes in activity. The following are ten capabilities hospitals should look for when choosing a partner.

  • First and foremost, hospitals should look for a partner that has extensive experience in both domestic and foreign claims. Collecting from overseas payers and patients can be vastly different due to coding variances and differences in regulations, technologies, and adjudication workflows. Trying to blend these into existing revenue cycle workflows can cause a cog in cash flow.
  • They need to have a deep understanding of the international insurance community. There are thousands of insurance companies across the globe. It’s not enough just to work with domestic payers. The best partners will have connectivity with all the top payers, no matter where they’re located.
  • Make sure the partner you choose can show results. If they aren’t achieving at least 90% collections, or claims paid above 70% of charges, you may want to keep looking.
  • It’s essential to find a company that can work with any size health system, domestic or abroad. This is increasingly relevant to the rise in M&A activity in the healthcare industry. A change in the number of claims should be no problem for your collections and billing partner.
  • Be sure to discuss payer contract liabilities. Choose a company that can protect against inappropriate access to domestic insurance contracts by international carriers.
  • Although the number of foreign patients can vary from hospital to hospital across the country, any amount of international claims can negatively impact your bottom line. Because of this, it is wise to choose a partner that employs multilingual collections agents. Having a financial conversation about patient responsibility is challenging enough for US patients. Add a language barrier to the mix, and that difficulty is significantly increased. Foreign currency conversions are also of concern, and the company chosen should have the ability to convey amounts due in any currency.
  • One thing many hospitals overlook when choosing a billing and collections partner is the company’s approach to the patient experience. The best companies will understand the importance of patient engagement and will treat your patients with respect and customer service excellence. They will understand they are an extension of your hospital and will embrace and convey your values with every engagement.
  • Many hospitals find it beneficial to have on-site support for their existing business office and registration processes. Look for a partner that can help in this capacity for both international and domestic claims.
  • Interoperability challenges should be no problem for the right billing and collections partner. They should have a broad array of EDI interfaces to interact with most any system.
  • Finally, it is critical to choose a partner that meets all domestic and international regulatory requirements. At the very least, they should be HIPAA, HITECH, and ISO compliant.

It is estimated that 35% of provider revenue now comes directly from patients.

[1] Hospitals simply cannot afford to keep writing off unpaid patient balances. Being able to mitigate the damage from post-holiday collections and foreign claims will go a long way in helping hospitals protect and grow their bottom line.

[1] https://www.forbes.com/sites/allbusiness/2017/06/28/what-we-can-all-do-about-rising-healthcare-costs/#67574d3d2f37