How is your patient financial services team organized at Johns Hopkins?
The staff at the three traditional hospitals we have work out of a central business office, and within the CBO teams are organized by payer. We have a Medicare group, a medical assistance group, there’s a separate Blue Cross group. Revenue control is a centralized unit, as is cash applications – the actual posting of payments. The only facility that has not been brought into the CBO is Suburban Hospital, in the D.C. suburbs. We recently acquired that hospital.
How has the recession impacted PFS at Johns Hopkins?
Self-pay collections have become a lot more important. The increased unemployment in the area has resulted in more people losing their health insurance. There has also been a rise in bad debt and charity care. Even though self-pay has become a larger part of our payer mix, we have always put an emphasis on upfront collections. Studies show that collecting from a patient becomes about 50 percent harder after the patient leaves the point of care.
Is patient-friendly billing important to Johns Hopkins?
Absolutely. The clearer we can be on the bill itself, the more likely the patient is to pay the bill. And clarity on the bill will actually cut down on the number of calls to our customer service center, which saves money. A lot of what makes a bill “patient-friendly” depends on the billing philosophy of the hospital. For instance, there are some hospitals that do guarantor billing. This type of billing would accumulate all the bills for a family that is on a health insurance plan, and produce them on one statement. I believe that increases the difficulty of having a clear statement. Another philosophy is to do individual patient billing. That can also be confusing, if there is a balance forward. And as a patient you receive many different bills.
Will healthcare reform impact PFS?
As more people are covered by insurance, our bad debt and charity care should decrease. As the reform legislation is currently written, we’re talking about a fairly substantial increase in medical assistance. It will be increasingly difficult to provide services to such a large number of medical assistance recipients and continue to make money. At this point, it’s anybody’s guess whether decreases in bad debt and charity care will offset that.
Could you talk a bit about the impact of denials?
We did some historical tracking about the type of denials we were getting and from which payers. If we identify a particular payer who is giving us lots of denials, we will work with that payer to determine how we can bill so that there system will better understand.
What’s the biggest issue on the horizon for PFS at Johns Hopkins?
The move from IC-9 to IC-10. That will increase the number of codes available, and offer more specificity. That will be a huge educational impact on our staff. The other issue is the next generation of the HIPAA electronic transactions that we use for eligibility verifications. Right now we use version 4010a1 and the move is to 5010, and the effective date for that is January 1, 2012. That’s affecting providers, payers and vendors.
Are there any best practices that you like to emphasize?
Communication is key. Communication with our patients, with our employees, between departments in the hospital, with insurance companies. One of the terms that has come into the healthcare lexicon is “revenue cycle.” You should have regular meetings, where you pull representatives from each of those points of the revenue cycle together, to talk about issues and solutions. That’s something we’ve done here, and it’s been very successful.