Healthcare Collections

Healthcare Definitions

The debt collection industry is a complex, technology-driven industry. This educational guide is to assist those new to the debt collection software industry in understanding terms and definitions.

Healthcare Collections

Healthcare collections relates to outstanding medical bills where a healthcare organization may seek payment from an insurance company, the government or the patient. A growing number of healthcare organizations are collecting accounts in-house to increase cash collections and decrease bad debt write-offs. Ontario Systems is a leading provider of healthcare collections software to the healthcare collections industry.

Ontario Systems provides healthcare collections tools to help automate your healthcare collections process, increasing efficiency and improving the healthcare organization’s bottom line.

Self-Pay Collections
The era of employer-provided healthcare without an out-of-pocket cost for the patient has past. Increasing deductibles and co-pays, as well as increasing uninsured and underinsured populations, have created significantly more self-pay accounts for healthcare organizations.

Given the sudden increase in account volume, many healthcare organizations struggle to adequately follow-up on the self-pay population. The Artiva Healthcare self-pay collection system can help healthcare organizations automate the follow-up process, allowing account representatives to focus on the most profitable activities.

Payor Follow-Up

Healthcare organizations often must follow-up with insurance companies to ensure appropriate payment for services rendered.

The Artiva Healthcare collections software allows account representatives to maximize payor follow-up efforts. Using the collection software allows accounts to be automated and prioritized so that account representative’s efforts are focused on the most important tasks. The overall result is increased cash flow and improved organizational financial strength.

Workflow Management

Workflow management allows organizations to establish business rules, which are automatically enforced by the collection software system. This ensures every account is worked optimally.

The Artiva Healthcare collection software implements workflow strategies, which can be based on account characteristics or risk. It also allows managers to use a champion/challenger scenario to test different account strategies.

Denials Management

Healthcare claims denied by insurance companies often are eligible for reimbursement with additional or corrected information. However, the claim must be resubmitted within a specified time frame or the healthcare organization incurs a loss.

The Artiva Healthcare collection software assists healthcare organizations in tracking and following up on denials, allowing the healthcare organization to positively impact cash collections.

Productivity Reports

Both standard and user-defined productivity reports allow management to review key elements of the organization and make decisions with confidence.

The Artiva Healthcare collection software reporting capability helps management review operations including staff productivity, trends and dollars in the accounting system, which can be turned into cash. The information provided can help in reducing bad debt expense and increasing cash collections.

Charity Care/Financial Assistance

With the exploding insured and underinsured populations, and increased regulatory scrutiny, it is imperative that healthcare organizations consistently implement and document charity care and financial assistance programs.

The Artiva Healthcare collection system provides powerful workflow engines that guide the account representative through the application process, ensuring that financial assistance is offered consistently, based on federal poverty guidelines. The collection software system also provides the ability to document the level of discounted or free care provided to the community.

Return on Investment

The Artiva Healthcare collection software allows healthcare organizations to reduce bad debt and increase cash collections with most clients receiving a rapid return on investment. Ongoing increased cash collections allow the hospital to have additional cash available to clinical departments.

Vendor Management-Placement Strategies

A healthcare organization’s account strategy may include outsourcing the account to a third-party collection agency. An automated system can select which accounts to outsource based on account criteria, select the most appropriate vendor, as well as send and automatically recall accounts.

The Artiva Healthcare collection software can automate placement strategies based on management-determined business rules and account characteristics. Through this functionality, the Artiva Healthcare collection software system can reduce bad debt and increase cash collections.

Collection Dialers/Telephony Technology

Collection dialers and additional telephony technology, such as interactive voice response systems, significantly improve internal collection results by making account representatives more efficient and productive. The account representative speaks only to live voices since the collection dialer screens all no answers, busy signals and disconnects. Interactive voice response systems can be used to answer non-revenue generating questions and set up payment arrangement for some account holders.

Ontario Systems is a leading provider of collection dialers and telephony technology, which is fully integrated with its family of debt collection software products. This integration creates additional efficiency and profitability.

Right-Party Contacts

Combining an automated interactive voice response system with text-to-speech technology allows collection dialers to verify the responsible party is available before connecting the call with a live account representative.

Ontario Systems’ Verified Contacts product is fully integrated with the Artiva collection software system, allowing account representatives to speak only to responsible parties. The Ontario Systems family of collection software products works together, making collection agencies more efficient and profitable.