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6 Predictions for the Healthcare Industry and Revenue Cycle Management in 2020

6 Predictions for the Healthcare Industry and Revenue Cycle Management in 2020

By Shawn Yates | Jan 14, 2020 | RCM

The healthcare industry has seen transformational change in recent years. The ‘20s will bring even more change and uncertainty. Economic, market, and regulatory forces will continue to reshape the landscape, making it even tougher to navigate.
 
With operating margins declining 21% in 2019 (despite positive gains in 2018), providers are struggling to maintain their footing.
 
In response, many are taking a hard look at their operations, business model, and growth strategies. They’re also embracing innovation as a means of strengthening their financial health and ability to compete.
 
 
“Burdened by expensive fixed assets, redundancy, and inefficient utilization levels, health systems need a major course correction if they are to provide 24/7/365 access, shift care to virtual and lower-cost settings, manage new competitive threats, and meet rising consumer expectations. Becoming 2 to 3 percent more operationally fit each year will not keep pace with the rate of change required.” – Geoff Martin, COO & Managing Principal, GE Healthcare Partners
 
In light of this increasing complexity and financial strain, providers will need to make a bold move in 2020 to improve their operations. Below, I’ve outlined my specific predictions for 2020 and why now is the time for providers to act.
 
 

1. Reimbursements Will Continue to Shrink

Healthcare spending is growing out of control; in fact, it’s growing faster than projected GDP growth. According to the Centers for Medicare and Medicaid Services, our national health expenditure is expected to grow 5.5% annually through 2026 and account for 19.7% of GDP by 2026 (up from 17.9% in 2016).
 
This growth rate is unsustainable. Unfortunately, the budget cuts required to curb healthcare spending will likely take the form of declining reimbursements—an existing trend that will continue into 2020 and beyond.
 
In a December 2018 survey of 100 healthcare executives, 62% listed declining reimbursements as their #1 organizational challenge. In 2020, that sentiment will undoubtedly spread as providers feel increasing pressure to reduce operating costs and address weaknesses in their revenue cycle.
 
 

2. Commercial Carriers Will Continue to Shift More Costs to Patients

Expect to see continued increases in high-deductible health plans (HDHPs) and growth in insurance premiums for 2020. The percentage of workers covered by an HDHP grew to 30% in 2019—a 1% increase over 2018, but more than double the percentage covered in 2010.  This is a continuation of a trend we’ve seen since 2006; there are no signs of this abating, and this growth will continue in 2020. 
 
Insurance premiums have grown 54% in the last 10 years. The average family now must pay over $6,000 a year for coverage, making it tougher for them to pay for unexpected medical bills. According to a 2018 report, 77% of providers indicated it takes more than a month to collect any payment, and over 80% of providers reported being unable to collect $1,000+ within 30 days. 
 
These trends are readily evident in a 2019 survey of healthcare executives, in which 85% identified consumer self-pay as a concern for their organization (see below). In 2020, consumer self-pay will continue to become more prevalent and more of a challenge for providers already struggling to collect payments.
 
 
consumer self-pay, healthcare, RCM, 2020
Source: HFMA-Navigant RCM Survey (2019)
 
 

3. Retail Clinics and Telemedicine Will Have a Greater Impact

The growth of retail clinics and telemedicine, which has been a major trend over the past few years, will likely accelerate in 2020. You’ll also see an expanding array of available options for consumers. More and more large employers will set up their own worksite clinics, for example, or create special contracts with certain providers.
 
 
retail medicine, healthcare, RCM, 2020
 
 
This growth in retail, employer-based, and remote healthcare services reflects employers’ focus on productivity and retention and consumers’ desire for immediacy and ease. But as traditional providers’ patient volumes drop, this will further reduce revenue and margins, creating more of a financial strain on providers and forcing them to make changes.
 
 

4. The 2020 Election Will Be a Major Turning Point

Democrats and Republicans have differing opinions on what to do with the Affordable Care Act (ACA). Republicans want to continue to dismantle it, while Democrats would either build it back up or go with another alternative like universal healthcare. 
 
No matter the 2020 election outcome, it will be pivotal for the financial environment in healthcare. Either the uninsured will continue to grow to pre-ACA levels, or an enhanced model/new program will have to be paid for—meaning more reductions in reimbursements.
 
 

5. Patient Engagement Will Come Into Sharper Focus

When it comes to adopting new technology, healthcare providers have often lagged behind other customer-facing industries. Consumers want and expect a convenient, personalized experience across all brand encounters, regardless of industry.
 
The pressure is on for healthcare providers to move beyond traditional letters, phone calls, and portals and provide digital communication options that could help improve treatment outcomes and make it easier for patients to meet their financial obligations. Moving forward, expect to see rapid growth in patient engagement platforms that combine more of these services into one offering for both providers and patients. 
 
 

6. A/R Collector Productivity Will Become a Top Priority

Over the past few years, healthcare providers have focused on automating as many tasks as possible. Automation is key to achieving optimal efficiency, but the bigger issue (and greater challenge) is managing employees in ways that help them be more productive and effective. This is especially true in RCM, on the back end of the revenue cycle.
 
In 2020, managing A/R collector performance (whether employees are working remotely or on site) will become an urgent priority across the healthcare industry. Providers will increasingly look for ways to give A/R teams more valuable feedback and tools as a means of controlling labor costs, shortening the revenue cycle, and maximizing revenue recovery.
 
Are you looking to build an accountable, more effective A/R operation? You’ll find the answers you need in our eBook “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix.” Download your free copy today, and start working toward a more profitable year.
 
 

 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Boost Your A/R Results — and Your Business Results — with Ease

In this brief guide, The Accountable Collector: Transforming Healthcare A/R with One Simple Fix, learn about the two big revenue drains every provider must address, and how to fill your “EHR platform gap” so you can start building an accountable collections team.

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A 5-Step Dive into HIPAA Compliance for Email and Text

A 5-Step Dive into HIPAA Compliance for Email and Text

Nov 7, 2019 | RCM

 Last week, I wrote about email and text guidelines the American Medical Association (AMA) set forth to help healthcare providers ensure their electronic communications comply with the Health Insurance Portability and Accountability Act (HIPAA). Thanks to this...

Why Ransomware Is Serious Business (and How to Minimize the Threat)

Why Ransomware Is Serious Business (and How to Minimize the Threat)

By Rick Clark | Dec 17, 2019 | ARM, GOV, RCM

Everywhere you look these days, it’s in the headlines: another healthcare network, business, or government entity has suffered a debilitating ransomware attack. What used to be a curiosity is now a raging epidemic that shows no signs of slowing—and no sector is immune. By 2021, ransomware damages could cost the world $20 billion (57 times more than in 2015).
 
Even worse, cybercriminals are shifting their strategy. Not only are they demanding larger sums of money—from a few thousand dollars to upwards of $50,000 in just the past few years—but they’re increasingly targeting small and midsize businesses, which may be less sophisticated on the IT front and more willing to pay.
 
I recently sat down with Steve Lodin, senior director of cybersecurity operations/corporate security at Sallie Mae, to discuss this growing threat. We also offered advice for organizations looking to harden their defenses and prepare to respond in the event of an attack.
 
Here are a few highlights from our webinar, “Be Smart, Take Charge: What You Need to Know About Cybersecurity and Ransomware Prevention, Detection, and Response” (you can access the free webinar here).
 
 

How Does Ransomware Work?

Ransomware is malicious code that’s designed to encrypt files on an infected system or storage device to prevent the owner of the data from accessing it. Cybercriminals demand a ransom in return for a decryption key.
 
Ransomware can infiltrate in various ways. Among the most common are phishing emails containing embedded links and innocent-looking email attachments. Email attachments don’t have to contain ransomware code; once opened or downloaded, they can simply run additional code that instructs the host system to download ransomware code from a website.
 
Think about what this means. Among tens, hundreds, or thousands of employees, it takes just one person, one email, one visit to a malicious website. Once that ransomware code finds a vulnerability in the host environment, it can take over in short order.
 
Now, here’s the really bad news: paying these criminals doesn’t always bring data back. In fact, according to a 2017 study, only 26% of businesses that paid a ransom in 2017 received a decryption key. (Of those organizations that paid, 73% were attacked again.)
 
 

How Can You Protect Your Business and Limit the Fallout?

Every organization needs a three-pronged approach to effectively address the ransomware threat: prevention, detection, and response. You’ll want to begin with proactive measures that lessen your odds of a successful attack and limit your vulnerabilities when ransomware strikes.
 
 
SYSTEMS
  • Limit access to your systems, including local admin access (the principle of least privileges).
  • Ensure your system is patched, along with third-party apps like Adobe and Flash.
  • Secure the system with antivirus, anti-malware, and email security services that block known threats; implement tools that scan incoming emails or flag employee activity on known malicious websites.
  • Invest in good data backups.
  • Evaluate and monitor connections with third-party vendors. Allow access only as required for them to provide services, and only on network segments they need.
 
PEOPLE
  • Instruct employees to report suspected phishing emails.
  • Communicate with employees about current ransomware threats.
  • Test employees periodically with sample phishing emails and unfamiliar attachments to maintain awareness.
 
PLANNING
  • Create an incident response plan, ideally involving IT, legal counsel, internal and client communications, and forensic analysis; test and refine it regularly based on newly identified weaknesses and threats.
  • Invest in cybersecurity insurance, with a full understanding of what’s covered in the event of an attack.
  • Make sure vendor contracts include language requiring vendors to notify you within a short period of time of any attack on their systems. Know how to shut down connectivity quickly in case of attack.
  • Enhance your tech stack. An incident response manager tool will allow you to see how/where you’ve been compromised, act fast, and minimize the impact of a ransomware attack; a file integrity management solution can tell you whether any changes made were authorized by your existing change management system.
  • Make sure you have access to enough Bitcoin in case paying ransom is your only option; you might want to establish a Bitcoin account expressly for this purpose.
 
EMERGENCY RESPONSE
  • Check with law enforcement to determine your odds of recovering data. Depending on the type of ransomware deployed, you might be able to get a decryption key from the FBI’s database.
  • Perform a system analysis to determine what communications went outbound and what specific actions were taken on the system. These details will help you determine what gaps in your security stack need fixing.
 

Want to Learn More About Ransomware Preparedness?

If this post left you with more questions than you had before, you’ll want to tune into our recent webinar, “Be Smart, Take Charge: What You Need to Know About Cybersecurity and Ransomware Prevention, Detection, and Response.” You’ll learn more details about the ransomware threat and come away with more resources and specific tips you can use to better secure your systems and develop a thorough, effective response plan.
 
Don’t wait till ransomware strikes to understand what you’re up against and fortify your business. Access the free recording here, and start taking steps to minimize the threat.
 
 
 
 
 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2019 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Info and Insights You Won't Want to Miss

Here on the OS Blog, we aim to give you just the right mix of high-level views, tactics, and tools you can use to optimize your collection operations and results. Subscribe today for a steady stream of practical, empowering content delivered to your inbox weekly.

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ARM Industry Leaders, Why Aren’t You Texting?

ARM Industry Leaders, Why Aren’t You Texting?

By Mike Meyer | Jan 29, 2020 | ARM

This is the first post in a new blog series highlighting the importance of text messaging for debt collections and what ARM businesses need to stay compliant.   Text messaging for debt collections might seem like a bridge too far. But it’s entirely within reach today....

For Leading Collection Agency, Ontario Reports™ Offers Simpler, More Sophisticated Reporting

Nov 25, 2019 | ARM, GOV, RCM

Asset Recovery Group (ARG), a premier collection agency with 5.8 million account records and a growing client base, was struggling to fulfill extensive reporting requirements and glean timely business intelligence from its FACS® database. ARG’s overburdened team needed a better way to build and share reports, but most available solutions were too complex and costly.

Recently, ARG discovered Ontario Reports™, an intuitive reporting tool that integrates seamlessly with its FACS system (and all Ontario Systems’ core receivables platforms). An easy five-minute installation led to huge gains in efficiency, reporting capabilities, and report quality.

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A 5-Step Dive into HIPAA Compliance for Email and Text

A 5-Step Dive into HIPAA Compliance for Email and Text

By Rozanne Andersen | Nov 7, 2019 | RCM

 
Last week, I wrote about email and text guidelines the American Medical Association (AMA) set forth to help healthcare providers ensure their electronic communications comply with the Health Insurance Portability and Accountability Act (HIPAA). Thanks to this roadmap, and current available technologies, providers and their business associates have what they need to email and text patients legally and responsibly when Protected Health Information (PHI) is at stake.
 
Today, I’m going to discuss HIPAA compliance more in depth—specifically, as defined and determined by the HIPAA Privacy Rule, the HIPAA Security Rule, and the Health Information Technology for Economic and Clinical Health (HITECH) Act. Each of these contributes to the pool of regulatory requirements controlling the exchange of PHI via electronic communications.
 
Understanding how these regulations (collectively referred to herein as “HIPAA requirements”) impact text and email communications is your first step toward launching a HIPAA-compliant text and email communication program.
 
 

First Things First: A Brief HIPAA Breakdown

Before we launch into our five-step dive, here’s a quick primer on how HIPAA requirements have evolved and expanded since 2000.
 
HHS Privacy Rule
Health and Human Services (HHS) published a final Privacy Rule in December 2000, which was later modified in August 2002. This rule set national standards for the protection of individually identifiable PHI by three types of covered entities: health plans, health care clearinghouses, and health care providers who conduct standard healthcare transactions electronically. Compliance with the Privacy Rule was required as of April 14, 2003 (April 14, 2004, for small health plans).
 
HHS Security Rule
HHS published a final Security Rule in February 2003. This rule sets national standards for protecting the confidentiality, integrity, and availability of electronic PHI. Compliance with the Security Rule was required as of April 20, 2005 (April 20, 2006 for small health plans).
 
HHS Enforcement Rule
The Enforcement Rule provides standards for the enforcement of all the Administrative Simplification Rules.
 
HHS Breach Notification Rule
Under certain circumstances, the Health and Human Services (HHS) Breach Notification Rule requires covered entities and business associates to report all PHI breaches to HHS and the impacted individuals. HHS enacted a final Omnibus rule that implements a number of provisions of the HITECH Act to strengthen the privacy and security protections for PHI established under HIPAA, thus finalizing the Breach Notification Rule.
 
Are you ready to text? Do you fully understand the requirements and risks? Don’t miss my recent webinar, “HIPAA’s Take on Email and Text: What You Need to Know to Comply and Serve Patients Well.” You can access the free recording here.
 
 

Now, Let’s Dive Into the HIPAA Requirements

These are five of the most important aspects of HIPAA as it pertains to email and text. If you’re considering using electronic communications to engage patients for any reason, these bottom-line takeaways should be top of mind.
 
Step #1: Relationships Matter
The HIPAA requirements for text and email communications differ depending on the relationship between the texting or emailing parties.
 
While all electronic communications sent from a covered entity or business associate to a patient must be secure, communications from the patient to the covered entity or business associate need not be secure. This is because the HIPAA requirements do not require covered entities and business associates to be legally responsible for the encryption of PHI sent by the patient to the covered entity or business associate.
 
Nevertheless, the covered entity or business associate still bears some responsibility regarding email and text communications received from a patient (see Step #2).
 
Step #2: Consumer Warnings Matter
As I mentioned in my previous blog post, providers and business associates who offer patients an opportunity to communicate electronically using a text or email service must warn consumers about the insecurity of the communication platform.
 
According to the AMA’s guidelines related to HIPAA requirements for communications between provider/business associate and patient, when communicating with patients electronically, the provider/business associate must also inform patients of:
 
  • The inherent limitations of electronic communication, including possible breach of privacy or confidentiality issues; and
  • The difficulty in verifying the identity of the parties when texting or emailing and the potential impact of delayed responses.
 
The provider/business associate should also provide patients with an opportunity to accept or decline electronic communication before privileged information is transmitted, and they should document the patient’s decision to accept or decline the opportunity.
 
Lastly, the provider/business associate should take steps to help the patient understand that any texts or emails he or she might send the provider/business associate are not secure and may be subject to intrusion, hacking, and identity theft.
 
 
Step #3: Patient Expectations Matter
The HIPAA requirements are not prescriptive with regard to text and email communications. Rather, they expect covered entities and business associates to meet the expectations within reason.
 
For example, if a patient demands the medical collection agency email a copy of his or her statement to a Gmail address and the collection agency has absolutely no process in place to email patients, HIPAA would not require the medical collection agency to accommodate the patient by implementing an email communication system.
 
On the other hand, if a patient indicates he or she does not want the medical collection agency to leave voicemail messages on his or her cell phone and to send texts instead (assuming the agency has a text message program in place), HIPAA would require the medical collection agency to cease leaving voicemail messages and restrict communications with that patient to text.
 
Step #4: Playground Rules Don’t Matter
Covered entities and their business associates often ask whether they can interpret a patient’s unsolicited email or text as consent to electronic communications.
 
The assumption behind the question is best reflected in the familiar line, “Well, they started it.” While this may work as a playground rule, it fails under the HIPAA requirements.
 
Parties who wish to communicate with patients electronically must obtain the patient’s consent to continue using the particular form of electronic communication, even when a patient initiates the text or the email.
 
Step #5: Encryption Matters
Email and text communications are inherently insecure; they’re not secured by default, and they’re easy to hack.
 
An individual’s email account can easily be accessed by a third party if a weak or easy-to-guess password is used for the email account. A provider’s email system is also vulnerable to attack if the organization does not use two-factor authentication and other simple controls such as passwords and screen time-outs.
 
Because all consumer-grade email platforms and texting programs are known to be insecure means of communication, their use for professional purposes may be considered in itself a breach of the HIPAA requirements.
 
The HIPAA Security Rule §164.312(e) requires covered entities and their business associates to consider the encryption of communications as an Addressable Implementation Specification. This is a defined term under the HIPAA Security Rule. Providers and their business associates must comply with this rule when contemplating the use of electronic communications.
 
 

HIPAA Is Complex, but Email and Text Needn’t Be

Technologies that can secure text and email communications as required by HIPAA are readily available today. In fact, providers have a range of options that are designed for this very purpose and perform their job well.
 
Once you understand what HIPAA requires and have the right tools in place, electronic communications will become less of an ongoing concern and more of an asset—a major advantage, in fact—for your operations and your business. Frankly, you’ll wonder how you ever got along without them.
 
 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2019 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Info and Insights You Won't Want to Miss

Here on the OS Blog, we aim to give you just the right mix of high-level views, tactics, and tools you can use to optimize your collection operations and results. Subscribe today for a steady stream of practical, empowering content delivered to your inbox weekly.

Subscribe to the Blog

Are You Ready to Text?

Take charge of compliance and start texting with confidence. This free eBook explains how.

GET THE EBOOK
A 5-Step Dive into HIPAA Compliance for Email and Text

A 5-Step Dive into HIPAA Compliance for Email and Text

Nov 7, 2019 | RCM

 Last week, I wrote about email and text guidelines the American Medical Association (AMA) set forth to help healthcare providers ensure their electronic communications comply with the Health Insurance Portability and Accountability Act (HIPAA). Thanks to this...

Electronic Patient Communications in the Wake of HIPAA: The Ban Has Lifted

Electronic Patient Communications in the Wake of HIPAA: The Ban Has Lifted

By Rozanne Andersen | Nov 1, 2019 | RCM

Healthcare providers remain skittish when it comes to email or text communications, and their reluctance is understandable.
 
Historically, both email and text messages were considered inherently unsecure modes of communication. In addition, many healthcare providers and business associates believe the Health Insurance Portability and Accountability Act (HIPAA) and the HIPAA Privacy and Security Rule’s restrictions on the use, transfer, and storage of demographic data and Protected Health Information (PHI) make email and text messaging far too risky.
 
In response to the concerns of the healthcare community as well as the financial services industry—which has similar needs to protect the confidentiality of personally identifiable information—the cellular phone and internet industries have built safe, secure electronic communication platforms that secure information both in transit and at rest.
 
If email and text are used properly and with the controls required by the American Medical Association (AMA) to send electronic messages containing PHI, healthcare providers can now embrace these forms of patient communications.
 
 

AMA Requirements for Email and Text

As the AMA makes clear, HIPAA does not specifically prohibit sending PHI by text or email. However, it does require the electronic communication platform to include:
 
  • Safeguards to ensure the confidentiality of PHI at rest and in transit;
  • Controls for who can access PHI;
  • Permissions for what authorized personnel can do with PHI when they access it; and
  • Processes to prevent the interception of plain text messages.
 
Healthcare providers and business associates should exercise due diligence when selecting a text or email communication platform provider. At a minimum, they should require the provider to ensure its text or email platform can support the AMA’s four requirements of an electronic communication platform.
 
The AMA has further clarified its position on sending PHI by text or email in Section 2.3.1 of the AMA’s Code of Ethics. As this section makes clear, concerns remain about privacy and confidentiality when communicating and transmitting PHI electronically. Physicians must uphold the same ethical standards when communicating with patients electronically as they do during other clinical encounters. They must also ensure the method of communication—whether virtual, telephonic, or in person—is appropriate to the patient’s clinical need and to the information being conveyed.
 
While HHS and the Center for Medicare and Medicaid Services (CMS) do not prohibit healthcare providers and practitioners from communicating with their patients by text messages or email, healthcare providers and practitioners cannot disavow their responsibilities under the law, HIPAA, the HIPAA Privacy and Security Rule, or the AMA Code of Ethics by hiring a business associate to manage their electronic communications. 
 
Business associate agreements must include specific provisions regarding the use of text messaging and email and delineate any privacy or security requirements of the covered entity.
 
 
Are you ready to text? Do you fully understand the requirements and risks? Don’t miss my recent webinar, “HIPAA’s Take on Email and Text: What You Need to Know to Comply and Serve Patients Well.” You can access the free recording here.
 
 

AMA Guidelines for Email and Text

Here are the AMA’s specific guidelines regarding electronic patient communications. These standard practices help to ensure day-to-day compliance and ethical, responsible patient care.
 
Physicians who choose to communicate electronically with patients should:
 
(a) Uphold professional standards of confidentiality and protection of privacy, security, and integrity of patient information.
 
(b) Notify the patient of the inherent limitations of electronic communication, including possible breach of privacy or confidentiality, difficulty in validating the identity of the parties, and possible delays in response.
 
Such disclaimers do not absolve physicians of responsibility to protect the patient’s interests. Patients should have the opportunity to accept or decline electronic communication before privileged information is transmitted. The patient’s decision to accept or decline email communication containing privileged information should be documented in the medical record.
 
(c) Advise the patient of the limitations of these channels when a patient initiates electronic communication.
 
(d) Obtain the patient’s consent to continue electronic communication when a patient initiates electronic communication.
 
(e) Present medical information in a manner that meets professional standards. Diagnostic or therapeutic services must conform to accepted clinical standards.
 
(f) Be aware of relevant laws that determine when a patient-physician relationship has been established.
 
 

For Providers and Their Patients, a Big Leap Forward

Healthcare professionals should welcome the AMA’s efforts to advance communications between patients and their providers. Text and email can be used to improve the patient experience, inform patients of their rights, remind them of important appointments, deliver treatment plans, follow up with recommendations, and even establish a lifeline between patients and physicians.
 
Today’s patients appreciate and deserve the opportunity to communicate with providers using a variety of methods. The AMA’s recognition of this fact, and the framework it has provided for healthcare-related electronic communications, is a major win for all involved.
 
 
 
 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2019 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Info and Insights You Won't Want to Miss

Here on the OS Blog, we aim to give you just the right mix of high-level views, tactics, and tools you can use to optimize your collection operations and results. Subscribe today for a steady stream of practical, empowering content delivered to your inbox weekly.

Subscribe to the Blog

Are You Ready to Text?

Take charge of compliance and start texting with confidence. This free eBook explains how.

GET THE EBOOK
A 5-Step Dive into HIPAA Compliance for Email and Text

A 5-Step Dive into HIPAA Compliance for Email and Text

Nov 7, 2019 | RCM

 Last week, I wrote about email and text guidelines the American Medical Association (AMA) set forth to help healthcare providers ensure their electronic communications comply with the Health Insurance Portability and Accountability Act (HIPAA). Thanks to this...

How to Use Email and Text for Collections Without Getting Burned (Part 2)

How to Use Email and Text for Collections Without Getting Burned (Part 2)

By Rozanne Andersen | Oct 17, 2019 | ARM, RCM

 
If you read part 1 of this two-part blog series or listened to part 1 of our AccountsRecovery.net webinar “Email Is Hot, Texting Is Hotter: Don’t Be the First to Get Burned,” you might have found some of our comments surprising. Perhaps you left with more questions than you’d had going in. Or you wonder how in the world communicating compliantly via email and text—consistently, day in and day out—is even possible.
 
I understand completely. There’s no shortage of legal requirements and practical issues to wade through, and there’s a lot riding on your communication practices.
 
That’s why I’m here today with part 2. It’s based on my continuing discussion with David Kaminski, chair of the Consumer Financial Services Law Practice at Carlson & Messer LLP in Los Angeles. (Part 2 of the AccountsRecovery.net webinar is available here.)
 
Let’s dive straight into some of the webinar highlights.
 
 

Work Email Addresses and Mobile Numbers: Are They Safe to Use?

If a consumer provides you with a work email address or mobile number, you should tread carefully. These channels may not be fully under the consumer’s control. If the consumer ends his or her employment, he or she could miss important communications. If a current or previous employer monitors or accesses email or text messages, you run the risk of third-party disclosure.
 
Here’s what David and I recommend:
 
  • Always ask consumers for personal contact information. Your best bet, legally speaking, is to minimize the number of work accounts your organization uses for collection-related communications.
  • Get consumers to agree to notify you if their employment status changes. If your terms and conditions are detailed enough, and the consumer assumes responsibility for keeping you informed, you’ll have done your part to ensure the integrity of the collections process. This will afford a good measure of protection in the event of a legal claim.
 
“So if that consumer had given you consent . . . but now you’ve added in the additional wrinkle of the fact that the person has left the office. She’s no longer there, but they’re monitoring her email. They open the email, and therefore the company gets the . . . analytic results saying, ‘I sent my 1692g notice.’ [ . . . ] Did she receive the notice, or did she not?” – David Kaminski
 
 

Text Messages: Navigating Carrier Demands, Consumer Expectations, and the Law

The Cellular Telephone and Internet Association (CTIA) is a self-regulatory body that represents mobile service providers and other industry organizations. The CTIA has its own messaging principles and best practices, but they’re not legally binding. You can’t be sued for violating them.
 
Still, it’s important to comply with CTIA guidelines so you know your texting practices align with carrier and consumer expectations.
 
  • Use simple, straightforward language. Consumers must fully understand anything they’re signing up to receive. Opt-in mechanisms must be clear, and when consumers unsubscribe, they must receive an acknowledgement of the action.
  • Be careful with abbreviations. Acronyms can’t spell out inflammatory words (I’d call this one a no-brainer).
  • Terms and conditions are essential. By getting a consumer to agree to terms and conditions upfront, you can effectively nullify gaps and inconsistencies between CTIA and Fair Debt Collection Practices Act (FDCPA) requirements.
 

E-Sign: How It Applies, and How to Comply

A consumer’s E-Sign consent gives debt collectors permission to substitute electronic delivery for snail mail delivery of legally required written documents. You don’t need E-Sign consent to email or text a consumer everyday collection-related communications such as paid-in-full statements, responses to balance inquiries, payment receipts, etc.
 
However, you DO need to obtain a consumer’s E-Sign consent before you may deliver legally required written documents and disclosures to the consumer electronically. Examples of legally required written documents and disclosures include post-dated payment reminders, validation notices not provided in initial consumer communications, and copies of Reg E recurring electronic funds transfer authorizations.
 
FACT: Obtaining E-Sign consent is a two-step process.
First, you must inform the consumer of his or her rights. There are several ways to inform consumers of their E-Sign rights:
 
  • During a recorded conversation with the consumer;
  • In an email;
  • In a text message;
  • In a writing;
  • On a website. 
 
Second, you must ask the consumer to demonstrate his or her ability to access the email address or use the mobile number he or she provided you for E-Sign purposes to receive legally required notices and disclosures.
 
The consumer can demonstrate his or her ability by: 1) sending you a text message or keyword using the mobile number they provided you for E-Sign; or 2) replying to an email or text message you sent to the email address or mobile number they provided you in connection with their E-Sign consent.
 
E-Sign consent takes effect only after the consumer has consented to using a particular channel (email or text) AND has demonstrated he or she can use that particular email address or mobile number.
 
FACT: An initial communication that includes the 1692g validation notice DOES NOT trigger the E-Sign requirement.
This is because there is no writing requirement in play for the initial communication. Section 1692g of the Fair Debt Collection Practices Act (FDCPA) makes clear you only need to “send” the consumer the validation notice [in writing] if you DID NOT provide it in the first communication (e.g., in the body of an email or verbally in a phone call) or if the consumer has already paid the debt.
 
Since E-Sign consent is required only for notices and disclosures that must be provided to the consumer in writing as a matter of law, it does not apply to the validation notice provided in the first communication.
 
FACT: A communication subsequent to the initial communication with the consumer DOES trigger the E-Sign requirement.
This is because the FDCPA imposes a writing requirement on a validation notice if it’s provided in a communication subsequent to the initial communication.
 
For example, if your first communication with the consumer was a text or phone call and you did not include the 1692g validation notice in that communication, you must send the consumer the validation notice within five days of that communication. In this context, the word “send” means by first class or certified mail with return receipt requested.
 
If you would prefer to email or text the written validation notice to the consumer, you may substitute the U.S. Postal Service mail delivery method with a digital delivery method if you first obtain the consumer’s E-Sign consent to do so.
 
Just remember: if you have an initial communication with the consumer that did not include the validation notice, you would be legally required to obtain E-Sign consent within the five-day window and electronically deliver the validation notice or link to the validation notice within the same five-day window.
 
If you fail to obtain the E-Sign consent, the validation notice is not opened, or the link to the validation notice in the email is not clicked within the five days of that initial communication, you must send the validation notice to the consumer using first class U.S Postal Service mail delivery.
 
TIP: To obtain proper E-Sign consent, provide detailed information and terms and ask for a response.
To obtain E-Sign consent properly, you’ll need to specify, among other things, the scope of consent (e.g., all active accounts now and in the future), the option to withdraw at any time, hardware and software requirements, whether any fees apply, instructions for obtaining paper disclosures, how to update contact information, and how to reach an agent.
 
When you send disclosures and terms, request a response (for example, “text YES”) so you can confirm the validity of the email address or mobile number and lock down the consumer’s formal consent.
 
TIP: Always confirm receipt of legally required documents.
There is no mailbox rule for electronic communications. Once you hit “send,” be sure to verify receipt via analytics. You can ask consumers to verify receipt themselves, but having indisputable proof on your end is essential legal protection for your business. Remember to verify open rates of emails as well as any links you use to provide information to the consumer.
 
“Revocation is that word that I think is so important in this whole context . . . . Anytime someone withdraws consent, whether you believe they did that in the proper manner . . . once that’s communicated, the best and safest course to minimize your risk is to honor that and comply with it.” – David Kaminski
 

Recommended Reading From Our Resource Library

Email and text may seem daunting, but you can implement an omnichannel communications strategy with confidence. It’s easier than you think, especially with compliance-minded tech that streamlines collection operations while safeguarding your business by helping prevent noncompliant communications.
 
If you’re eager to distinguish your service and strengthen your market position via consumer-friendly electronic communications, here are a few resources we recommend for further reading:
 
 
 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2019 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Info and Insights You Won't Want to Miss

Here on the OS Blog, we aim to give you just the right mix of high-level views, tactics, and tools you can use to optimize your collection operations and results. Subscribe today for a steady stream of practical, empowering content delivered to your inbox weekly.

Subscribe to the Blog
ARM Industry Leaders, Why Aren’t You Texting?

ARM Industry Leaders, Why Aren’t You Texting?

By Mike Meyer | Jan 29, 2020 | ARM

This is the first post in a new blog series highlighting the importance of text messaging for debt collections and what ARM businesses need to stay compliant.   Text messaging for debt collections might seem like a bridge too far. But it’s entirely within reach today....

How to Use Email and Text for Collections Without Getting Burned (Part 1)

How to Use Email and Text for Collections Without Getting Burned (Part 1)

By Rozanne Andersen | Oct 8, 2019 | ARM, RCM

Is communicating via email and text still a pipe dream for your collection operations? If so, you might want to settle in and keep reading. It really isn’t as scary as you might expect.
 
Despite the high costs and marginal returns of relying on phone calls and printed letters, many ARM agencies and healthcare providers have yet to embrace email and text. Widespread confusion and uncertainty about various state and federal requirements (including the proposed CFPB rules and E-Sign) can make digital communication an intolerable compliance risk.
 
I recently had the pleasure of discussing email and text compliance standards as well as their practical implications for businesses with David Kaminski, chair of the Consumer Financial Services Law Practice at Carlson & Messer LLP in Los Angeles. Although we weren’t in a position to offer legal advice, our goal was to help listeners better understand the laws governing electronic channels so they can move forward with greater confidence.
 
Here are a few of the topics David and I covered in detail during part 1 of our two-part AccountsRecovery.net webinar, “Email Is Hot, Texting Is Hotter: Don’t Be the First to Get Burned.”
 
 

Legally Speaking, Emails are Considered Writings

Emails are writings. If sent to a consumer by a third-party debt collector, emails must comply with the  Fair Debt Collection Practices Act (or FDCPA). If the email communication pertains to healthcare debt, the Health Insurance Portability and Accountability Act (HIPAA) applies.
 
Emails trigger compliance with the CAN SPAM Act as well, meaning they must (among the law’s other requirements) include an opt out or unsubscribe provision. Emails must also include any state-required disclosures and special verbiage requirements.
 
There is no legal requirement per se to obtain the consumer’s consent to email. This means third-party collection agencies may rely on client-provided email addresses. Just remember to include the required opt out/unsubscribe language in the body of every consumer-facing email and, as a routine practice, ask consumers to confirm their consent for you to email the particular address.
 
Whether you’re sending legally required documents via email or text, you’ll need E-Sign consent (more on that below).
 
 

Legally Speaking, Text Messages are Considered Calls

Text messages are calls. As such, texts must comply with the requirements of the Telephone Consumer Protection Act (TCPA). The TCPA requires the “calling” party to obtain the express prior consent of the consumer associated with the mobile phone number.
 
The TCPA is not limited to debt collection calls. In fact, it applies to any person placing a call or text to a consumer using the consumer’s mobile number. As is the case with emails, text messages sent to a consumer by a third-party debt collector must comply with the FDCPA.
 
Text messages initiated by a third-party debt collection agency are subject to call restrictions and auto dialer rules, and frequency of delivery can run afoul of state harassment laws and FDCPA laws. If you don’t have TCPA-mandated consent, you may be subject to legal action. Even prior verbal consent is fine, as long as you record it for legal purposes.
 
Mobile numbers are often reassigned, so consider the source of the number you’re using and the currency of the information to gauge the risk of third-party disclosure. Certain technologies can determine whether a mobile number has been deactivated or ported and, if so, block any further text communications.
 
As a practical matter, both emails and text messages may contain links to secure URLs and must encrypt data at rest and in transit.
 
 
“People think, ‘If I’m sending an email, I’m not really bothering anybody, they can get an email anytime. Although Federal and state call time restrictions do not apply to emails, excessive emailing could be viewed as harassment and cause the agency to be blacklisted.” – David Kaminski
 

When and How Does E-Sign Apply?

Informal consent and formal consent (E-Sign) come into play at different times, depending on the nature of the communication. Informal consent relates to getting the consumer’s permission to use email or text to relay basic information—payment receipts, account balance, verifying a payment plan, etc. Formal consent, or E-Sign, is needed for all legally required notices.
 
For an initial communication—which you would use to introduce your organization and purpose, confirm you’re dealing with the correct person, and secure permission to use that channel—E-Sign is not needed. You’re free to send your 1692G notice in that first communication. But for validation notices and other legally required documents not included in the initial communication (a post-dated payment notice, for example), E-Sign is a must.
 
“E-Sign has been an enigma for so many of you. Everyone has come up to me and said, ‘What is this E-Sign? I don’t really understand it. People throw it around like a frisbee.’ Rozanne and I are going to really lay out what it is, what it means, what you need to be concerned about, and how to launch your program.” – David Kaminski
 
 

What Should Collectors Consider When Crafting Emails and Texts?

You’ll need to think carefully about how emails and texts are worded and what they will include. Even the most (seemingly) minor details can mean the difference between a positive, productive interaction and a costly legal challenge.
 
For emails, you’ll want to include your true name in the “From” field (an attorney might advise you to use a DBA), keep subject lines simple and professional (e.g., “Your [Creditor Name] Account,” “Your Payment Date”), and avoid any verbiage that might trigger a spam filter.
 
Text messages must include certain disclosures as required by the Cellular Telephone and Internet Association (CTIA). Short codes can be used in text messages to allow consumers self-service options such as accessing account information, making payments, and communicating with you. Avoid using words that could be confusing, misleading, or inflammatory. If you don’t have prior written consent, including any type of marketing or solicitation in a text message can land you in hot water.
 
“Just be careful when you’re rolling out the language that you’re going to be using in your text messages to consumers. Make sure you’re not using something that will mislead, misrepresent, or potentially even harass the consumer, especially when you’re looking at federal and state laws.” – David Kaminski
 
 

Coming Up: Creating the Right Setup for Compliant Emails and Texts

In the second half of this blog series, I’ll recap the rest of my discussion with David about emails and texts—particularly when it comes to technology and what you’ll need to launch a program you can trust. Stay tuned for more actionable insights from our two-part webinar, “Email Is Hot, Texting Is Hotter: Don’t Be the First to Get Burned.”
 

 

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2019 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Info and Insights You Won't Want to Miss

Here on the OS Blog, we aim to give you just the right mix of high-level views, tactics, and tools you can use to optimize your collection operations and results. Subscribe today for a steady stream of practical, empowering content delivered to your inbox weekly.

Subscribe to the Blog
ARM Industry Leaders, Why Aren’t You Texting?

ARM Industry Leaders, Why Aren’t You Texting?

By Mike Meyer | Jan 29, 2020 | ARM

This is the first post in a new blog series highlighting the importance of text messaging for debt collections and what ARM businesses need to stay compliant.   Text messaging for debt collections might seem like a bridge too far. But it’s entirely within reach today....

RCM Reality Check: 3 Reasons Automated QA Is a Must for Healthcare Collections

RCM Reality Check: 3 Reasons Automated QA Is a Must for Healthcare Collections

By Mike Mullins | Sep 19, 2019 | RCM

This article concludes our “RCM Reality Check” series highlighting costly RCM issues and what providers need to address them.

 

Throughout this series, we’ve explained the importance of closing the EHR platform gap. This simple step could help streamline your A/R operation, introduce accountability on the front line, and make your collectors (even those working at home) more productive and more effective at recovering revenue. We’ve also explained how you can accomplish all this without disrupting operations or nullifying your EHR investment.

The last step to A/R optimization is an automated quality assurance (QA) program—one that’s efficient, data rich, and precise.

If you rely on a manual QA process now, you might feel like you’re running in circles. Between manual spreadsheet entries, paper shuffling, and combing through account records for a handful of calls to audit, QA can be a constant mad dash that drains resources and leads nowhere.

What if you could simultaneously reduce the QA burden, make QA a more powerful performance management tool, and start moving the needle (and never stop)? Imagine the value for your operation and your enterprise.

Here are three reasons an automated QA program—one that complements existing EHR functionality—is essential for improving collector performance and results over the long term.

 

1. Allows for More Frequent, More Valuable Feedback

Manual QA tasks are tedious and time consuming. They not only leave managers with fewer opportunities to help collectors perform better, but also slow the QA review process. An audited call might be weeks old, and the collector might not recall the circumstance or context—thus diminishing the QA review’s relevance and value.

Automation drastically reduces administrative burdens and streamlines the QA process. Every step of the process feeds into the next, making performance management easier and more effective.

For example, when a call ends, the collector is prompted to select specific tasks performed. All performance data is automatically fed into the QA scorecard, which is customized for the collector or his or her unique role. The collector’s QA score is updated in real time.

A complete scorecard is routed to the collector electronically. It shows the criteria the collector was scored on and specific accounts he or she worked. Once the collector signs off on the score, the scorecard is stored in the system.

With real-time at-a-glance views on their dashboards, managers can mine scorecard data to identify individual and team performance trends. They can also respond to automatic alerts informing them of urgent training needs. Thanks to automated QA, team leaders have the time, tools, and visibility they need to address performance issues in the moment.

 

2. Offers a Comprehensive View of Performance

In an automated QA process, all conversations are automatically recorded and matched with the account record. When an account is pulled up to be scored, the corresponding voice recording immediately plays. As the team leaders goes through the scorecard, he or she can see and hear what collectors have done.

These recordings have several important uses. They can be compared with collectors’ notes about the call to ensure proper steps were actually followed, they allow team leaders to score on behavioral measures of quality, and they reveal how much effort the collector put into working the account.

If a collector’s account volume soars near the end of the day—possibly in an attempt to inflate the number of accounts worked during his or her shift—team leaders are automatically notified so they can access accounts in question, hear the recordings, and ensure collectors are working all accounts to the fullest extent.

Team leaders can also discern how well collectors perform on site and at home. Comparing these results can help improve resource allocation. If some collectors perform better at home than in the call center, granting them more work-at-home privileges is an easy decision.

 

3. Ensures QA Is a Reliable Indicator

How accounts are selected for review can be a big point of contention among collectors. If the selection isn’t truly random, it could present a distorted view of the collector’s overall performance. Collectors could also claim favoritism if other collectors are scored based on less demanding accounts. If a collector feels a QA review is unfair, the QA score becomes meaningless.

This scenario (all too common with traditional QA) can negatively impact motivation, loyalty, and retention—an industry problem made worse by rising labor costs.

With automated QA, accounts are chosen randomly across the board. Collectors don’t feel singled out or misrepresented, so they’re more receptive to their scores. They’re also more invested in improving them.

If your goal is to help collectors follow proper procedures and develop their soft skills—for the sake of your company’s image and your recovery rates—it’s important to build a scorecard that reflects your priorities for both. Fortunately, automated QA makes this easy; performance data can help you build and refine the scorecard. With a comprehensive measure of quality as their guide, your collectors will know exactly what to aim for during every call.

 

With Automated QA, Keeping Collectors Accountable Is Easy

A quality assurance program that can’t fulfill its purpose drains resources and revenue. For providers, it’s an obstacle to progress. Performance issues that hamper revenue recovery can’t be detected, addressed, or corrected. Attempts to drive improvement, ill informed as they are, can adversely affect team morale and performance.

Automated QA changes everything. It eliminates mundane tasks, speeds the review process, and frees and empowers team leaders to drive meaningful improvements on the front line. In an automated environment, QA offers tremendous value for collection teams and the providers they serve.

If you’re looking to supercharge the back end of your revenue cycle, this complimentary eBook is made for you. “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix” explores the EHR platform gap and what it may be costing you. You’ll also learn about the EHR-friendly solution that can turn your once costly A/R operation into a profit-driving machine. Download your free copy today.

 

Don’t miss the other posts in this series:

 

Want more insights and tips you can use to improve your financial health? Subscribe to the OS blog, and we’ll deliver them straight to your inbox.

Boost Your A/R Results—and Your Business Results—with Ease

In this brief guide, “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix,” learn about the two big revenue drains every provider must address and how to fill your “EHR platform gap” so you can build an accountable collections team.

Download eBook

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

A 5-Step Dive into HIPAA Compliance for Email and Text

A 5-Step Dive into HIPAA Compliance for Email and Text

Nov 7, 2019 | RCM

 Last week, I wrote about email and text guidelines the American Medical Association (AMA) set forth to help healthcare providers ensure their electronic communications comply with the Health Insurance Portability and Accountability Act (HIPAA). Thanks to this...

RCM Reality Check: Is There an EHR-Friendly Way to Boost Collections Results?

RCM Reality Check: Is There an EHR-Friendly Way to Boost Collections Results?

By Shawn Yates | Sep 5, 2019 | RCM

This is the fourth in a series of five articles highlighting costly RCM issues and what providers need to address them.

 

Your electronic health record system (EHR) is a big investment, and a crucial one. As the beating heart of your operation, it powers your patient services, operations, and revenue cycle. It has revolutionized the way you provide care and manage your business.

There is, however, an “EHR platform gap”—the missing piece that could be costing you substantial profits.

While your EHR system excels with registration and clinical aspects of the revenue cycle, it lacks the visibility you need as to how  your collectors are performing day-to-day. Procedural mistakes, missed opportunities to discuss high-priority claims, long hold times, too much time off the phones—all of these daily realities can add up to big losses.

To optimize your A/R operation, you need three things you don’t already have:

Is there a way to integrate these capabilities without changing your current setup or nullifying your core EHR investment? Surprisingly, there is.

 

 

The EHR Enhancement That Transforms the Revenue Cycle

If you already rely on your EHR system for RCM functions, a “bolt on” A/R workflow management platform would likely create friction by disrupting or overriding existing functionality and workflows.

This is a reasonable concern. We’ve heard it firsthand from providers who want A/R accountability but don’t want to upend their current system. We developed the Artiva Magnify™ solution specifically to complement EHR systems, work seamlessly with them, and enhance their capabilities and value.

The Artiva Magnify solution is also designed to integrate easily, with its unique mix of A/R functions (automation, communications, monitoring, and reporting) working together as part of a harmonious “ecosystem” that’s easy to adapt and maintain.

This simple addition to an existing EHR can simultaneously enable A/R teams to accomplish more with less, drive employee engagement, and boost revenue recovery—all of which create the conditions for improved retention on the front line. Together, these top- and bottom-line benefits turn A/R into the profit center it was meant to be.

 

 

Learn More About the Industry’s Simplest A/R Fix

As financial and market pressures increase and account volumes grow, having a loyal, motivated collections team that’s well managed, maximizing work time, and making the most of every payer call is a major advantage. But if you have to disrupt your current EHR setup to get it, you’re giving up too much.

 

Our complimentary eBook “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix” explores two of the most common A/R profit drains, the performance questions your EHR platform won’t answer, and the secrets to creating an accountable (and more effective) collections team. Download your free copy today.

 

 

Don’t miss the other posts in this series:

 

Want more insights and tips you can use to improve your financial health? Subscribe to the OS blog, and we’ll deliver them straight to your inbox.

Boost Your A/R Results—and Your Business Results—with Ease

In this brief guide, “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix,” learn about the two big revenue drains every provider must address and how to fill your “EHR platform gap” so you can build an accountable collections team.

Download eBook

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

RCM Reality Check: 3 Keys to Improving Your A/R Team’s Performance and Results

RCM Reality Check: 3 Keys to Improving Your A/R Team’s Performance and Results

By Shawn Yates | Aug 21, 2019 | RCM

This is the third in a series of five articles highlighting costly RCM issues and what providers need to address them.

 

If your A/R operation isn’t as streamlined and effective as you’d like, and turnover is typically high, you’re in good company. Many healthcare providers struggle to manage and retain the people who power the back end of the revenue cycle.

Perhaps you’re resigned to these realities. You’d love to help your collectors improve their performance, but there’s no way to track their daily activity. How your work-at-home collectors spend their time is a complete mystery. A manual, labor intensive and data-lacking quality assurance (QA) process offers little value.

Without effective management and support, many collectors tend to disengage. They’re not motivated to excel, or even to stay.

You could continue hiring and onboarding new collectors, setting them loose, and watching a large percentage of them leave. Or you could unleash and strengthen your team by bringing accountability to the collections process—and drive productivity and recovery rates higher and higher, even as account volumes grow.

If you’re determined to optimize your revenue cycle, accountability is the way to go. Below, we’ll walk you through the three things you’ll need to achieve it.

 

 

What If You Take the Wait Out of the Equation?

By simply enhancing their EHR host architecture, providers can do a lot to boost their collectors’ productivity and results. Insurance Hold Manager (IHM), a key feature of the Artiva Magnify™ solution, is an easy fix designed to address the long IVR navigation and hold times that plague so many A/R operations.

The Artiva Magnify solution determines which payer to call next and uses IHM to automatically navigate payer IVRs and consume the time collectors historically spend waiting on hold. With IHM, the collector completes follow up on claims with the current payer and is then connected to the next payer call that is already in progress with IHM, thereby dramatically reducing time spent navigating IVRs and listening to hold music. All day long, collectors move seamlessly from one call to the next without having to navigate payer IVRs or endure painfully long and unproductive hold times.

This simple EHR complement translates into a significant increase in productivity and can have a dramatic impact on A/R operations.

 

1. Visibility Into Collector Performance

IHM is one of many EHR enhancements that can supercharge your collectors’ productivity. But the health and success of your A/R operation also depend on how well your collectors—including the growing number who work from home—perform in their roles.

 

“Often, a leadership team believes something is being done a certain way, but an analysis of day-to-day operations reveals it’s actually being done another way—and important things are slipping through the cracks.”

Katy Dettman, Plante & Moran, PLLC
“Healthcare accounts receivable valuation: Four pitfalls to avoid”

 

This is where your A/R transformation begins: knowing precisely how your collectors are using their time, the quality of their interactions with payers/patients, and any procedural errors or missed opportunities that need to be addressed. The process of measuring individual and collective performance has never been easier or more reliable.

Voice and data monitoring
Managers can listen in on calls, listen to recorded calls, and monitor account-related activities to evaluate performance from every angle.

Dashboard displays
Through their individual dashboards, collectors and managers can see the same steady stream of performance data on a variety of metrics (accounts worked per payer call, time talking vs. holding, calls made, etc.). Managers have what they need to deliver valuable one-on-one coaching, and collectors can independently self-correct.

Performance alerts
When collectors aren’t maximizing their time or progressing toward daily or monthly goals, managers receive timely notifications so they can intervene early.

Collector rankings
Who are the top performers on the team? Knowing where they rank motivates collectors to challenge themselves and improve their standing. Friendly competition among team members builds cohesion, increases engagement, and naturally drives progress on the front line.

 

2. A Performance Management Program That Drives Results

 

“If we expect performance improvement, then we must constantly measure and then actively move. Effective revenue cycle reporting should be developed not only to monitor our current success, but to manage it to the next level.”

Luanne Yeley, Halley Consulting Group

 

Regular, intentional coaching and training is essential for driving performance gains and keeping collectors engaged. With a steady stream of data, a more efficient and relevant QA process, and the benefit of timely alerts, managers can provide specific, actionable feedback that helps collectors make meaningful improvements and reaffirms their value to the organization.

Automated QA tasks
Call recordings are automatically matched with account records, and performance data is fed directly into collectors’ QA scorecards. Free from having to manually pull and evaluate random payer calls—which may not be representative of a collector’s overall performance—managers can use their time to coach and train as needed.

More relevant scorecards
Arbitrary or subjective definitions of “quality” might not reflect what collectors should focus on to get the best possible results. A QA scorecard that’s shaped by performance data is a more relevant and useful measure.

Better team management
As they watch performance data and QA scores change in real time, managers can identify widespread problems and provide refresher training. They can also share information with other internal teams to improve RCM overall.

Bigger performance gains
With more meaningful QA scoring and timelier intervention by managers, collectors can set goals, understand how they’re progressing, and continue to improve their scores, rankings, and recovery rates.

 

3. Tools That Boost Agent Productivity

Ample performance data and timely, valuable feedback help keep collectors sharp and motivated. But collectors also need help juggling high account volumes and making the most of every call. The right tools and resources can eliminate a lot of wasted time on the phone and ensure nothing gets missed.

Work queue scheduling
Collectors always know in advance which accounts they should prioritize. Collectors can be scheduled to move between queues based on time of day or duration so they can work accounts more evenly.

Insurance Hold Manager
We discussed Insurance Hold Manager (IHM) in our previous RCM Reality Check post. By drastically reducing IVR navigation and hold times—which can consume a third of the average collector’s workday—IHM alone can significantly increase productivity.

Agent Playbook
Process guide helps new collectors perform on a par with their more seasoned counterparts. Each time a payer picks up, collectors can refer to dynamic content on their dashboards related to SOP, relevant training, and state regulations governing payer responsibilities.

Look-ahead functionality
No more missed opportunities on the phone: from one call to the next, dashboard displays show collectors which high-priority claims they need to discuss.

 

 

Building an Accountable A/R Team Is Easier Than You Think

Filling the “EHR platform gap” with these missing capabilities might seem complicated and costly. In fact, the opposite is true. You can have it all, without disruptive change—and, in the process, get far more out of your EHR investment.

Want to know how to transform your A/R operation while preserving existing functionality and workflows? You’ll find all the details in our complimentary eBook “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix.” Download your free copy today.

 

Don’t miss the other posts in this series:

 

Want more insights and tips you can use to improve your financial health? Subscribe to the OS blog, and we’ll deliver them straight to your inbox.

 

Boost Your A/R Results—and Your Business Results—with Ease

In this brief guide, “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix,” learn about the two big revenue drains every provider must address and how to fill your “EHR platform gap” so you can build an accountable collections team.

Download eBook

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

A 5-Step Dive into HIPAA Compliance for Email and Text

A 5-Step Dive into HIPAA Compliance for Email and Text

Nov 7, 2019 | RCM

 Last week, I wrote about email and text guidelines the American Medical Association (AMA) set forth to help healthcare providers ensure their electronic communications comply with the Health Insurance Portability and Accountability Act (HIPAA). Thanks to this...

RCM Reality Check: How to Free Your Collectors From Long Hold Times (and Fast Track Their Success)

RCM Reality Check: How to Free Your Collectors From Long Hold Times (and Fast Track Their Success)

By Mike Mullins | Aug 8, 2019 | RCM

This is the second in a series of five articles highlighting costly RCM issues and what providers need to address them.

 

For large healthcare providers looking to recover more revenue with fewer resources, the back end of the revenue cycle is ripe for change. A/R teams are under increasing pressure to recover every payer dollar, and they’re struggling to handle growing account volumes. Meanwhile, high churn on the front line continues to sabotage collection efforts and eat profits.

Underlying all these challenges are two of your A/R team’s biggest productivity drains when calling payers: time spent navigating IVRs, and time spent on payer hold.

To determine how much time collectors lose waiting to connect with insurance reps, we conducted our own analysis of thousands of calls to various payers. Our findings indicate it takes a collector eight minutes, on average, to navigate an IVR and wait on hold for a payer. This means collectors can spend roughly a third of their shift trapped in limbo, simply waiting to follow up on a claim or denial.

Imagine your collectors’ frustration. Think about the revenue you’re leaving on the table. Fortunately, there’s an easy way to eliminate all that wasted time.

 

 

What If You Take the Wait Out of the Equation?

By simply enhancing their EHR host architecture, providers can do a lot to boost their collectors’ productivity and results. Insurance Hold Manager (IHM), a key feature of Artiva Magnify™, is an easy fix designed to address the long IVR navigation and hold times that plague so many A/R operations.

The Artiva Magnify solution determines which payer to call next and uses IHM to automatically navigate payer IVRs and consume the time collectors historically spend waiting on hold. With IHM, the collector completes follow up on claims with the current payer and is then connected to the next payer call that is already in progress with IHM, thereby dramatically reducing time spent navigating IVRs and listening to hold music. All day long, collectors move seamlessly from one call to the next without having to navigate payer IVRs or endure painfully long and unproductive hold times.

This simple EHR complement translates into a significant increase in productivity and can have a dramatic impact on A/R operations.

 

 

The Other Side of the Coin: What’s Happening During Payer Calls?

IHM is one of many EHR enhancements that can supercharge your collectors’ productivity. But the health and success of your A/R operation also depend on how well your collectors—including the growing number who work from home—perform in their roles.

Without a steady flow of specific, timely performance data, there’s no way to know:

  • How many claims collectors are working on each payer call
  • How much time collectors are spending away from their desks
  • Which accounts they’re working on each call
  • Whether they’re asking the right questions
  • How well collectors are performing relative to each other

If you’re operating with these blind spots, you can’t identify knowledge or productivity gaps across the team. And you can’t help collectors improve their individual performance.

We can show you how to manage on-site and work-at-home collectors, recover revenues more easily, and combat attrition, all in one easy step. Download your free copy of “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix,” and learn how easy it is to build a high-performing, profit-driving A/R team.

 

Don’t miss the other posts in this series:

 

Want more insights and tips you can use to improve your financial health? Subscribe to the OS blog, and we’ll deliver them straight to your inbox.

 

Boost Your A/R Results—and Your Business Results—with Ease

In this brief guide, “The Accountable Collector: Transforming Healthcare A/R with One Simple Fix,” learn about the two big revenue drains every provider must address and how to fill your “EHR platform gap” so you can build an accountable collections team.

Download eBook

Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2020 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.