Mental Health Professionals Best Practices for Revenue Cycle Improvements

Tom Barrett:

Thank you for joining our webinar. That's "Mental Health Professionals -- Best Practices to Improve Your Revenue Cycles." With me today are Brian Grimes and Megan Covert. Brian?

Brian Grimes:

Thanks, Tom. Good morning and welcome everyone. My name is Brian Grimes. I am the company president at CBSI and with me, I have our sales and marketing associate, Megan Covert. Since 1955, CBSI has provided patient-friendly collection services for several industries, including mental healthcare professionals. As a collection agency that cares, we focus on connecting with patients, resulting in better returns while fostering genuine patient relationships. As we all know, the amount of self-pay medical debt is rising dramatically. On average, patient pay now represents 30% of provider revenue. High-deductible health plans are on the rise and 68% of patients under 65 high-deductible health plans. At CBSI we're seeing a dramatic rise in people registered as self-pay. In other words, you know, people without health insurance. And overall the number of uninsured patients has increased more than 12%. That's why it's extremely important for you to maximize your amount of self-pay collected both on the front end and on the back end.

Megan Covert:

Revenue Cycle Improvements. The more work that is done upfront to collect payment, the better. With increasingly more self-pay patients using your services, you need to do as much as you can to collect the payment upfront. Pre-service pricing is the most important priority. Helping your patients understand what their costs are going to be upfront greatly increases your chances of getting paid. Friendly and consistent communication is key. Giving your patients the feeling that you are willing to work with them -- not against them -- will foster better relationships and will help in getting payments. Engage early with payment options.

Educating your patients on different ways payments can be made will lead to more payments. And finally develop an insurance discovery process. Are there any payers that should be responsible for this bill? (Workman's comp, auto insurance, Medicaid presumptive, etc.?) An insurance discovery solution can convert 1% to 5% of your uncompensated care accounts.

Brian Grimes:

A well-trained staff on the front lines is crucial for your upfront collections. It can be tough to ask for payment. You need to make sure that your staff is able to address payment issues in a tactful manner. It's really no different than the way that we train our collectors on overdue accounts. You need to cater your approach to the specific personality of the patient. For example, if someone is very emotional, you need to remain calm and composed.

Acknowledge what the individual is saying, show empathy, but at the same time, ask for payment. If somebody is argumentative or doesn't believe that they owe payment, make sure to have all your ducks in a row. Produce documents for every denial and copay and make sure to have that ready ahead of time. If the staff member is not able to ask for payment after extensive training, you may need to find a better fit for the position.

And intake forms and patient contact info are key to the success of your collection agency. Make sure you're obtaining as much information as possible on your intake forms, including date of birth, social security, number, middle initial, employment (including employer phone number and address). And sometimes you guys can find this right off your insurance cards that people have. And phone numbers are also very important -- both landline and mobile numbers -- and email addresses as well. It's not currently widely used in collections, but there is some new legislation in the works providing a safe harbor for agencies to use email.

And due to high legal and privacy concerns, we do not currently utilize credit reporting in the mental health field. In the case of a child, do make sure you get all the information for the spouse as well, as both parties are responsible for medical debts, regardless of what the divorce decree says. And among all the normal disclosures, make sure your intake forms grant permission to contact patients via autodial, automated messages, email and text.

Megan Covert:

So having multiple payment options for your patients is very important. We all like to have options, and we want the payment process to be convenient. Your more traditional patients will still want the ability to pay by check and mail their payment in, so they need to have this option. Online bill pay is becoming increasingly popular, especially with the millennial population. They want to be able to access their account from their computer or their phone and make their payment. CBSI receives 20% of its total payment revenue online.

Acquiring credit card information and keeping it on file for payments is another way to make sure payments can be made. Letting your patients set up a reasonable payment plan is very important. Having to pay a bill in full can be very overwhelming for some patients, which is why they just don't pay at all. But if they know they can set up a plan that will work within their budget, they'll be more likely to pay. Setting up automatic payments is also a good option.

Brian Grimes:

Upfront collections are truly best. However, we all know there'll be times where you have to send somebody to collections. You know, Megan and I get asked this every day, "When is the right time to send an account to collections?" And typically our current best practices include the following: Once insurance has been applied, typically 30 days after the service, you send out your first statement. And if no payment is received, send out a past-due text, phone call, or email. And at the 60-day mark, send out a past-due statement as well. And have a different look and feel to that second statement, if you can. You want it to, I guess, escalate things. And once again, if payment is not received, send a past-due text, phone call or email. And at 90 days, send out a final notice. You can explain they're going to be turned over to collections if not paid within X amount of days.

And I typically recommend 10 (days), as this creates a sense of urgency. And if no payment is received, the collection agency should go into play around 100 or 120 days past due. Now a lot of agencies do push to send the account sooner, like the 30- or the 60-day mark. Although I really think it is too soon. Your patient relationships are a concern, obviously. So are commissions, at that point, from the collection agency too. So if somebody is not willing to pay after three statements and 120 days, the stats do show that you end up with more in your pocket by sending that account to collections, than just to continue statements. Of course, there are situations where you may be waiting on insurance, or if you're going past six months, it's going to cost you, as that is very time-sensitive. So once an account goes to collections with CBSI, we then verify addresses with the USPS.

We scrub for bankruptcies and deceased accounts. We score each account based off the collectability. And the accounts are then grouped with any other existing accounts we have in our database. And currently that happens roughly 90% of the time. Then send out a validation notice. There's a law that requires patients be given 30 days to dispute a debt. And each letter has a link or online payment negotiator to set up payment plans.

And then next, the collection calls start. And legal action can be used after regular efforts are completely exhausted. And we only pursue legal if we believe the patient has the ability to pay; however, he's choosing not to. And this chart shows that collectability drops over time. The longer you wait, the less chance you have of collecting the debt. And after one year, you'll have less than half of what is owed. And after two years, you have very little chance of collecting any money at all. So this chart represents all debt collections, not necessarily just medical.

Megan Covert:

Another way to look at this is, the longer your debt is owed, your dollar shrinks. Your dollar is worth considerably less the longer the money is owed. This is why it's so important to have a consistent process in place to ask for the money. Using a professional collection agency is a key component in this process. The sooner you start the collection process, the more likely you'll collect.

Tom Barrett:

So with me today is Amy Vroegh. Amy has been with CBSI for the last 14 years. She is their collections manager, and she's going to walk us through a typical collection call. She'll follow it up with tips for a successful collection call, and then what we are experiencing today with collections during the pandemic. Amy, how are you doing?

Amy Vroegh:

Good. How are you?

Tom Barrett:

Good. Will you go through a collection call with me, just for our audience, so they can understand what a typical collection call would sound like?

Amy Vroegh:

Sure.

Tom Barrett:

Okay. So I'll be the debtor. You'd be the collector.

Amy Vroegh:

Hi, is this Tom Barrett?

Tom Barrett:

Yes, this is him.

Amy Vroegh:

Good morning, Tom. This is Amy calling from the Credit Bureau Services of Iowa, and we are a debt collection agency. Can you verify the last four of your social or date of birth so I can verify I have the correct Tom?

Tom Barrett:

Yes. It’s 4525.

Amy Vroegh:

All right, Tom. So I do need to tell you since it's the first time we've spoken, we are the Credit Bureau Services of Iowa. This is an attempt to collect a debt and any information obtained will be used for that purpose. I'm giving you a call today, Tom, about an account that was placed in our office for collections from ABC Hospital. It looks like it has a balance of $1,200 from a date of service of 2/3 of 2020. I was just calling to see if you could possibly take care of that today or set up some sort of payment arrangements with us.

Tom Barrett:

Well, Amy, I don't know of anything that I owe.

Amy Vroegh:

Do you remember possibly being at ABC Hospital back in February of 2020?

Tom Barrett:

Yeah. It was an emergency room visit. And I thought my insurance covered it.

Amy Vroegh:

Okay. Well, I will tell you, Tom, most of the time when it's during the first of the year, you probably haven't met your deductible or co-insurance yet. So that's possibly what this balance could be for. A lot of times you'll get an EOB from your insurance company, letting you know what your balance could possibly be. Do you remember getting something like that?

Tom Barrett:

No, I don't. What's an EOB?

Amy Vroegh:

It's called an explanation of benefits. Your insurance company provides it to you to let you know what portion of the bill's been paid by them and what portion is your responsibility.

Tom Barrett:

Well, I don't pay too much attention to those things.

Amy Vroegh:

Yeah. It's kind of like other mail. You don't look at it as closely.

Tom Barrett:

Okay. So how can I satisfy this debt?

Amy Vroegh:

Well, if you could take care of a day, that'd be great. If you're unable to do that, we can definitely set up payment arrangements. Are you working at this time, Tom?

Tom Barrett:

Yes, Amy, I'm still working at the hospital. But it's been kind of rough. They've had some layoffs and I'm just not sure about my job right now.

Amy Vroegh:

I understand with the pandemic right now, everything's a little uneasy. So I understand. We're more than willing to work with you, Tom. Like I said, we could set up payment arrangements. Would you possibly be able to pay like $600 of it today and then set up payment arrangements on the balance?

Tom Barrett:

$600 is a little bit much. And then how long on the balance?

Amy Vroegh:

With a balance that size, if we were setting up payments on $600, if you could do at least $100 a month, I would be more than willing to work with you on that.

Tom Barrett:

I can't do $600 now. Um, I could do $400.

Amy Vroegh:

Okay. I would be willing to work with that. And then we could set up on the balance bi-weekly, weekly, monthly payments. Whatever works more convenient for you.

Tom Barrett:

You sound pretty easy to work with. I get paid on the first and the 15th of every month, and I could handle, I think, $100 the day after I get paid.

Amy Vroegh:

Okay. So do $100 biweekly then? That'd be $200 a month. And that would get you taken care of with your balance of $800 in about four months. Would that work for you, Tom?

Tom Barrett:

Yeah, but I can't do $400 plus $200 this month. So could I start the payments on the first of next month and pay the $400 now?

Amy Vroegh:

Sure. I would be happy to do that with you.

Tom Barrett:

So, okay. How can I pay you the $400?

Amy Vroegh:

We can do debit card, credit card, check by phone. We have an online web portal that you can go to, Tom. Or you can mail it to us or, if you're here in town, you can drop off your payment.

Tom Barrett:

Hmm that's sounds pretty easy. Um, okay. Let me pay with a check. You can take an ACH over the phone?

Amy Vroegh:

Yes, sir.

Tom Barrett:

And I'm worried about my job. What happens if I lose my job?

Amy Vroegh:

Just keep in contact with us, Tom. If something comes up and you're unable to make the payments, we are more than happy to work with you. We can skip payments, we can lower the payment. Whatever makes you feel more comfortable, we can work with you to try to get it taken care of.

Tom Barrett:

Okay. Okay, good. So, Amy, you sound really nice to work with. Here's what I see happening during a collection call. And this applies, I think, to first party, as well as third party. I think it's really important that you asked me, "How can we help you?" Your people are trained to do that, aren't they?

Amy Vroegh:

Yes. You know, we all truly feel that we are here to help people. You know, nobody expects to be in debt, especially for medical bills. We don't expect to have to go to the hospital. So in these instances, we are here to help them resolve the debt and help our clients as well.

Tom Barrett:

So I would imagine that you might get some people that are pretty upset that you'd be calling during a pandemic.

Amy Vroegh:

We do once in a while, but not very often. You have to remember that they're not upset with you. They're upset with the situation. We try to "talk them off the ledge," so to say, and work with them to resolve the issue and get the debt taken care of.

Tom Barrett:

So if I had started to talk about my sick mother or concerns that I have for my children, and they're not in school now, how do you handle that?

Amy Vroegh:

We do our best to listen. We want them to know we care and we're here to help. But we also try to get back on task to get the account taken care of.

Tom Barrett:

So, how has it been going since people have been getting their stimulus checks?

Amy Vroegh:

Rather well. More people are calling or answering the phone when we call. You know, they want to talk. They're stuck at home and they have time to look at things and work on things of their own. So they're more likely to answer the phone and willing to set up payment arrangements or work to take care of whatever they've got here.

Tom Barrett:

And as I understand it, most of your collectors have been in a similar situation where they're a debtor and they owe a bill.

Amy Vroegh:

Yes, yes. We've all been there. So we understand and, you know, you treat each other just like you would want to be treated if you were on the other end of the phone. So we do our best to work with them and make them understand that we're here to help.

Tom Barrett:

So do you ever get any compliments?

Amy Vroegh:

We do on occasion. Yes.

Tom Barrett:

So here's some of the things I think that we've seen, and this is true especially for first-party collections. The most important piece is that you select personnel who are willing and really do want to help people settle their medical bills. Whatever it is, most people by and large do not want to be in debt. And if they can see a way out of it, they would really like to pay it off. Amy, do you agree?

Amy Vroegh:

Yes, very much so.

Tom Barrett:

So the people, the personnel, that you select also have to be able to manage the call. So the right people doing this is really important. And they have to have the time to manage a ton of phone calls. And so that it doesn't go on and on and on.

Amy Vroegh:

Right.

Tom Barrett:

Amy, do you have a time limit on your calls?

Amy Vroegh:

Well, we try to let the collector make that decision, but we also want them to know that, you know, you can't spend 20 minutes on the phone with a consumer discussing their family issues. But we also want to listen. So, you know, we do our best to make it work.

Tom Barrett:

Yeah. You bring it back to the conversation, back to the subject and you keep on asking for payment.

Amy Vroegh:

Yes. Because we're here to get the client their money, as well.

Tom Barrett:

And as I understand it, the online payment has been a tremendous support mechanism.

Amy Vroegh:

It has, and we have a lot of people going online to set up payments.

Tom Barrett:

So they can check their balance. They can see exactly when it's going to be paid off. They know where they stand at all times. And I noticed that you asked for payment in full, but you pretty quickly split it down and gave me the offer that I could make payments.

Amy Vroegh:

Right. Because not everybody has extra money sitting around. But if they do, that's the opportunity to say, "Hey, let's get this taken care of, so it's not here in our office." But if they don't, we're willing to work with them to set up those payment arrangements.

Tom Barrett:

And you really seem to want some sort of payment today. You want to come off the phone with some commitment.

Amy Vroegh:

Yes. We do.

Tom Barrett:

Okay. So being flexible is critical.

Amy Vroegh:

It is. Very much so.

Tom Barrett:

And on a balance that I had of $1,200, how low would you have gone?

Amy Vroegh:

With the pandemic and the situations going on... Most of the time I would tell you that we would like to have at least $100 to $150 a month to get this taken care of in a decent amount of time. But with things going on right now, I would tell you that we would go down to $50 a month on that.

Tom Barrett:

Okay. So flexible is important and supportive is critical.

Amy Vroegh:

Yes.

Tom Barrett:

Anything you'd like to add?

Amy Vroegh:

We also are reaching out or letting our consumers know of certain resources that they can get to. You know, 211, the United Way. Also, putting them in touch with state and federal benefit places that they can get in contact with. And letting them know that they could possibly apply for Medicare or Medicaid. Just things to help them out. So they understand that there is help out there if needed.

Tom Barrett:

Sweet. So what have you been experiencing since the pandemic first started?

Amy Vroegh:

Just more people calling, more people answering and wanting to take care of their debts. It's a concern and now they have time to do so.

Tom Barrett:

So you're experiencing a high connection rate as well as a pretty high collection rate.

Amy Vroegh:

Yes. Yes, we are right now.

Tom Barrett:

And people seem to have time on their hands.

Amy Vroegh:

They do.

Tom Barrett:

And then, Amy, you also said that, for people who really can't pay, you do have resources available for them. And as I understand it, in Iowa, there's a 211 that leads into the United Way and they can provide childcare resources, Medicare/Medicaid resources. Presumptive Medicaid is a pretty interesting concept. It's been expanded. So it's no longer limited to pregnant women and children. Most of the hospitals are aware of this, but a lot of the private practices are not. And the goal of the presumptive Medicaid eligibility process is, a practice can offer immediate healthcare coverage if they qualify for Medicaid before a full Medicaid determination has been made. And you also will refer people to local food banks and you have a list of mental health resources.

Amy Vroegh:

Yes, we do.

Tom Barrett:

Yeah. You sound like you really enjoy your job.

Amy Vroegh:

I do. I've been here 14 years and I truly love what I do. I am here to help and get people out of debt. Nobody wants to be in debt and nobody wants to have to deal with a collection agency. But we want them to feel comfortable if they have to deal us.

Tom Barrett:

I also understand most of your collectors have been there for a long time.

Amy Vroegh:

Yes. Yes, they have.

Tom Barrett:

Well thanks very much, Amy. Anything you'd like to add?

Amy Vroegh:

Nope.

Tom Barrett :

Okay. Back to you, Megan.

Megan Covert:

Thanks, Tom. Thanks, Amy. So if you're considering a collection agency, here are some things you'd want to look for. An agency that works your local market will generally return more than a national agency. So a local agency will usually have more patient contact information because they are working with the local market extensively.

You'll want to ask the agency about their license. Many states require licensing. This is important because it protects the patient and you as the client or provider. Also check, can the agency pursue legal? Not all agencies offer legal services, which can include pursuing a judgment. At CBSI we pursue legal via right of assignment in CBSI's name, not yours. We only pursue legal in situations when the patient has the ability to pay, but is just choosing not to.

And we do have the ability to accurately determine if the patient has the ability to pay. Membership in the Association of Credit and Collection Professionals (also the ACA international) indicates that the agency adheres to industry standards for ethical and professional conduct. Check the agency's Better Business Bureau rating. Although sometimes individuals will complain to the Better Business Bureau to try to get out of paying a legitimate debt, make sure your agency is responding to any complaints and does not have an unusually low rating.

Having access to a secure online website can save you time and give you the information about your accounts 24/7. So a low contingency rate can be misleading. Most agencies work on a contingency basis and only get paid when you get paid. Some agencies will offer an exceptionally low rate to get your business. However, a low rate will not maximize your recovery. Net dollars returned, which is the amount of recovered dollars less the agency's pay, is a better measure of an agency's performance.

Brian Grimes:

Thanks, Megan. And just a little bit more about CBSI in general is, we are a patient-friendly debt collection agency. We have been in business for over 60 years. And as you guys heard with Amy there, we're very flexible. And we take pride in helping patients get out of debt. And a lot of agencies are moving much more towards a patient-friendly collection approach, but you know, sometimes it's hard to teach an old dog new tricks, especially on the collector side. So we are very familiar with mental health type collections and our clients can sleep at night, knowing that we are very serious about your patient’s experience and privacy. We have a really large local database. It's one of the main things about CBSI, almost 1,300 clients, mostly Iowa, two million collection accounts in our database. And if you don't have a good phone number or address for a patient, we probably do.

I mentioned earlier, I think 90% of the time when you send us an account, we already have that name in our database. So they owe one of our clients -- other clients -- money as well. So the net result is more accurate data, already-established relationships, and a higher recovery rate. And we work in multiple industries. We may get a new account even down the road, after we've gotten yours, with more current information, and then we can revisit all accounts at the same time. And skip tracing. We can find patients that have moved with our own database. Also several other pay-for databases to find addresses. And we do pursue legal. Roughly I'd say 95% of our mental health clients do allow us to pursue legal via right of assignment. We're going to pursue that in CBSI's name, and then typically garnish wages to find a way to collect on that.

It is effective on those accounts that can pay, but kind of choose not to. We also keep everything private by only pursuing a single party on those lawsuits, and we redact all medical information. And industry experience. We do work with multiple mental health professionals, including some pretty large ones here in the state of Iowa. And we are complaint-free, and we have an A-plus rating with the BBB. And we work strictly on a contingency basis and only get paid on accounts that we collect. So with that, I want to thank everybody and open it up to questions. If anybody has anything out there that they'd like to ask.

Guest:

I guess my question would be, what would be the lowest amount owed that you would be willing to take? I mean, that you would take on a client that owes what low amounts, like $30, $60, $80, or does it have to be in the hundreds?

Brian Grimes:

A lot of agencies do have a minimum dollar amount placement. Usually it's $50 or $100, somewhere around in there. Ours is we say typically $20, because a lot of times we already have that name in there, just adding another account to the mix, so to speak. Or if you have several encounters, for example, small deductibles, that add up to be $20 or more, we would be glad to take a look at those accounts. We also typically draw the line at five years of age on accounts. Now, obviously not as collectible, like we mentioned earlier, but we can have pretty good luck on some older accounts. You'd be surprised just being able to find people is more or less than anything. So five years is roughly where we draw the line there.

Guest:

Thank you.

Brian Grimes:

We do seem like the go-to for mental health facilities, just because of our approach. And it's not just that way for mental health folks, it's for medical and everybody else out there. And that's what they've always kind of wanted is to, you know, have that patient friendly. And I think it works a lot better here in Iowa. We'll get, you know, more luck with kindness.

Tom Barrett:

Brian, you can also gauge a little bit by your experience on the collectability of an account too, can't you?

Brian Grimes:

That does help a lot. You know, not only that database, if we have that account in there we can tell, "Oh, well we've already got a hundred accounts on this person. They've never paid a dime." Are we going to beat that to death? Probably not. But you have somebody who's working full-time and they're not paying, you know, we have more leverage there for sure.

Tom Barrett:

Thank you, everybody, for joining our webinar, "Mental Health Professionals -- Best Practices to Improve Your Revenue Cycles."