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Case Study

ATD Resources

Lakewood, CO

Proven Results

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Insurance and other payor
sources identified for
16% of self-pay patients

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Medicaid eligibility
confirmed 35% of the time

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Returned mail
reduced by 10%

ATD Resources, LLC finds $800K in coverage for ED self-pay


Breaking Through Returned Mail and Uncovering Self-Pay Patient Payment Sources

Located in Lakewood, Colorado, ATD Resources provides billing, coding, account management and financial improvement services for emergency medicine practices. Established in 2006 and owned and directed by physicians, the company has 25 employees. ATD Resources serves five emergency departments with a combined total of more than 140,000 visits per year.

As director of operations, Amy Propp, CPC, CEDC, holds a key position in driving staff efficiencies that translate into positive business results. Her role requires firsthand experience with the evolving world of payor regulations and policies that impact emergency physician reimbursement.

ATD Resources was missing reimbursement due to a confluence of issues, including a high rate of returned mail, an increase in self-pay patients, and inaccurate patient information. Propp and her team considered various solutions and eventually partnered with the self-pay specialists at AR Boost, offering tools and expertise to help get her ED self-pay revenue under control.

 

Challenges

 

Solutions

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Transient emergency services patient population

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Identify payor sources for self-pay

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Incorrect contact details and demographic information

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Calculate payment propensity

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Influx of self-pay, high-deductible health plans (HDHPs) and Medicaid

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Determine federal poverty level (FPL) status

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High rate of returned mail—50%

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Verify or correct patient demographic information

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Labor intensive back-end processes

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Streamline front-end processes, reduce back-end clean up

Slashing Returned Mail

Before working with AR Boost, more than half of ATD’s 181,000 patient statements sent annually were returned. Managing returned mail was both labor intensive and time consuming – increasing the effort required by Propp’s staff to collect payment. “We would have buckets of returned mail coming in nearly every day,” recalls Propp.

ATD Resources began to see progress by having a list of returned mail–rather than “physical pieces” – sent to its office. The list was then sent through AR Boost’s Demographic Verifier to have records updated with correct demographic information. This front-end solution addressed the returned mail issue before statements were ever sent.

“Front-end demographic correction helps ensure that all of our back-end processes run smoothly,” Propp adds.

With AR Boost, returned mail volume was cut by 10 percent — more than 18,100 pieces — over a 12-month time period.

 

Clarity for Self-Pay

Many people who come to the emergency department don’t present a means to pay, and it’s difficult to collect payment at the time of service. Though the Affordable Care Act has helped, it doesn’t solve all the problems. “It’s great that more patients have insurance, but we sometimes find out after the fact, and collectability is difficult with this patient population,” says Propp.

When a batch of billing work is received from their ED clients, ATD Resources divides out self-pay patients. Payor Logic takes this information and cleans up the demographics, provides updated social security numbers, and looks for insurance or other payor sources for patients who originally reported no coverage.

For the self-pay accounts in 2014, Payor Logic identified insurance coverage for 16 percent of all ATD clients’ patients. Of the 16 percent, 35 percent were eligible for Medicaid.

Within 12 months, more than $800,000 in coverage was found for people who originally presented as self-pay.

AR Boost also determines federal poverty level (FPL) status for ATD, clearing qualification for hardship discount, presumptive Medicaid or charity.

Predicting Payments

AR Boost helps predict who will pay – also known as propensity to pay. If a patient isn’t likely to pay, ATD can quickly adjust the debt or send it to collections. “We use AR Boost to identify payment likelihood,” says Propp. “The scores are remarkably accurate.”

If a patient does have a higher propensity-to-pay score, then it moves forward in the billing process. Depending on payment propensity and FPL, the bill can be discounted accordingly.

 

AR Boost Set Apart

Whether balance after insurance, or pure self-pay, accurate information is key for collecting payment in a timely manner. Working with AR Boost, ATD Resources was able to significantly improve its returned mail problem and discover coverage for a percentage of their clients’ ED patients –especially those who presented as self-pay.

“When you track and review the return on investment, the value is clear –and that’s just for hard costs, not even considering soft costs like the amount of staff time saved,” says Propp. “AR Boost cares about clients and how they use their products. They really adapt to meeting their clients’ needs.”

Propp values the ED industry knowledge and self-pay experience that AR Boost brings to the table. “Deeper understanding of my specialty was important – not just healthcare in general, but my specific niche,” she says. “While some clearinghouses are starting to offer similar products for determining eligibility, AR Boost is light-years ahead. Their unique self-pay and propensity-to-pay offerings are invaluable to our business.”

 

“AR Boost cares about clients and how they use their products. They really adapt to meeting their clients’ needs.”

- Amy Propp
CPC, CEDC, Director of Operations
ATD Resources, LLC

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