Solutions

Recondo provides SurePayHealth to the hospital market as a Software as a Service (SaaS) offering.

For More Information

Download the free Adobe Acrobat Reader here.

SurePayHealth

Consumers make up a greater percentage of provider revenue than ever before. The consumers come from self-pay categories that include the uninsured, the under-insured, and high-deductible plans emerging in Consumer-Directed Healthcare (CDH) trends. As a result, providers are forced to collect from thousands of consumer patients, in addition to their process of collecting from regular 15 to 20 payers. This trend is increasing, and requires providers to adopt business policies, practices, and systems to address the growing challenge of collecting from patients (which is significantly different and more complicated than submitting an insurance claim).

Collecting from patients requires providers to invest in new technology that provides access to:

By investing in this new technology, providers will realize substantial ROI by supporting essential revenue cycle best practices required to thrive in today’s financially challenging times. SurePayHealth, from Recondo, is specifically focused on helping providers improve their financial interactions with payers and patients. SurePayHealth is made up of many components.

The following flow chart displays the transaction flow across SurePayHealth.

SurePayHealth-Identity Check and Patient Verification

Getting accurate patient identification and demographics up front is the key to reducing errors and mistakes later in the revenue cycle that can be time-consuming and expensive. In SurePayHealth, Access Plus and Eligibility Plus, providers check patient full name, payer, and payer benefit plan (or group number), date of birth, address and phone numbers, and other key demographic information for the patient and guarantor and compare that data against national third-party databases:

Patient registration can capture serious identity and demographic errors that create significant rework later in the provider’s processing or claims reimbursement process, and cause a significant loss of funds (bad debt write-off) for providers. By gathering, checking, and validating identity prior to service and at point-of-service, providers streamline the accuracy of all eligibility and claims processes. A single source for identity verification at registration is vital to subsequent steps in the SurePayHealth calculation process and the final claims submission.

Specific Identity Verification Steps

SurePayHealth-Eligibility Plus

In most provider organizations, checking insurance eligibility is a time-consuming task, and administrative staff spends many hours each day on the phone with payers verifying patient insurance eligibility. Some payers offer eligibility information via a website, but this is complicated by the constant switching between websites. In some cases, a provider can check eligibility via a third-party service that charges on a per-transaction basis. These current processes are so cumbersome and difficult that eligibility is usually not completed in advance of the patient’s appointment, or administrators make errors and submit inaccurate claims to the wrong health plans (payers), or even worse, errors result in a denied claim weeks later (correct payer but inaccurate patient data).

In addition to the initial POS eligibility check, a provider needs to re-check a patient’s eligibility throughout the payment process. Automatic checks at scheduling, registration, and periodically throughout the entire treatment and payment cycle help providers identify potential payer sources, reducing the number of denied claims, bad debt write-offs, and staff hours while increasing revenue through improved collection rates.

Accurate patient insurance eligibility verification at the time of scheduling or Point-Of-Service (POS) is a provider’s number-one defense against denied claims and reduced reimbursement amounts. A recent HFM feature story, “From a Ripple to a Wave, Why Eligibility Matters.” considers eligibility verification the “most critical” step in driving a provider’s revenue cycle. Zimmerman’s Patient Payment Blueprint considers automated insurance eligibility verification the key to maximize patient payment.

Specific Eligibility Steps

SurePayHealth – Patient Amount Due Calculator

Most insured patients owe a portion of health care costs. Due to the increasing number of high-deductible plans under Consumer Directed Healthcare (CDH), the amount of money owed by the patient is now significant and is predicted to grow from 10 percent to 30 percent of provider revenue over the next several years. Even if the patient has the ability to pay, if the provider does not collect payment from the patient at the time of scheduling or point of service, the provider’s probability of collecting drops exponentially.

SurePayHealth - Patient Amount Due Calculator uses the specifics of the patient’s health plan for covered versus non-covered service items, provider-payer contractual allowed amounts, co-pays, co-insurance, limits, and status of the remaining accumulators, including deductibles, OOP (Out Of Pocket), and lifetime limits to calculate which portion is owed by the patient. Since accumulators are often not entirely up-to-date due to manual bills flowing through the process, the SurePayHealth calculation may be slightly greater than the final outcome, and as a result, the provider needs a trustworthy process to offer timely refunds to the patient. On the contrary, when the final adjudication process results in amounts due from the patient that are greater than the SurePayHealth calculated amount, then a provider needs a process for presenting the patient with a friendly bill for further collection. There may be factors outside the scope of the solution; e.g., a patient goes in for surgery, experiences unexpected complications, and the patient’s bill ends up being higher.

Armed with the most accurate possible calculation of the patient’s financial responsibility, registration staff and financial aid counselors are able to more effectively communicate with patients at point-of-service regarding payment options and plans.

This new and effective Recondo technology automatically accesses a payer’s benefit plan and then calculates billing payment using all components of a patient’s benefits including current accumulators, producing the following benefits:

SurePayHealth - Credit Checks:

Patients who are uninsured, self-paying, or have high-deductible plans will have a potentially significant amount due at POS. A key step in helping patients deal with this financial obligation is to perform in-depth credit checks using a well-qualified third-party source. Credit checks provide valuable information for the financial counselors to determine which paths to pursue for individual patients. This check indicates whether the patient has the credit ability to pay the amount, and if adequate sources of credit are available, along with their baseline ability to pay. Armed with this information, financial counselors can have a positive advisory discussion with the patient on available options for payment.

Specific Steps:

SurePayHealth-Check Medicaid or Charity or other Financial Assistance Programs

Until recently, it was very difficult for providers to check other sources of financial assistance to help a patient pay for his or her health care financial obligations. Owing to the complex paperwork, most providers do not even attempt to check available financial assistance. To better assist patients to meet financial obligations, providers must pursue a holistic solution to ensure payment. Providers now have access to technology advancements to evaluate availability of financial assistance. Recondo performs an accurate assessment of Medicaid criteria, and includes a comprehensive listing of local, county, state, and federal charity or financial assistance programs that can  may offer help to patients.

Specific Steps

SurePayHealth-Stratification of Self-Pay Accounts

Since providers face a major challenge in prioritizing payment and collection efforts, Recondo helps provider professionals by developing priority queues. Recondo creates the best stratification based on provider-specific criteria, which include highest amounts, highest ability to pay, opportunity to pursue financial assistance programs, and other issues. In addition, the providers can seek to use financial products to help patients meet health care costs. Providers then submit rankings of self-pay accounts to automated processes that search for payer coverage or financial assistance programs. Providers can also add incentives to patient-friendly bills and discussions to increase the probability of payment. Providers also determine other key criteria such as collection goals, policies, and practices so some accounts are turned over to outside organizations for collection.

Connect Directly with Recondo Technology

The Recondo Payer Services Team is ready to assist payers committed to delivering the real data their health care providers, employers, and members need. Our developers and analysts can assist in connecting any organization to the Recondo member network and, if needed, overcome challenges associated with delivering the data that will reduce the cost of health care.

Contract Administration in Support of SurePayHealth

Recondo Contract Administration provides the health care contract specialist with an indispensable tool that forms the foundation of SurePayHealth. Contract Administration works in real time to calculate price to help determine patient responsibility.

Rule Entry

Recondo Contract Administration simplifies contract entry and rule creation in several ways.

Summary of Benefits

Identity Verification Benefits

Eligibility Benefits

SurePayHealth-Patient Portion Calculation Benefits