The recent uptick in high-deductible health plans, along with the downturn in the U.S. economy, came as a double whammy for Tennessee-based STAR Physical Therapy and its customers. Many patients who entered one of STARS’s 67 clinics across the state suddenly faced the reality of having to pay more than $100 upfront for their visit. And with many physical therapy regimens requiring multiple visits per week, some patients on tight budgets were forced to walk away.
By Neal Learner, Contributing Writer
STAR Physical Therapy needed to do something to help patients deal with higher deductibles and multiple-treatment care plans. What they found reduced both the A/R backlog and paper statement usage.
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The recent uptick in high-deductible health plans, along with the downturn in the U.S. economy, came as a double whammy for Tennessee-based STAR Physical Therapy and its customers. Many patients who entered one of STARS’s 67 clinics across the state suddenly faced the reality of having to pay more than $100 upfront for their visit. And with many physical therapy regimens requiring multiple visits per week, some patients on tight budgets were forced to walk away.
STAR needed a flexible payment system that would give its patients more options to spread the fi nancial burden out over time. STAR also needed a modern claims management system to better communicate with patients, streamline its billing and collections systems, and ultimately reduce the company’s considerable accounts-receivable (A/R) backlog.
Enter ZirMed, Inc., a health information connectivity and management company. STAR selected the company’s suite of claims management, patient statements, and patient payment solutions because, according to STAR director of operations Damon Adelgren, they were “game changers” for his company. “Right now we’re using a lot of things that are very smart,” notes Adelgren, who receives no compensation from ZirMed. “I just really believe in them.”
Indeed, ZirMed’s tools have significantly improved STAR’s operations in recent years, including a 70 percent reduction the A/R backlog and a 50 percent reduction in use of paper statements. Health IT Outcomes caught up with Adelgren to get his thoughts on these accomplishments, as well as the next health IT steps for STAR.
Q: What are the biggest payment challenges your patients are facing and how are you addressing them?
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A: One of the best things we’ve done — and one of the worse things we’ve done — is to clearly communicate what the patient’s benefits are before starting therapy. A lot of healthcare providers don’t even talk about your benefits. And because of that, if you don’t do your own due diligence and come in and get your service done, you wait and get the bill and deal with it later.
We have a very intensive benefit verification program. Th ere are some unique things in our industry, such as visit limits. You may have benefits, but you can only come 20 times, for example. So it doesn’t matter if this is your second shoulder surgery and it’s medically necessary, your insurance will not pay more than 20 visits to therapy. So we as practitioners say, “What are we going to do with this patient’s shoulder?” We’re not just going to discharge them, because we’ll send them back to the doctor with a frozen shoulder. We’re stuck. We have to look at ways to make it affordable for that patient and get them back to life.
So once the sticker shock sets in, we figure out what are we going to do with them. We do collect on a per-visit basis. Depending on their benefits, if the patient raises any red flags, or we feel like there is a problem, then we have a time-of-service payment plan that we do. It’s like a credit that you don’t have to apply for. Th e idea is that you pay what you can afford per visit and then we’ll be able to bill you in the back end at a rate that you can afford.
Q: How did you various payment solutions help?
A: One the back end, we use ZPay for collecting. Th at was a big deal when we implemented it. Before, when patients called in to pay off their bills, our staff would literally — with a pen and piece of paper — write down all of their credit card information and run to a back room where we had a credit card machine and enter all that data, and then take that receipt and stick it in an envelope and mail it to the patient.
It was extremely laborious and costly. When we implemented ZPay, the first thing we did was have all of our A/R account reps take down the information customers were giving us right there on ZPay. It’s more secure. We’re not writing down their information on a piece of paper. And we’re able to immediately initiate that transaction, which also results in an immediate receipt that we email to the patient. Th is is phenomenal.
At the same time, the ZPay payment plan was a game change for us. When a patient calls in and questions their bill, and they have an $800 bill that they can’t afford to pay off right there, we’re able to set them up immediately on a payment plan that is extremely savvy in that it automatically computes the dollar amount they want to pay each month or a minimal payment that they say they can afford. We’re able to immediately email that to the patient. That’s been a big, big tool for us.
ZPay also allows you to have a payment portal that you can offer to patients on your website. So you’re in your pajamas at midnight and you’re going through your mail, you can do it right there and then. They can pay by credit card, or using their checking or savings account. When they pay that, it feeds into the same back end.
Q: Describe how the technology allows you to communicate payment information with patients?
A: We have implemented a new system in the last few months that allows us to customize statements and provide patient education. Th e way we lay out the statement — with the patient information section, where we were able to customize it and help answer questions before they were even asked —that’s huge for us. So when a patient gets a statement, they can look at it and go pay their bill. Or if they still have a question, they can at least address that. It’s reduced the number of questions that are coming in to us. But more importantly, the ability to customize what patients see is a big deal.
And if a patient isn’t paying their bill we send them a first, second, and third notice. We send our pre-collection letter, which is a soft letter saying “We’ve recently reviewed your account, it’s past due.” We don’t have to use another service, it’s not fancy. But it’s completely customizable, and it’s a big deal to have that kind of muscle. We have 67 clinics throughout the state of Tennessee, I can’t fold and stuff anymore. It’s too labor intensive.
Q: What’s next for STA, particularly in implementing electronic remittance advices (ERAs) from insurance companies?
A: We realize that 80 percent of our revenue comes from insurance companies. What happens is insurance companies will pay your claim or deny your claim, and there are standardized lists of denial codes. Th e process of sorting through the [physical] remittance advice has been a pain in the behind over the years. Literally an accounts-receivable rep has to go through the stack and mark manually is it was paid or not. You could have a remittance advice that is an inch and a half thick of paper.
Where we’re moving next, and others are moving, is we’re taking the ERA and putting it into the work fl ow. So instead of going through a two inch stack to find your 20 things that you need to resolve, now you can see here are the 20 things you need to resolve right in this workflow que. That’s huge. Managers can manage it, reps can see it, and we can turn around and resubmit those claims back electronically.
In 2016 we will start beta testing and using it. If it does what it says it does, this will be very similar from having to manually post everything to be able to electronically upload it. Now we have a game changer: instead of manually working all of your denials, electronically they’re built into the workflow.
Q: What advice do you give others to improve collections and payment communications?
A: The technology is available for everyone, even smaller clinics. Sometimes it’s just two people who have to do everything. For them to be able to use the muscle of a large entity like ZirMed for their needs, albeit smaller in volume, is just as important for their business. They only have 24 hours in their day too. We all face the same challenge. So when we can all collectively use a resource like ZirMed to meet our needs, it’s a good thing.
The recent uptick in high-deductible health plans, along with the downturn in the U.S. economy, came as a double whammy for Tennessee-based STAR Physical Therapy and its customers. Many patients who entered one of STARS’s 67 clinics across the state suddenly faced the reality of having to pay more than $100 upfront for their visit. And with many physical therapy regimens requiring multiple visits per week, some patients on tight budgets were forced to walk away.
A: One of the best things we’ve done — and one of the worse things we’ve done — is to clearly communicate what the patient’s benefits are before starting therapy. A lot of healthcare providers don’t even talk about your benefits. And because of that, if you don’t do your own due diligence and come in and get your service done, you wait and get the bill and deal with it later.
