The administrative costs of community-based health insurance: a case study of the community health fund in Tanzania

Community-based health insurance expansion has been proposed as a financing solution for the sizable informal sector in low-income settings. However, there is limited evidence of the administrative costs of such schemes. We assessed annual facility and district-level costs of running the Community Health Fund (CHF), a voluntary health insurance scheme for the informal sector in a rural and an urban district from the same region in Tanzania. Information on resource use, CHF membership and revenue was obtained from district managers and health workers from two facilities in each district. The administrative cost per CHF member household and the cost to revenue ratio were estimated. Revenue collection was the most costly activity at facility level (78% of total costs), followed by stewardship and management (13%) and pooling of funds (10%). Stewardship and management was the main activity at district level. The administration cost per CHF member household ranged from USD 3.33 to USD 12.12 per year. The cost to revenue ratio ranged from 50% to 364%. The cost of administering the CHF was high relative to revenue generated. Similar studies from other settings should be encouraged.

Banking: shop and compare

There are many reasons to take a critical look at the practice's banking relationship(s)--technology advancements, security measures, improvements in available services, recent banking enhancements designed specifically for medical practices, the impact of the financial crisis on bank ratings and stability, changing practice needs, opportunities for operational automation at the practice--and it is just simply smart to periodically evaluate and compare the features, pricing, and potential savings offered by vendors.

Why banks say NO to great healthcare practitioners. Five reasons why banks reject loans to quality small-business owners and what you can do about it

If you have a dream of opening or expanding a practice, then bank lending is probably an option you've considered. However, many practitioners are under the false assumption that banks are currently not lending. Untrue! Between 2008 and 2012, banks have loaned an average of $216 billion to small businesses throughout the United States each year. There are two aspects to a bank loan package: (1) your loan application with tax information, asset information, etc.; and (2) your business plan. This article delves into the five reasons banks say "no" to a great healthcare practitioner and what you should include in your business plan to not only have the bank say "yes" to financing your business but also to create a situation where multiple banks are offering to lend you money.

Comply with regulations or risk paying hefty fines: ten tips for choosing call recording to help ensure compliance

Medical practices are paying hundreds of thousands of dollars in fines for not complying with various governmental regulations, including a variety of HIPAA rules and credit card compliance. One solution to help reduce this risk and avoid fines is to use call recording to help ensure compliance. This article provides readers with key considerations for choosing and implementing a call recording solution for their medical practices to ensure that it will be compliant with key regulations. These tips include being able to customize call recording policies and procedures for their unique needs; providing secure, private storage; allowing easy access for authorized users; secure sharing of call recordings; regulatory compliance training; disaster recovery; and maintaining an audit-ready and compliant-evident state at all times.

A new imperative for patient relationship management

Managing relationships with patients and their families before, during, and after treatment is central to the success of health systems of the future. Revenue cycle staff are critical to an organization's efforts to build patient loyalty, because revenue cycle operations involve one of the few standardized processes in health care to engage with patients on and off campus. A patient engagement initiative implemented by Gwinnett Medical Center in Atlanta delivered a better billing experience for 86 percent of patients surveyed--either with Gwinnett or with another hospital.

Documenting the health insurance needs of cancer patients and providing scarce resolutions

The American Cancer Society's Health Insurance Assistance Service provides callers to its National Cancer Information Center with detailed knowledge to help them access or maintain health insurance coverage for which they might be eligible. Demographic data from April 2009 to June 2011 show that 76 % were uninsured and between the ages of 40-60; 65 % were Caucasian, 17 % African American, and 12% Hispanic; and monthly incomes were $1,999 or less. Current trends indicate that callers are similar to those identified in various health care reform publications: callers are unable to afford co-pays; facilities are requesting cash upfront; callers report loss of coverage, less adequate or less affordable coverage from employers; large out-of-pocket expense or high deductibles are needed; and modification of the CDC's Breast and Cervical Screening Program's eligibility guidelines create challenges. Six lessons that have been learned while initiating and managing this program are presented.

Achieving revenue integrity in hospitals and health systems

The Bellevue Hospital sought to improve its performance in three areas-days in accounts receivable (A/R), denials, and charge capture-to enhance revenue integrity. Results included the following: A 30-percent reduction in days in A/R. A nearly 200 percent increase in bad debt collections. A more than $1.6 million reduction in denials write-offs. An improvement in net revenue of more than $1 million.

You must have financial office policies in place to maximize your profits: part I

In summary, it is clear that A/R and collections relate to the business side of medicine and are critical to your financial success. After patient care, your focus should be on getting paid for your services and collecting what is due, having a fine-tuned billing process with all its components working in a coordinated fashion, maximizing revenue, managing patient payments and overdue accounts, and ensuring that your employees are operating in a trustworthy manner. The key to managing your A/R is to be consistent while at the same time flexible with your patients. Staff training and continuing education must be a job requirement. Setting performance and expectation standards is necessary for each and every employee. In your training sessions, which must include all providers, staff members must understand the tasks for which they are accountable and how their individual roles contribute to the success of the entire practice. Remember that the overall goal in managing your A/R is to collect what is due you on a timely basis. The longer funds are due from the patient or insurance company, the longer the practice waits for the money. In some cases, you may never receive payment, so it is critical that you have a team in place to act on collections and everyone in your practice is on the same page. Your staff must learn to work smarter, not harder, when it comes to collecting what you have earned.

The three most effective strategies for handling patients with overdue accounts

Many medical practice employees find the collections tasks assigned to them to be a source of discomfort, reluctance, and even dread. This is understandable. Talking about overdue accounts is not something most people want to do. This article focuses on the three most effective strategies that medical practice employees can use to help them feel more confident when they handle patients who have overdue accounts. It provides a sample 135-day collection program and variations of it that many medical practices use. It offers medical practice employees 10 tips to help them develop a stronger, more businesslike attitude when they approach their collection duties. It provides a list of more than 15 daily affirmations that medical practice employees can use to develop a more positive attitude about making collection calls and having one-on-one collection meetings with patients. Finally, this article presents a worst-case scenario exercise to help medical practice employees face their worst fears about collection calls and meetings and to feel more at ease when they confront patients about their debts.

Using third-party financing to help today's patient pay for treatment and care

Patients walking into your practice today are different than the ones you saw a few years ago. Larger deductibles and out-of-pocket costs may cause many of them to put off recommended treatment. What can you do to ease patients' cost concerns and help them move forward with the care they want and need? Creating a comprehensive financial policy that includes a third-party patient financing program is a good place to start. Here's how to ensure that you select the best program for you.

The right patient

This article offers professional opinions and advice on how physicians should prepare in order to protect themselves and their practices during this turbulent time in healthcare reform. This article presents real-life scenarios to help physicians understand what they may face and what actions they should take in anticipation of the future in healthcare. The article focuses on the concept of "the right patient," defining the characteristics of patients that benefit the financial aspect of a practice and those who do not. Its purpose is not to encourage physicians to deny care to patients who are poorly insured or uninsured, but to guide in the establishment of a smart and safe balance between the two. Strategies are discussed on how to attract the right patient and what these patients mean to the practice. The importance of practice marketing is also highlighted, along with an emphasis on the necessity of change in order to survive in the future healthcare environment.

Analysis of cash flow in academic medical centers in the United States

PURPOSE

To examine cash flow margins in academic medical centers (AMCs; i.e., teaching hospitals) in an effort both to determine any significant differences in a set of operational and financial factors known to influence cash flow for high- and low-cash-flow AMCs and to discuss how these findings affect AMC operations.

METHOD

The authors sampled the Medicare cost report data of 103 AMCs for fiscal years 2005, 2006, and 2007, and then they applied the t test to test for significant mean differences between the two cash flow groups across operational and financial variables (e.g., case mix, operating margin).

RESULTS

Compared with low-cash-flow AMCs, high-cash-flow AMCs were larger-bed-size facilities, treated cases of greater complexity, generated higher net patient revenue per adjusted discharge, served a significantly lower percentage of Medicaid patients, had significantly higher average operating profit margins and cash flow margin ratios, possessed a higher number of days of cash on hand, and collected their receivables more quickly.

CONCLUSIONS

Study findings imply that high-cash-flow AMCs were earning higher cash flow returns than low-cash-flow AMCs, which may be because high-cash-flow AMCs generate higher patient revenues while serving fewer lower-paying Medicaid patients.

Next-generation vendor management: the experience of Centura Health

Denver-based Centura Health implemented a new approach to working with vendors that deliver out-sourced collection services. The approach requires: Engaged leaders with a comprehensive and communicated strategy. Structure, process, and policies aligned with the strategy and designed to make it operational. Technology to streamline and provide broad access to comprehensive account-level data.

Financial advantages. Preventative measures ensure the health of your accounts receivable

Running a dental practice is no small task; from staying on the leading edge of new medical developments and products, to monitoring ever-changing dental insurance plans, to simply overseeing the fundamental day-to-day operations. But there is one area of your practice that can be streamlined to significantly improve your cash flow, minimize delinquencies and optimize fiscal operations. Your accounts receivable and collections can be economically and efficiently managed by a savvy combination of internal efforts and the partnership of a third party resource.