On the Commercial side, we've reached this equilibrium of what I call the 90/90 rule. Ninety percent of the claims are adjudicated and we collect 90% of the Allowed Amount.
Most of the claims not adjudicating are for eligibility reasons. And over a calendar year, the payer typically pays 80% of the Allowed Amount and we get 50% of Pt Responsibility paid. Like others, we hold our Commercial Claims with the intention of getting in line behind others and hoping those ahead of us take most of the deductible and copay. And it does help holding claims. We can't discharge non-paying pts. Holding claims is one of the few tools a hospital based physician has in addressing low Pt Responsibility payments.
Always interested if others are successful in moving the needle on this 90/90 rule. Pt Responsibility payment is usually dependent on your community. We've used legal action, credit reporting, and other means to address Pt Responsibility. Not much luck in getting it to move from the 50% mark. Holding claims does help limit the amount going to Pt Responsibility.
Good luck.....Chris
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R. Christopher Sluder CPA
Administrator
Rome Radiology Group
Rome GA
(770) 324-7464
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Original Message:
Sent: 03-06-2024 12:21
From: Christy Hembree
Subject: Reducing Deductibles and Co-insurance Turned to Collections
Good afternoon,
I am curious if any hospital-based groups have implemented strategies to reduce the number of deductibles and co-insurance amounts that end up in collections. For example, are there specific tactics such as adjusting the frequency of text or paper statements, refining the language used on statements, or offering more flexible payment plans? If you have, would you be willing to share what has worked effectively for you?
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