Written by Dave Shaffer

When Robert Gaitan started as director of patient accounting at Medical Arts Hospital in Lamesa in 2014, he ran an aged trial balance report — and was shocked to see the rural, 22-bed hospital had outstanding insurance claims going back to 2009, worth more than $6 million in gross charges.

Nobody in the billing unit was following up with those insurance companies once they denied payment for whatever reason – a miscode or need for further information, or even termination of coverage.

“We didn’t have the expertise we needed in the billing department,” Gaitan said. “Billing is not like a utility bill. You have to know exactly what you’re billing, or (the hospital’s) not going to get paid. But in smaller communities like this, recruiting qualified people for billing is no easy task.” 

For a small hospital, losing any revenue is significant, Gaitan said, so collecting the debt was important. But Gaitan didn’t feel the hospital had the internal resources to do that effectively.

Healthcare Receivables Solutions had been handling Medical Arts’ bad debt for nearly a decade and had recently begun handling the early out billing — which gives self-pay patients a chance to resolve past-due accounts before they’re sent in for full collection. Gaitan decided to hand over the duties of following up on those old insurance claims to see if it would have more success.

Gaitan’s decision quickly paid off; soon HRS began handling all the billing for insurance claims and for Medicaid and Medicare, too.

A Friendship That Increases Collections

“HRS can take over a hospital’s entire revenue cycle process or just the pieces they’re having trouble with,” said HRS CEO Barbara Folts. It acts as an extension of its clients, even using the hospital’s logo and letterhead on its letters.

What makes HRS different is its focus on customer service, said Amber Billman, director of billing for HRS. “Of course we want to make our clients happy and collect for them, but at the same time we want the community to know that we’re behind them, that we’re here to support them, that we will help them. We don’t want to send them back to the hospital for a question regarding an explanation of benefits or a balance or a bill.”

HRS’s personal service stands out, Gaitan said. “With other agencies, our communication was all business. With Barbara and Amber, it has a personal feel. In a small town like this, a small hospital, you need that personal touch. You’re working with a good friend, basically.”

Gaitan gave the HRS team access to the hospital’s management system so it could connect with all the billing information that an in-house staff member would have. That allows HRS to see information in real-time and to update Medical Arts’ records simultaneously, so if a patient calls asking about the status of a bill, hospital staff can convey the latest information.

By handing the billing functions over to HRS and trimming his billing staff from eight employees to three and a half, Gaitan saves about 35 percent on his personnel budget, which more than pays for HRS’s services.

Saving Money and Reputations

Thanks to Gaitan’s reorganization, the hospital is collecting more and adding needed room in the hospital’s margins.

In August 2016, Medical Arts had $3.3 million worth of unpaid insurance claims from 7,150 accounts. Two years later, those numbers were down to $1.8 million and 3,276 accounts. “This tells you how much more on top of our game we are now,” Gaitan said.

HRS records every call it makes when following up on a bill. If a patient complains about the manner in which an HRS representative talked to them, Gaitan has the option to listen to the call and judge for himself.

Gaitan admitted he was hesitant to continue using HRS when he first came onboard at Medical Arts for both early out and bad debt collections. He previously had a bad experience using a single company for both early out and bad debt; letting the claim go to bad debt means a higher percentage of collections fees.

Plus, “I wanted to come in and make my own changes. I wanted to use the companies I like,” he said.

“But I gave HRS the benefit of the doubt and stuck with them, and I’m really glad I did because it has worked out really well. Amber and Barbara are some of the best people I’ve ever worked with in the industry.”

This sponsored section is underwritten by HealthShare. Healthcare Receivables Solutions has been endorsed by the Texas Hospital Association since 1980. For more information, go to www.healthshare-tha.com/HRS.