Self Pay Revenue Collections

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Client Profile:

13-hospital health system with an academic medical center, community hospitals, specialty hospitals, community medical group and a payor plan.


Due to increasing regulatory pressure concerning the management and collection of self-pay balances, our client required all seven of their organization's business offices to migrate onto a standard vendor management program including standardized bad debt and financial assistance policies, outsourcing timeframes and vendors, and reporting protocols.

Prior to this project, the health system was using a total of 15 self-pay outsourcing vendors, had significant variation in their bad debt processes and policies, and were unable to effectively compare performance across hospitals within their self-pay account population.  

The project required several phases to complete, including the following: 

  • Define consistent future processes, policies and reporting methodology:  Each independent business office within the health system had their own methodology for managing self-pay account balances.  Before any changes could be made, the team had to clearly define an organizational methodology on how the process should work, write policies to support these processes that could be used consistently in each business office, and clarify how they could better support their patients with excellent customer service and understanding in the pursuit of obtaining payment on outstanding balances.  Once complete, the new methodology was shared with the organization’s senior leadership and their Board for approval.
  • Selection of business partners:  i3 then facilitated the organization through the evaluation and selection of a short list of vendors including the contracting process, helping choose business partners who were not just willing and able to flex with the needs of the organization over time, but also grow with them.  Through focused negotiation, the health system achieved one rate for all early out and primary bad debt collection services now aligning the goals of the organization with those of their business partners. A single rate was also negotiated for all secondary bad debt and litigation support.
  • Implement adjusted policies, practices and reporting: Implementing the new policies meant adjusting bad debt and write off practices for nearly all of the organization’s hospitals.  New write off codes were created to better track and compare performance across hospitals and vendors.  Employees and vendors were trained on the new policies and performance expectations.  Hospital extract files were created, tested and retested to make sure the right accounts were reaching each vendor at the right time.  i3 also assisted the organization by working with each vendor to create standard reporting packages to better allow the leadership team to compare performance across the organization.

As a result of our work the health-system reduced overall self-pay processing and collection costs by 6% and improved collections by over 10% system-wide.