The Revenue Solution

One area where most programs fall short is patient responsibility collection. Many programs don’t even try to collect patient responsibility, leading to the loss of anywhere from tens to hundreds of thousands of dollars. Just imagine what your center could do with $100,000 a month. The reality is that your center very well may be losing out on that much or more each month as patient responsibility gets overlooked, or programs have the mistaken belief that trying to collect such monies will scare patients away.

Compliance is another issue here. One of those things that’s not a problem — until it is — and then, when it is, it’s a very big problem — often a multimillion dollar problem. Not just half-hearted attempts or collections of promissory notes, but actual documented patient collections and good faith attempts are a requirement for compliance. When a payer does an audit, and they will, then they have the legal right to claw back reimbursements over a multi-year period if they find a treatment program wasn’t faithfully collecting on patient responsibility.

The reality is, you cannot devote 100 percent of your attention on just clients, or just revenue. You have to find the balance that not only keeps the lights on, but also keeps the focus on treating patients at the heart of your operation. The good news is that there are ways to find that balance that we can uncover together.

Treatment center owners are pulled in many directions. As your heart tells you to continue giving more and more to clients, your brain understands the fact that revenue must increase to continue moving forward. It is a constant internal battle that can bleed into the work being done by nurses, doctors, and other facility workers as they see the stress that management is under.

The focus of our work needs to be centered on the clients and their treatment, regardless of whether it is substance use or a mental health disorder. However, without focusing somewhat on the business aspect, how are we to keep our center afloat?

The reality is that your treatment center might be losing out on hundreds of thousands of dollars a month due to overlooking or ignoring patient responsibility collections.

In the case of servicing out-of-pockets, deductibles, and coinsurance amounts, most treatment centers struggle, and many don’t even make an effort. This function is one of the most important drivers of business profitability. It is desperately needed cash flow that goes directly to the bottom line. For smaller treatment centers it amounts to hundreds of thousands of dollars annually, while larger centers are losing millions. Patient responsibility can account for as much as 10-15% of the total revenue per patient.

“It is clear that insurance reimbursements are not what they were even five years ago,” President and Founder of The Revenue Solution TJ Ferris says. “Because of that, our treatment centers are being forced into collecting patient responsibility. The ones that are bringing people like us in, are getting a huge competitive advantage. We are talking about a 20-30 percent increase in revenue as opposed to the centers that are still turning a blind eye in fear of losing clients.”

Again, what could your treatment center do with those figures coming in as found revenue? In all likelihood, your treatment center has been taking the patients that cannot pay their portion anyway, because in the end we just want to help. Think of the immediate support to cashflow. Patient responsibility is revenue in the door immediately. No 45-60 day wait on reimbursement. No payments to billing companies or internal staff.

Often the idea is to turn to a collection or billing agency for these services, but that could only sink your center deeper into the hole.

“If a center goes out and just hires a collection agency to do this that isn’t familiar with treatment and the sensitive nature of it — not only what the patient is going through but what the family is going through — they are going to drive people away against medical advice, driving up a huge AMA number,” Ferris said. “We have been in treatment centers ourselves and know how to deliver to the client without driving people away, like a collection agency might do.”

With decades of experience between them, the people at The Revenue Solution know how to hold a completely non-threatening conversation with clients and their loved ones about finances, without driving them further away from treatment at your facility. ​

For a long time in the treatment industry, staying compliant in the world of patient responsibility has been overlooked for many reasons. It helped centers grapple and compete with each other to bring clients in and collect insurance reimbursements. Reimbursements were enough for treatment centers to stay profitable, but those days have passed, and they are not coming back.

As the treatment industry continues moving forward, insurance companies are going to continue to find ways to cut into reimbursements by taking advantage of the fact that for so long our centers were non-compliant.

“This industry, for as long as I have been in it (more than a decade), and even before then, moved in a direction of promising away money,” Ferris said. “Whether that be co-pays, deductibles, out-of-pockets, and so on. For so long insurance reimbursements were sizeable enough to not only function, but remain profitable. Insurance companies have caught on though. They are putting the squeeze on treatment centers to force them into collecting patient responsibility, but many are not good at asking for money, because for so long they have not done it the right way.”

“Most people are, in reality, not comfortable asking for money,” Ferris said. “It is uncomfortable. We have specialized in it though, and know that it is much more than just calling and asking someone for money. We have tested and perfected our scripted calls so that we remain compassionate and understanding, while being thorough, to successfully recoup substantial sums and maintain a high degree of customer satisfaction.”

Along with collections comes compliance. The Revenue Solution keeps detailed and concise documentation in all of their clients’ EMRs/CRMs. Their exhaustive collection notes will confirm and build a reputation for your treatment facility as a compliant and successful facility.

One of the biggest fears of treatment center owners and managers is losing the competitive edge in customer satisfaction as you balance the scales between increasing admissions and increasing revenue through patient responsibility.

It is common to fear that by asking for money, you will drive potential patients away from your program to go elsewhere. Almost the exact opposite is true. ​

As time has passed, it has become clear that honesty goes further than anything else. Clients of treatment centers have caught on to the lies over time and have become skeptical. This is the most common among repeat clients.

“By doing things like waiving patient responsibility or failing to make an effort to collect it as a whole, the market has been set at a place where patients are being told different things by different treatment centers,” Ferris said. “One is saying you have to pay this much and the other is saying you do not need to pay anything. Patients have caught on over time though, especially those that are returning patients. They know they are being lied to.”

By coming to The Revenue Solution for assistance, you are able to be honest with your prospective patients and their families.

Recently, a client of The Revenue Solution was faced with a task of proving themselves when confronted with an audit of their books from Cigna. As part of the audit, Cigna requested documentation of collections for patient responsibility and efforts made from 60 different random clients from past and present.

With The Revenue Solution’s meticulous and accurate record keeping in the EMR for the client, they were able to provide proof of collection and/or proof of exhaustive efforts across all 60 clients.

The Revenue Solution provided documentation showing that nearly $250,000 in patient responsibility was collected from these 60 clients. Among clients where funds were not collected, The Revenue Solution was able to document the reasons those clients provided as to why they were not able to pay, which included joblessness due to the COVID-19 pandemic and other valid reasons. The notes left by The Revenue Solution in the EMR provided enough information to keep Cigna from attempting to claw back the reimbursements they previously paid.

In calculating the amount paid by Cigna from just these 60 clients, TRS was able to avoid having the client pay back as much as $1.319 million to the insurance company! That breaks down to over $22,000 per client.

If your treatment center is facing the hard reality that insurance reimbursements are no longer enough to pay your employees and keep the lights on, or if you are trying to beef up compliance, looking to grow your program, get a leg up on the competition, and take it to the next level, The Revenue Solution is here to help!

Utilizing the proven methods of collection, compliance, and documentation by The Revenue Solution, you are taking care of the future of your business and opening the door to help hundreds or thousands of people moving forward.

The Revenue Solution charges no upfront fees or regular monthly fees. TRS is paid a percentage of the funds that they account for, so they only get paid when you get paid!

The Revenue Solution works with treatment providers across the country. You can reach TRS online at therevenuesolution.com, by emailing info@therevenuesolution.com, or by calling (844) 314-8867.