3. Evaluate the events that can lead to a risk (i.e., Accountable Care Organizations or bundled payments).
4. Determine solutions for mitigating those identified risks.
5. Enact solutions and assign an owner for each risk area.
"An [ERM] tool can be used for this, but it can be done without one," he says. In order to make this risk management session productive, you will need to provide the team with your gross charges and profits for each procedure, the costs and opportunities to reduce them, and the reimbursement levels.
Once the risks have been identified, one of them is likely to be the area of payment transparency and that’s where your front office may need to change.
"The whole conversation that I had at the ER registration could’ve gone better if the woman had had the data I wanted in her hands. Then we could’ve had a meaningful conversation," he says. "But with only limited information, she wasn’t empowered and when I pushed back she gave up. That now puts a lot of risk on the hospital as to whether I pay my balance after I leave."
Silva-Craig’s colleague Jim Bohnsack, vice president of product development at TransUnion, says hospitals and health systems already have many of the tools in place to provide patients answers to their payment questions. However they lack the ability to pull all of the pieces together in the front office at the point of service.
"One of the pieces everyone does to verify insurance benefits and eligibility is a HIPAA 1270/1271 … they check it on a binary level for a ‘yes’ or ‘no’, but there is a ton of other information that can be pulled from that transaction," Bohnsack says.