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F2 Insights

Top 10 Insights in Medicare/Advantage Bad Debts



F2 has completed 40+ net revenue recovery engagements related to Medicare / Advantage deductibles and coinsurance and associated bad debt in the last 18 months. Engagements have yielded consistent insights as follows:

1. Uncommon, Surprising Value

More than any other insight, the resounding comment we heard in 40 of 40 situations is “this niche net revenue area seems to hold uncommon, surprising value.” From a safety net hospital identifying $3M and going from a negative to positive line to a system conversion that resulted in $2.5M of unidentified (potentially lost) MBD, results of taking a deep dive into MBD have surprised most in a positive way.

2. MBD Compilation Does Not Equal MBD Analytics

Many providers operate under a false understanding that internal/outside assistance in MBD log compilation ensures all MBD is claimed. Understanding the entire universe of what should be claimed through deep analytics is fundamentally different from compiling logs under traditional methodologies. Analytics coupled with MBD compilation (internal or external) yields significantly higher MBD.

3. Impacts of System Conversions

In 10 recent instances of system conversion (primarily to EPIC), there were agency return and/or crossover reporting issues totaling over $10M in unclaimed MBD. Mapping old MBD practices to new system processes has been a key issue.

4. Impacts of Turnover

In addition to changing systems, turnover can have dramatic impacts on claimed MBD. New personnel utilizing incorrect write-off codes and/or not understanding the documentation requirements for MBD leads to frequent under-reporting.

5. Impacts of Hospital Consolidation/Mergers

Consolidation and merger bring system conversion and turnover to the forefront. In addition, policies and procedures frequently change in the CBO, with agencies and many other areas that can significantly impact MBD. Understanding how changes impact each organization’s MBD reporting is important.

6. Know Your Collection Agency

Collection agencies are typically compensated based upon net cash collection/returns to the hospital and health system. Decisions to hold accounts for extended periods of time and/or to write-off in certain ways create numerous under-reporting situations for MBD.

7. Know What Happens When Your Collection Agency Changes

Outside collection agency practices, having a transition plan for change in agencies is critical to MBD.

8. Know Your Bad Debt ATB

“Accounts go to bad debt and offer low % yields prospectively.” The bad debt ATB holds an enormous inventory of potential assets for the average hospital and health system. Understanding the universe of inventory on the BD ATB and avenues to improve yield (sometimes through Medicare/Advantage bad debt) should be done at least semi-annually.

9. Understand MBD Rules and Regulations

For MBD, all patient D&C must be handled consistently from early out, to first/second collection, and other. This basic “rule 1” is frequently misunderstood in the revenue cycle and agency community.

10. Insights Beyond “MBD” – Advantage, Uncompensated Care

Taking a look at MBD has unlocked data in new ways at many organizations. The right data, in the right analytical tool, has identified fresh new insights into Medicare Advantage bad debt and Uncompensated Care.

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