Credit Industry News

How Much Do You Know About the Benefits of Laughter?

Wed, 08 Apr 2026 15:00:00 GMT

How Much Do You Know About the Benefits of Laughter?

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Test Your Knowledge
With Our Humor Quiz

For the past 50 years, the month of April has been designated as National Humor Month.

Established in 1976 by author and humorist Larry Wilde to promote the therapeutic benefits of laughter, the annual observance serves as a reminder to embrace joy and introduce more levity into our lives.

How much do you know about the therapeutic effects of humor and laughter? Take our quiz and find out.

#1. “Laughter therapy” incorporates humor into clinical settings. Who is credited with pioneering this approach?

Norman Lear created and produced many popular and groundbreaking 1970s sitcoms, including “All in the Family,” “Maude,” and “Sanford and Son.” Norm Macdonald was a Canadian stand-up comedian and “Saturday Night Live” cast member.

Norman Rockwell was an American painter and illustrator, most famous for his cover illustrations of everyday life for The Saturday Evening Post. Norman Fell was an American actor who was best known for his comedic portrayal of landlord Stanley Roper on the 1970s hit TV show “Three's Company,” for which he won a Golden Globe Award.

#2. Humor and laughter are medically documented to induce multiple physical health benefits. Which of the following is NOT one of them?

#3. Which of the following humor styles typifies the late comedian Rodney Dangerfield?

Self-defeating humor is used when attempting to please others by poking fun at oneself. Affiliative humor entails cracking jokes and engaging in banter to bond with others and recognize the humor in everyday life. (Think Jerry Seinfeld.) Aggressive humor uses sarcasm, teasing, criticism, and ridicule at the expense of others. (Think Don Rickles.) Self-enhancing humor laughs at oneself or at the absurdity of a situation in a constructive way, ala Jon Stewart.

[Curious about which category best describes your sense of humor? Check out this quiz .]

#4. Patch Adams, a medical doctor portrayed by Robin Williams in the eponymous 1998 film, believes that laughter is an integral part of the healing process. What’s the name of his non-profit healthcare organization?

Child’s Play is a charity that provides games, toys, and gaming consoles to about 200 hospital pediatric wards worldwide. Clowns Without Borders is an international organization that visits communities in crisis (such as natural disaster areas and refugee camps) to entertain and lift the spirits of suffering people.

Kidding Around is an international yoga organization dedicated to promoting the benefits of yoga to children. Patch Me Up is the name of two different companies, one is a clothing repair platform, and the other produces wellness patches.

#5. What is laughter yoga?

A. Activation of the abdominal muscles that naturally occurs when laughing

B. Laughing at people attempting yoga poses

C. Laughing instead of crying when you contort yourself into a difficult and painful yoga pose

D. A form of exercise that encourages participants to laugh for no reason

E. There is no such thing.

Answer D. Developed in 1995 by Indian physician Dr. Madan Kataria, laughter yoga is based on the belief that the physical body cannot distinguish between simulated and spontaneous laughter. Therefore, forcing oneself to laugh provides all the same benefits as reflexive laughter. Practiced in more than 110 countries, laughter yoga incorporates laughter exercises with yoga breathing techniques.

#6. The American Medical Association offers several suggestions for incorporating humor within a clinical setting. Which of the following is NOT one of them?

A. Adding humorous reading material to your waiting room

B. Playing funny TV shows in your reception area

C. Demonstrating comical pratfalls

D. Displaying humorous photos of your kids or pets in your office

E. Placing funny signs in public areas

Answer: C. While the AMA encourages humor in clinical settings, it draws the line at demonstrating pratfalls. All the other suggestions are AMA-approved.

Laughter Heals

If laughter is the best medicine, then the prescription is simple: make space for humor. Take time out of every day to simply yuck it up; your body and mind will thank you. The following video clip should get you started:

Sources:
Featured Image: Adobe, License Granted
Other Image: Designed by Freepik
Science News Today
Psychology Today
Gesundheit! Institute
Laughter Yoga International
AMA Journal of Ethics

The Personality of Debt

Wed, 11 Mar 2026 04:00:00 GMT

The Personality of Debt

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How Personality Impacts
Financial Health

Our unique personalities shape our spending and saving habits, impacting our financial health.

Although personality alone does not determine financial behavior, it does significantly influence the way individuals manage their money. For instance, research studies have identified a definitive connection between certain character traits and the probability of accumulating debt.

Mapping Personality Traits

When correlating personality traits with financial health, most psychologists employ a widely accepted model known as the “Big Five.” This method describes personality in terms of five broad dimensions: Openness, Conscientiousness, Agreeableness, Neuroticism, and Extraversion. Each of us possesses a unique combination of these traits, influencing our behavior and reactions to various situations.

These traits exist on a spectrum, and individuals differ in the degree to which they express each one. For example, a person may be very extraverted, somewhat extraverted, or not at all extraverted.

Linking Personality Traits and Debt

For each of the Big Five, there is a definitive correlation between the individual trait and the likelihood of accumulating debt:

Openness

Openness to experience is associated with creativity, curiosity, and a willingness to explore new ideas and perspectives. Some studies suggest that individuals with high levels of openness are more willing to assume debt for novel experiences or to invest in personal growth.

Conscientiousness

This personality trait is associated with responsibility, organization, and a desire to achieve goals. Research indicates that individuals with high levels of conscientiousness tend to be better at budgeting, planning for the future, and controlling their spending habits, making them less likely to accumulate debt. On the other hand, people with very low levels of conscientiousness tend to be impulsive, acting without considering the consequences. Such consumers are often driven by a desire for immediate gratification and struggle with self-control when it comes to spending.

--Article Continues Below--

Agreeableness

Agreeableness as a personality trait is associated with cooperation and kindness. However, one of the few drawbacks to this trait is in the domain of personal finances. Highly agreeable people tend to perform worse on various key financial metrics, including lower savings balances, lower incomes, and greater economic hardship (e.g., debts, insolvency). Agreeable people may also be more easily manipulated into making irresponsible spending decisions.

Neuroticism

Neuroticism is characterized by emotional instability, anxiety, and a tendency toward negative perceptions. Individuals with high levels of neuroticism may use spending as a coping mechanism to deal with stress and painful emotions. They may also be more prone to making impulsive financial decisions because of their emotional reactivity.

Extraversion

Extraverted individuals are outgoing, sociable, and assertive. Studies of this personality trait have yielded mixed results regarding debt accumulation, with some suggesting a positive correlation (possibly due to a desire for material possessions or social status) and other studies finding no significant relationship.

Type vs. Trait

Personality types and traits both aim to describe human behavior, but they do so in fundamentally different ways.

Personality types refer to the classification of individuals into distinct categories based on specific patterns of behavior, thought, and emotion. Types are often seen as qualitative categories; you either fit into a type or you don’t. They provide a broad framework for understanding motivations and behaviors.

Personality traits, on the other hand, are enduring characteristics or qualities that reflect consistent patterns in an individual’s thoughts, feelings, and behaviors. Traits are typically measured on a continuum, such as the Big Five personality traits.

In other words, types are categorical (e.g., introvert vs. extrovert), while traits occur on a spectrum (e.g., varying levels of extraversion).

Source: Personality Types

Debt Personalities

In addition to the Big Five personality traits , financial psychologists have identified distinct personality types with respect to how consumers manage and perceive debt. (See sidebar, “Type vs. Trait.”)

Let’s take a look at the five most common “debt personalities” recognized by financial behavior experts:

#1. The Avoider

This personality type avoids confronting financial issues, particularly debt. Avoiders may feel overwhelmed by finances and neglect to open bills or check account balances. This person also tends to procrastinate making debt payments or even acknowledging the amount owed.

The avoider’s anxiety about money often stems from childhood experiences or a lack of financial education. On some level, they believe that ignoring debt will make the problem go away.

#2. The Compulsive Spender

Compulsive spenders are conspicuous consumers, often buying things they don’t need. They’ll frequently use credit cards or arrange loans without considering long-term consequences. This personality type justifies debt as a way to “live in the moment” or “treat oneself.”

The compulsive spender’s unrestrained purchasing may be a reaction to stress or low self-esteem, or simply cultural pressure to maintain a particular lifestyle.

#3. The Anxious Saver

Fearful of debt and financial insecurity, anxious savers tend to over-save and under-invest. They’re often unwilling to spend money, even on necessities or meaningful experiences, due to fear of debt accumulation.

Frequently, these individuals were raised in a financially unstable environment, or they experienced monetary hardship at some point. As a result, they developed a belief that spending money inevitably leads to financial disaster.

#4. The Rational Debtor

Rational debtors are every A/R professional’s dream. They approach debt with logic and a clear repayment plan, often incurring debt strategically for investment purposes or to advance their career goals. These consumers are disciplined about making their payments and managing interest rates. Financial education at some point in their lives has made them pragmatic about spending and borrowing.

#5. The Carefree Borrower

Debt is not a serious issue for carefree borrowers, who are usually unconcerned about paying it off quickly (if at all). They rely on minimum payments and/or frequent refinancing instead of creating a feasible repayment plan. “Mañana” is their mantra, as they assume the debt will be easy to repay at some future date.

These individuals may have a history of readily accessible credit or financial assistance, which can lead to an “optimism bias,” the belief that future income will resolve their current financial issues without any consequences.

Collection Challenges

Collecting from avoiders, compulsive spenders, and carefree borrowers is often challenging. Avoiders must be located through skip tracing, compulsive spenders often have numerous accounts in collections at the same time, and carefree borrowers need to understand the seriousness of defaulting on their obligations.

If your collections team is overwhelmed by the time and energy required to collect from these consumers, it’s time to call for reinforcements. The CBSI professionals have the required technology and training to ensure you’re paid what you’re due.

Sources:
Featured Image: Adobe, License Granted
FinTraits
True You Journal
Potentash
Social Science Research Network

The Health Benefits of Hugging

Sat, 07 Feb 2026 14:05:41 GMT

The Health Benefits of Hugging

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How Embracing Others
Helps Us Embrace Life

"The world is not comprehensible, but it is embraceable through the embracing of one of its beings."

- Martin Buber
Austrian-Israeli Philosopher

Whenever Valentine's Day rolls around, our hearts and minds tend to focus on the loving relationships in our lives.

But are you aware of the multiple health benefits associated with each warm embrace you give or receive? Decades of scientific research confirm that the simple act of hugging primes the human immune system and improves both physical and emotional health.

For example, consider a 2015 study in which scientists at Carnegie Mellon University exposed 400 healthy volunteers to the common cold virus over 14 days. Participants who received multiple hugs during that two-week period were 60% less likely to contract the infection than those who were rarely hugged. And the hugged participants who did get sick recovered more quickly and had stronger immune responses than their hug-deprived counterparts.

The Physiology Behind the Stats

There are at least two physiological reasons for these results:

Gentle pressure on the sternum activates the thymus gland, generating disease-fighting white blood cells.
Hugs increase circulation in the body's soft tissues, reducing inflammation by delivering healing nutrients to the inflamed area.

This conclusion was confirmed by a 2020 study that revealed a significant association between hugging and fewer proinflammatory molecules. Using saliva samples from 20 adults, researchers found that inflammation was inversely related to the number of hugs these subjects had received over two weeks. In other words, more hugs equal less inflammation.

The Heart of Marriage

A happy marriage can lead to a longer and healthier life, particularly for men.

Ongoing research from the Framingham Offspring Study evaluated 3,682 adults over 10 years and found that married men had a 46% lower death rate than unmarried men, regardless of major cardiovascular risk factors.

In a similar study, Japanese scientists reported that never-married men were three times more likely to die from cardiovascular disease than married men.

Then, in 2023, researchers from the American College of Cardiology found that lifelong bachelors are more than twice as likely to die from heart failure within five years of diagnosis than married men or women of any marital status.

Source: Harvard Health

"Cuddle Nerves" and "Feel-Good" Hormones

Upon closer examination, the physiological effects of embracing someone encompass both neurobiological and neurochemical impacts.

Neurobiologically, hugging stimulates C-tactile afferents , sensory receptors under the skin, known as "cuddle nerves." These nerves send signals directly to the brain's center for emotional processing (the insular cortex), releasing endorphins — the body's natural painkillers and mood enhancers.

From a neurochemical standpoint, hugging triggers the release of several feel-good brain chemicals, primarily oxytocin (the "love hormone"), dopamine (the "pleasure hormone"), and serotonin (the "happiness hormone"). When oxytocin binds to specific sites along the central nervous system, it can significantly reduce chronic pain.

Hugs All Around

Physical touch also improves cardiovascular health by increasing heart rate variability, a crucial measure of how well the body responds to stress. (See sidebar, "The Heart of Marriage.”)

A 2003 study revealed that hugging contributes to lower reactivity to a specific stressful life event: public speaking. In this study, couples who held hands for 10 minutes, followed by a 20-second hug before delivering a speech, exhibited blood pressure and heart rate measurements that were 50% lower than those without prestress partner contact.

Research published in the International Journal of Environmental Research and Public Health in 2023 revealed the carryover effects of hugging. This study found that first-year college students who received daily hugs from friends and family members demonstrated reduced stress levels the following morning.

In addition, the Journal of Sleep Research reported in 2024 that adults who receive consistent physical comfort sleep more soundly and wake more refreshed than those lacking such contact.

Hold It!

How long should a hug be for maximum physical benefit? As it turns out, there is a hug-duration sweet spot between the two extremes of the awkward, too-short hug that leaves you feeling shortchanged and the over-hugger who clings like a koala to a eucalyptus tree.

—Article Continues Below—

Researchers who tested different hug styles and durations have discovered precise requirements for optimal health benefits: five to ten seconds. (Of course, hugs should always be consensual, regardless of duration.)

For intimate relationships, a 20-second embrace produces the strongest measurable benefits.

Wrapping It Up

Hugging is a powerful tool for enhancing health and well-being that requires no expensive equipment, special training, or pharmaceutical intervention. People who are consistently hugged report better overall physical, emotional, and mental health, as well as improved medical outcomes, compared to those who are hug-deprived. Every embrace we give or receive helps us embrace life more fully.

Have you hugged someone today?

Sources:
Featured Image: Adobe, License Granted
National Center for Biotechnology Information
American Heart Association
ScienceAlert
The Epoch Times
MedicineNet
NeuroLaunch

How Much Do You Know About MLK?

Wed, 07 Jan 2026 13:45:00 GMT

How Much Do You Know About MLK?

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Celebrating a Civil Rights Icon

On January 19, Americans will celebrate the birthday of our most prominent civil rights leader -- Dr. Martin Luther King Jr.

A tireless activist, Baptist minister, and political philosopher, Dr. King continues to inspire a nation almost 60 years after his assassination. But how much do you actually know about MLK? Take our quiz and find out!

#1. Martin Luther King Jr. was jailed 29 times during his career, primarily for engaging in civil disobedience. What were the other charges?

In January 1956, he was arrested for driving five miles per hour over the speed limit; in May 1961, his offense was obstructing a sidewalk and parading without a permit; and in September 1958, he was arrested for loitering.

#2. How old was MLK when he entered college?

He graduated four years later and went on to earn a doctorate in theology from Boston University at age 25. By the time he was 19, Martin had already earned a Bachelor of Arts degree in sociology. A year later, he graduated from Crozer Theological Seminary in Chester, Pennsylvania. He went on to earn a doctorate in theology from Boston University at age 25.

#3. Ten years before his death, MLK survived another assassination attempt. Who was his attacker in the earlier attempt?

Thomas Hagen was the assassin of another civil rights leader—Malcolm X—who was shot in 1965 while addressing the Organization of Afro-American Unity in New York City. Sara Jane Moore , an unassuming San Francisco bookkeeper, raised a gun and fired at President Gerald Ford's head in 1975. James Earl Ray was convicted of assassinating Dr. King in 1968 (although the King family has consistently stated that they believe Ray was innocent).

James Earl Jones is a distinguished African-American actor of stage and screen. (But he has been confused with James Earl Ray. In 2002, a plaque intended for Jones at a Florida MLK celebration mistakenly displayed the inscription: "Thank you, James Earl Ray, for keeping the dream alive." Fortunately, the error was corrected before the presentation.)

#4. Dr. King was a prolific writer, authoring several inspirational books. Which of the following is NOT one of them?

#5. Which of the following awards did Dr. King receive?

In 1971, three years after his death, Dr. King won a Grammy for Best Spoken Word Recording, "Why I Oppose the War in Vietnam." The Presidential Medal of Freedom was bestowed on him in 1977, and the Congressional Gold Medal in 2004.

#6. Who prompted MLK to talk about his "dream" during his 1963 iconic speech at the Lincoln Memorial?

A. Mahalia Jackson

B. Jesse Jackson

C. Jackie Robinson

D. Rosa Parks

E. His wife, Coretta Scott King

(Need a hint? Click the video below.)

Answer: A. While all of the people mentioned attended this transformative speech, it was the legendary gospel singer Mahalia Jackson who prompted Dr. King, "Tell them about the dream, Martin." King then disregarded his prepared notes and improvised the remainder of his historic speech.

And with that, a civil rights icon was born.

Sources:
Featured Image: Adobe, License Granted
Black History
Morehouse College
King Institute
TopTenz
Grammy.com
History.com

Paws for Concern: Holiday Pet Safety

Wed, 03 Dec 2025 17:23:53 GMT

Paws for Concern: Holiday Pet Safety

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Keeping Our Furry Friends
Safe at Yuletide

Americans love to pamper their pets during the holiday season.

According to a recent TotalVet survey, a large number of Americans not only buy gifts for their companion animals but also prepare special meals for them and include them in holiday activities. But amidst all the holiday bustle, it's easy to overlook potential hazards lurking behind a delicious meal or seemingly harmless decoration.

Not surprisingly, an analysis of Google Trends data for the past five years revealed that internet searches for "ER vet" peak during the last two weeks of December. Here are a few suggestions to help keep your pet from becoming a holiday statistic.

Drop It! Foods That Are Toxic to Pets

Before handing Fido or Muffin that tasty tidbit, check this list of common holiday foods that are toxic to pets:

Chocolate. The theobromine and caffeine in chocolate can lead to gastrointestinal upset, agitation, tremors, and even seizures at high doses.

Macadamia Nuts. Even small amounts of these nuts can lead to serious health issues, including weakness, tremors, vomiting, and potentially seizures or paralysis.

Fatty Foods . Bacon, ham, and cheese can cause GI problems in pets and can lead to pancreatitis in dogs.

Grapes and Raisins . Grapes and raisins contain tartaric acid, which, even in small amounts, can lead to kidney damage or acute kidney failure, requiring prompt medical attention.

[Note: smart pets know where they can find leftovers, so be sure to remove trash and secure lids on garbage cans containing food.]

Virtual Vet

Veterinary telemedicine enables pet owners to consult with a veterinarian via text, phone, or video chat to receive real-time advice.

However, this service is not a replacement for regular in-office visits, and most vets who offer telemedicine services are not permitted to diagnose or prescribe medications for pets they haven't previously examined in person.

While some states prohibit veterinary telehealth, Iowa is not one of them.

Source : WIRED

Typical symptoms of food poisoning in pets include vomiting, diarrhea, and upset stomach. If you notice these signs, call the Pet Poison Helpline® at 855-764-7661 as soon as possible. They can help determine if the food or ingredient is toxic.

Continued vomiting, lethargy, trouble walking, and weakness are indications that emergency care is needed.

Deck the Halls – With Caution

Holiday decorations pose many potential hazards to your animal companions. For instance:

Ornaments. Dogs and cats view Christmas tree ornaments as colorful toys. If chewed or broken, they can cause injury to your pet's mouth or paws. Consider purchasing shatterproof ornaments instead.

Tinsel and Ribbons. One of the most common pet emergencies at this time of year is the surgical removal of ingested tinsel or ribbon obstructing a pet's intestine. So, skip the tinsel and ribbon, particularly if you have curious kitties.

Electrical Cords. Puppies are prone to chewing on the power cords used for holiday lights, which can cause electrical shock. Keep the cords wrapped and off the floor.

Holiday Plants. Mistletoe, holly, poinsettias, lilies, and yews (used in Hanukkah decorations) are all poisonous to pets. If you suspect your pet has ingested any of these plants, seek medical care immediately or call the Pet Poison Helpline. (Also, see sidebar, "Virtual Vet.”)

Tree Water. Ensure the Christmas tree water is covered and/or inaccessible to curious pets, as it can become a breeding ground for bacteria that may cause nausea, diarrhea, or an upset stomach.

Candles. Whether lighting a menorah or filling your home with holiday scents, never leave burning candles unattended. Curious paws and happily wagging tails can easily knock them over, possibly burning your pet or starting a fire.

Snow Globes. Snow globes contain ethylene glycol (the same chemical used in antifreeze), which is highly toxic to all pets. A broken snow globe emits a sweet fragrance that can attract pets to taste it, often with fatal results.

Making Sure "All Is Calm"

Changes in your pet's routine during the holidays can induce stress. Here are some strategies for reducing such anxiety:

Place your pet in a safe interior room, away from holiday guests and loud noises.

Keep pets occupied with interactive toys or by spreading pet-friendly treats on a lick mat.

Use pet pheromones (e.g., Feliway® for cats and Adaptil® for dogs ) or soothing music to help keep companion animals calm.

—Article Continues Below—

Keep Watch

Keep a close eye on your pet as much as possible to ensure they don't slip out the door while guests are coming and going. Affix signs to keep the door securely closed and install dog gates to prevent escape. If your pet is not microchipped, make sure they're wearing their collars and ID tags.

In Case of Emergency

Be prepared for emergencies by keeping the following phone numbers handy:

Animal clinic used by your veterinarian

24/7 emergency veterinary clinic (if different)

Pet Poison Helpline: 855-764-7661

ASPCA® Animal Poison Control Center : 888-426-4435

The holidays should be fun and joyous times for everyone involved. Following the above guidelines can help ensure your yuletide celebration doesn't beget a pet tragedy.

Sources:
Featured Image: Adobe, License Granted
Total Vet
dvm360
ASPCA
Chewy

Veterans and PTSD: The Ongoing Battle

Fri, 07 Nov 2025 12:57:07 GMT

Veterans and PTSD: The Ongoing Battle

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The Mental and Emotional
Aftermath of War

In February 2015, Iraq War veteran Richard Miles entered a VA hospital in Des Moines, Iowa, and told the staff: “I need help.”

This wasn’t his first visit to the Iowa VA. Between 2008 and 2009, Miles had been admitted four times after two unsuccessful suicide attempts.

This time, he was diagnosed with “worsened PTSD,” anxiety and insomnia. He assured the staff that he was not a harm to himself, but “I do need some medicine so I can just rest.” He was given the medication that had helped him in the past.

Five days later, Miles was found frozen to death in the woods, having consumed a toxic amount of the pills. He was 40 years old.

Every Veterans Day, we celebrate the brave individuals who have served our country through the armed forces. For many of them, however, the mental and emotional warfare continues long after they've left the physical battlefield behind.

Recent studies indicate that almost 16% of U.S. veterans will experience PTSD at some point in their lives, compared to a 9% PTSD rate for the general population. (See sidebar, "PTSD by Service Era.”) In addition, veteran suicide rates hover around 35% -- more than double the 15% rate for non-veterans.

Regional Differences

U.S. states vary widely in the PTSD rate among their military veterans, from 9.9% (Alaska) to 3.8% (Hawaii). Military and governmental authorities offer several reasons for this discrepancy:

PTSD by Service Era

The following table outlines PTSD rates for U.S. veterans engaged in military conflicts since WWII:

Source: VA National Center for PTSD

Veteran Demographics

States with more post-9/11 vets (such as Alaska, New Mexico, and Wyoming) see higher PTSD rates. According to Mission Roll Call , younger combat veterans, especially those who served multiple tours, are much more likely to carry psychological trauma than older, peacetime veterans.

Access to Mental Health Care

Mental health care is not always accessible in remote or rural areas. While telehealth is helping to bridge that gap, broadband access remains spotty in many rural areas.

Stigma and Culture

In tight-knit rural or traditional communities, veterans suffering from PTSD can be encouraged to "tough it out." Dissuaded from talking about mental health or seeking treatment, their PTSD goes untreated.

Screening and Reporting Practices

Some government sources indicate that VA-heavy states, such as Rhode Island and Massachusetts, may be detecting more PTSD cases early or offering better support. Other states may underreport PTSD because of cultural or logistical barriers.

Ways You Can Help

Here are four key ways to lend support to PTSD victims suffering from the aftermath of combat.

1. Listen

If the veteran wants to talk about what they experienced, encourage them to do so. Give them your full attention, maintain a non-judgmental attitude, and don't rush them.

Keep your questions unintrusive. Avoid offering advice or opinion unless asked.

2. Build Social Support

Social withdrawal is a common symptom among veterans struggling with PTSD. Encourage the veteran to maintain other relationships, participate in social activities, and confide in at least one other safe individual.

3. Create a Sense of Safety

Stability is essential for veterans with PTSD. Take care to provide a consistent, steady presence in the veteran's life.

The timing of recovery is a personal matter for each individual, so be sure to respect the veteran's privacy. Treat everything they tell you as completely confidential (unless you're genuinely afraid they're about to harm themself or another person).

4. Encourage Specialized Treatment

Finally, encourage the veteran to seek out and enroll in specialized treatment for military PTSD.

--Article Continues Below--

Treatment Options

Proper mental health care can not only minimize the symptoms but also reduce the long-term risk of developing additional health conditions. Many treatment options for PTSD in veterans are available:

Medication for anxiety and depression
Counseling and talk therapy, including:

Cognitive Behavioral Therapy

Schema Therapy

Dialectical Behavior Therapy

Eye Movement Desensitization and Reprocessing

Chemical dependency detox for individuals struggling with addiction or substance use

Holistic treatment, such as meditation, mindfulness, acupuncture, music, or pet therapy

In-person and online mental health services are available through the VA .

Ensuring Proper Diagnosis

Military veterans deserve our support. Unfortunately, PTSD is often underdiagnosed or misdiagnosed. The website Tethered to PTSD is designed exclusively for healthcare professionals, providing the resources they need to identify probable PTSD in a primary care setting.

Sources:

Featured Image: Adobe, License Granted
CNN
VA National Center for PTSD

National Alliance on Mental Illness
Help for Heroes

Doctor’s Prescription: “Go Outside!”

Fri, 10 Oct 2025 16:21:10 GMT

Doctor’s Prescription: “Go Outside!”

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Spending Time Outdoors Benefits
All Aspects of Human Health

Want to improve your mental, emotional and physical health? Take it outside.

In today’s relentless, techno-driven world, anxiety, stress, and burnout have become commonplace. However, one of the most accessible, effective, and low-cost therapies for overall wellness is right outside our doors.

Nature’s Remedy

“Nature’s therapy” (also known as ecotherapy or green therapy) is being promoted by an increasing number of healthcare providers, as scores of scientific studies confirm the health benefits of being outdoors. Evidence-based research suggests that even brief interactions with nature reduce stress, elevate mood, and enhance physical well-being.

A 2015 Stanford University study published in Proceedings of the National Academy of Sciences concluded that natural environments have directly affect brain function. Research participants who walked for 90 minutes in a natural setting showed decreased activity in the prefrontal cortex—the brain area associated with negative thoughts, anxiety and depression.

Further research from the University of Exeter Medical School found participants who spent at least two hours per week in nature were significantly healthier than those who did not.

Prescribing Nature

Other studies have confirmed the physiological benefits of spending time in both green spaces and “blue spaces” (aquatic environments such as lakes, rivers and oceans), specifically:

Digging in the Dirt

Direct exposure to diverse soil microbes has been proven to enhance both physical and mental wellbeing.

With more than a billion bacterial cells, fungi and viruses per gram, soil is a microbial heaven that significantly benefits our immune systems.

In addition, one particular soil bacterium – Mycobacterium vaccae – actually increases the circulation of serotonin (the feel-good hormone) in our brains. In other words, this microbe affects mental health much like an antidepressant, but without any negative side effects.

Source: Neuroscience

Lowering of cortisol levels and blood pressure

Regulation of melatonin and serotonin levels due to exposure to natural light

Improvement in heart rate variability, indicating a balance between the sympathetic and parasympathetic nervous systems

Reduction of activity in the brain area responsible for fear and stress response

Improvement in chronic conditions, such as hypertension, diabetes and obesity

Reduction in symptoms for cancer patients and mitigation of the negative consequences of treatment

Enhanced cognition and memory

Increased levels of blood oxygen and natural killer cell activity

Reduction in cardiovascular disease

Strengthened immune function

As a result, a growing number of physicians are now writing “nature prescriptions” as part of their treatment plans, often in collaboration with park and public land agencies.

ParkRx and Park Rx America (PRA) are two initiatives driven by medical professionals seeking to improve their patients’ health by connecting them to nature. Doctors affiliated with these programs work together with local parks to integrate nature-based interventions. (Click here for instructions on writing a nature prescription.)

Wilderness Therapy is another organization that matches licensed clinicians and their patients with structured outdoor activities. Designed for youth with psychological, emotional, behavioral, or substance abuse problems, wilderness therapy programs treat patients suffering from PTSD, ADHD and depression.

Getting Your Daily Dose

To receive optimal health benefits from nature, scientists recommend exposure to natural environments for at least two hours per week. To this end, every small, consistent interaction with the outdoors can make a significant difference in human health.

Here are some ideas to get you started this fall:

Take a daily walk in a park, woodland, or even along a tree-lined street to enjoy the fall foliage.

Now’s the time to plant spring bulbs. Tending to plants and digging in the soil nurtures mental health and boosts the immune system. (See sidebar, “Digging in the Dirt.”)

Practice mindfulness or yoga outdoors to enhance relaxation and deepen your connection to nature.

--Article Continues Below --

Disconnect from technology and immerse yourself in a natural setting on a camping overnight or weekend getaway.

Engage in outdoor fall activities, such as apple picking, hayrides, fall festivals, or playing touch football.

Visit a pumpkin patch or head to the farmers market for winter vegetables.

Go birdwatching for migratory species.

Before the cold weather sets in, enjoy picnics with family and friends in a natural setting.

Observe the beauty of a sunrise or sunset, or practice stargazing to enhance personal reflection and gratitude.

Get Out!

Now that you know what to do, it’s time to get out there! The following award-winning video offers a little additional incentive:

Sources:
Featured Image: Adobe, License Granted
Proceedings of the National Academy of Sciences
Scientific Reports
The Epoch Times
American Psychological Association

What Goes on Inside a Debtor's Brain?

Wed, 10 Sep 2025 04:00:00 GMT

What Goes on Inside a Debtor's Brain?

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Understanding the Neuroscience of Debt

Debt changes the way our brains work.

Understanding the chemical reactions that take place in the consumer's brain -- before and after debt is incurred -- can benefit professional debt collectors.

Neurological Reasons for Incurring Debt

How do people get into debt in the first place?

According to noted science journalist Jonah Lehrer, the human brain is vulnerable to certain innate flaws. "These are the situations that cause the horses in the human mind to run wild, so that people gamble on slot machines and pick the wrong stocks and run up excessive credit card bills," Lehrer told InsideARM .

Because the brain craves certain sensations and chemicals, it can compel certain behaviors (such as gambling or overspending) that produce these chemicals. In addition, consumers can subvert their brains' pain/reward response when they rely on credit instead of working hard to achieve a financial goal. Paying with plastic allows them to receive the reward first without the pain of hard work.

When credit is overused, the brain becomes confused, triggering a destructive loop of bad spending. Once this occurs, the ensuing financial stress hijacks neural pathways, rewiring consumers' minds in unexpected ways.

--Article Continues Below--

Impact of Financial Stress on the Brain

The brain perceives financial strain as a threat, stimulating a "fight or flight" response. The adrenal glands then pump out stress hormones adrenaline and cortisol, which induce physical reactions like increased heart rate, sweating, and anxiety.

If financial stress is prolonged, the area of the brain responsible for logical thinking (the prefrontal cortex) can be impaired. We become more reactive and less capable of managing situations. Strain also weakens the brain's primary memory hub (the hippocampus). The end result is difficulty concentrating and remembering important details that could help resolve our money troubles.

Take Back Your Brain

Consumers have the power to minimize the psychological and neurological impact of debt.

Here are a few strategies to help lower stress hormones and boost feel-good brain chemicals (like serotonin):

Practice self-care through exercise, sleeping well, and limiting alcohol and caffeine intake.

Challenge negative thoughts and reframe your situation more constructively.

Set small, manageable goals to give yourself a sense of progress.

Don't isolate yourself; seek others' input and support.

Overcoming debt and financial stress is difficult, but a more positive financial future is attainable with the right mindset and proper self-care.

Source: Neuro-Based Leadership Centre

The good news is that our brains are plastic and can rewire themselves. (See sidebar, "Taking Back Your Brain.”)

Attacking the Problem

Successful debt collection requires acknowledging that consumers often feel anxious, ashamed, and stuck. Empathy is essential from the get-go.

Validate the consumer's feelings. Then, help them understand how much better they'll feel once they have a repayment plan in place. With every payment made toward their goal, the consumer's brain will release dopamine, the reward chemical.

Because a consumer's willpower is exhaustible, encourage them to set up an automatic payment plan. If credit card debt is the problem, you could suggest they unsubscribe from store marketing emails and sales notification pop-ups to reduce temptation.

Finally, reframe the situation in the consumer's mind. Help them view their debt as a temporary condition that they have the power to remedy through a realistic repayment plan.

Survey Says...

In 2017, a curious Australian debt collector surveyed every consumer who paid in full within 24 hours of the account being sent to collections. He wanted to know what had changed for these people, since they clearly had had access to the funds all along.

Here are the results of the collector's unofficial survey:

62% said they didn't understand how serious the matter was until a collection agency contacted them.

22% said they forgot.

9% said they didn't want to part with the funds

7% said they had been waiting on money and always intended to pay after it arrived.

So, helping consumers understand the seriousness of their debt is key to getting paid.

At CBSI, our professionals are trained to recognize the influence of financial stress on a debtor's mind. We know that successful debt recovery requires a proper balance between patience and persistence.

If you're ready to let us carry the debt collection burden for you, we're ready, too.

Sources:
Featured Image: Adobe, License Granted
Trends in Cognitive Sciences
InsideARM
Brainz Magazine
Collect More Australia

How Much Do You Know About Summer's Last Hurrah?

Wed, 20 Aug 2025 14:15:00 GMT

How Much Do You Know About Summer's Last Hurrah?

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Test Your Knowledge With Our Labor Day Quiz

Many of us will spend the Labor Day weekend feasting on barbecue or lolling in the sun.

But "summer's last hurrah" was actually borne out of the toil and sweat of America's manual laborers. How much do you know about the history of Labor Day? Take our quiz and find out:

#1. When was Labor Day officially designated a national holiday?

In 1879, Congress designated George Washington's birthday as a federal holiday. Most Americans now deem it "Presidents' Day" to honor all U.S. presidents. However, the official name has never been changed.

#2. How long was the average work week for American industrial laborers in the late 1800s?

A. 80 hours
B. 100 hours
C. 60 hours
D. 120 hours
E. 40 hours

(Need a hint? Check out the video.)

Answer: B. U.S. industrial workers regularly toiled for 100 hours per week in deplorable conditions before the Labor Movement.

Nowadays, about 2-3% of American workers regularly work more than 80 hours per week. Most work in high-demand professions such as tech, finance, and healthcare. Most U.S. farmers average 60 hours of work per week—80 hours during harvest season and about 40 hours in winter. Few Americans attempt to work 120 hours per week.

#3. What instigated the fashion rule against wearing white after Labor Day?

Also, back in the days when industrial pollution was severely unchecked, soot and smut emissions made white clothing a high-maintenance color choice. The condition worsened in fall and winter, when colder air trapped more pollution, and mud and slush compounded the problem.

#4. If you were a male New Yorker in 1922, which fashion item did you not want to be seen wearing after Labor Day?

This practice reached a climax on September 13, 1922, when enthusiastic youths began removing and stomping on straw hats worn by dock and factory workers. The incident sparked a series of riots that lasted more than a week, with mobs roaming the city and destroying hats. Several people were injured and arrested.

Two-tone shoes, striped blazers, and linen suits were typical summertime fashions for men in 1922. Although they were not typically worn after Labor Day, doing so never caused a riot.

Newsboy caps were worn year-round by all classes but were especially popular with the young, the working poor, and the rich while playing sports.

#5. Which state has the lowest percentage of labor union members?

#6. Who is credited with originating Labor Day?

Many sources, including the U.S. Department of Labor, credit Peter McGuire for the holiday. However, the New Jersey Historical Society recently revealed that the true father of Labor Day may, in fact, be Matthew Maguire. Both Peter and Matthew were respected union leaders in their day. However, Matthew Maguire's politics were a shade too radical for American Federation of Labor (AFL) leader Samuel Gompers. So, he publicly credited Peter McGuire instead.

The Molly Maguires was the name of a secret (often violent) society best known for activism among Irish-American and Irish immigrant coal miners in Pennsylvania. (Tobey Maguire is Spider-Man.)

Sources:
Featured Image: Adobe, License Granted
Forbes
NPR
ProProfs
U.S. Bureau of Labor Statistics
The Science Survey
Vintage Dancer
U.S. Department of Labor

Court Vacates Medical Debt Reporting Rule

Thu, 31 Jul 2025 19:44:34 GMT

Court Vacates Medical Debt Reporting Rule

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CFPB Rule Will Not
Take Effect

The U.S. District Court for the Eastern District of Texas has vacated the CFPB’s medical debt reporting rule, which was originally scheduled to take effect last March.

On July 11, the district court decided in favor of Cornerstone Credit Union League and Consumer Data Industry Association, who filed a lawsuit in January challenging the government agency’s rule.

The CFPB rule would have removed medical debt information from consumer credit reports and prohibited lenders from using such information in credit decisions. The lawsuit argued that the rule exceeded the agency’s statutory authority and violated the Administrative Procedure Act and Fair Credit Reporting Act.

The court agreed and completely nullified the CFPB rule, which will not take effect, pending any potential appeal.

A Big Win

This news marks a big win for the credit and collections industry. Had the rule been enacted, healthcare providers would have lost $24 billion in the first year alone and potentially more than $972 billion over 10 years, according to the ACA.

In addition, medical collections referred to third-party debt collectors would have decreased by 8%, further reducing revenue for medical providers.

CBSI President Brian Grimes is currently serving as president of the Iowa Collectors Association and Vice President of the Iowa HFMA. He believes the court’s ruling is “a significant victory for fairness and financial accountability.”

“By preserving the ability to include medical debt on credit reports, the court ensures that consumers and lenders can continue to rely on accurate, comprehensive credit information,” Grimes said, adding that “it also protects vital revenue streams for healthcare providers, helping them maintain operations and continue caring for patients. This decision supports responsibility while safeguarding access to credit and healthcare."

Sources:
Featured Image: Adobe, License Granted
ACA International

Iowa State Fair Trivia You Never Knew

Tue, 22 Jul 2025 15:27:23 GMT

Iowa State Fair Trivia You Never Knew

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♫ “Don’t Miss It – Don’t Even Be Late” ♫

The only state fair to be immortalized in a novel, two feature films, and a Rodgers and Hammerstein stage production, the Iowa State Fair runs from August 7 through August 17 this year.

Where else can you find traditions like outhouse races, mutton busting, and – many an Iowan’s personal favorite – a cow chip throwing contest?

In 2024, state fair attendance was a record-breaking 1,182,682. Perhaps you already knew that. Here’s some state fair trivia you may not know:

Collision Course

In the late 1800s, the Iowa State Fair was in deep financial distress. Organizers needed an event that would draw crowds willing to pay the fair admission price.

Along came theatrical manager and carnival barker Joe Connolly -- later known as "Head-On Joe” -- and his idea to stage a head-on collision of two locomotives. The resulting fireball was sure to attract spectators. (This was long before the days of demolition derbies and monster truck rallies.)

State Fair Safety Tips

Consuming corn dogs and riding roller coasters is a lot of fun, but be sure to take precautions when visiting the state fair:

Stay hydrated – with water, not soft drinks.

Wear closed-toe shoes to protect your feet from injury and animal waste.

Wash hands frequently, especially after petting animals and before eating.

Avoid overindulgence in fair food.

Watch kids carefully and have a separation plan.

Follow the ride rules, including height restrictions, and review them with your children.

Source: Johnson Memorial Health

Fair organizers quickly jumped on board. Connolly purchased a couple of obsolete trains, laid down some tracks in front of the grandstand, and set the engines on their destructive course.

"I believed that somewhere in the makeup of every normal person, there lurks the suppressed desire to smash things up.”

– Joe Connolly

The scheme worked. The first explosion in 1896 was so successful that it was repeated in 1922 and 1932. Each time, the state fair drew between 40,000 and 70,000 paying visitors -- huge crowds for that era. Organizers netted more than $10,000 (about $250,000 in today’s currency) in direct gate receipts.

Connolly staged the 1932 crash as a presidential year showdown, pitting a Roosevelt train against one named for Iowan Herbert Hoover:

Soapbox Derby?

Several sitting presidents have visited the Iowa State Fair over the years. Dwight D. Eisenhower was the first in 1954, accompanied by former President Herbert Hoover. The others were: Gerald Ford in 1975, George W. Bush in 2002, and Barack Obama in 2012.

Since the fair precedes the Iowa caucuses (the first major contest in the presidential and congressional nomination process), it’s a political magnet for candidates.

For decades, the Des Moines Register has sponsored a "Political Soapbox,” providing candidates of all persuasions with 20 minutes to speak to the crowd and answer questions. Noteworthy presidential candidates who’ve taken advantage of this opportunity include Jimmy Carter, Donald Trump and Joe Biden.

Ronald Reagan also visited the fair – but not as a president or candidate. In the 1930s, young Reagan broadcasted from the fair as sports director for Des Moines-based WHO radio.

Our State Fair Is a Great State Fair

Between 1904 and 1954, Iowa's population increased by only 17%, while state fair attendance increased by a whopping 400%.

After being canceled during the war years of 1942-1945, the fair came back in full force in 1946. That year's attendance was partly boosted by the 1945 release of the Rodgers and Hammerstein musical film "State Fair." It was the team’s only musical written directly for the screen.

--Article Continues Below--

The movie was a remake of a 1933 film based on a novel of the same name, all set in Iowa. (A third feature film, remade in 1962, was set in Texas.)

The 1945 R&H version was a huge success, winning an Oscar for Best Song ( “It Might As Well Be Spring” ) and boosting attendance at state fairs nationwide. Iowa State Fair turnout continues to grow (see infographic above) , increasing by more than 25% from 1998 to 2024, even though state population declined slightly during that time.

And that’s more than you ever knew about the Iowa State Fair. Enjoy!

Sources:

Featured Image: Adobe, License Granted

Iowa State Fair Image: Wikimedia Commons , Phil Roeder
Des Moines Register
The Marcus News
Guinness World Record
Iowa State Fair.org
University of Iowa
Turner Classic Movies

Iowa's Challenge; Enticing Physicians “Into the Field”

Wed, 11 Jun 2025 15:15:00 GMT

Iowa's Challenge: Enticing Physicians “Into the Field”

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The Ups and Downs
of Rural Medicine

A rural doctor recently shared his story about a grandmother who was bitten by a snake.

The elderly woman drove two miles to her nearest neighbor, and together they hopped on an ATV to kill the snake before driving to the emergency room.

The doctor asked her if she was sure the snake was a copperhead. “Yep,” she replied, pulling the critter’s head out of her purse.

Medical practitioners who serve rural communities encounter a wide variety of unusual situations and colorful characters, which is one reason they find the job both challenging and rewarding. But in Iowa, the number of rural physicians falls far short of the demand.

State of Emergency

Iowa’s physician shortage is one of the worst in the country, ranking 45th in the nation for physician-resident ratio, according to the Iowa Medical Society . In addition, a 2024 report by the American Association of Medical Assistants (AAMA) revealed that the state retains only 22% of its medical school graduates and 36.5% of its residency graduates.

Travel Subsidies?

A recent University of Iowa study explores another possible approach to addressing the gap in rural medical care. Noting that health care specialists are particularly scarce in rural areas—and getting scarcer—the U of I researchers suggested that these physicians be subsidized for their travel expenses.

In Iowa, specialists typically visit consulting clinics to treat rural residents, but traveling can be costly and time-consuming for physicians in high demand. Paying them for their travel encourages specialists to continue these clinical visits.

Source: Iowa Capital Dispatch

Two-thirds of Iowa's 99 counties are federally designated as lacking in primary care physicians. More than a third (37%) are classified as completely rural, meaning they have no urban population at all.

Earlier this year, Iowa Gov. Kim Reynolds introduced legislation to increase medical access in rural areas. Her plan would expand the number of residencies by 115 and draw down $150 million in federal funding for the new positions, creating around 460 new physician positions across the state in six years. The bill also would double the state's loan repayment programs for any doctor who practices in rural Iowa for at least five years.

Becoming a Center of Attraction

What can Iowa health care executives do to attract medical talent to the state? Rural health management experts suggest a three-fold recruitment approach:

Appeal to physicians' greater purpose
Proactively address potential concerns
Emph asize non-monetary benefits

Appeal to Their Greater Purpose

Delivering much-needed care to rural populations can be extremely fulfilling, ideal for physicians who seek to have a measurable positive impact on their communities.

Highlight the intrinsic benefits of working rurally beyond the clichés of small-town life. (See sidebar below, “4 Reasons to Practice Rural Medicine.”) Collect materials from the local Chamber of Commerce or tourism office and share videos on YouTube and other local websites so candidates can develop a feel for the area.

Address Potential Concerns Head-On

Anticipated heavy workload, lack of continuing education and networking opportunities, and family considerations can present potential concerns. Address these concerns head-on by communicating:

Available telemedicine programs and technology

--Article Continues Below--

Any affiliation with regional institutions and practices that offer networking and educational opportunities

Educational and extracurricular options for school-age children

Local recreational and cultural offerings (even quirky festivals, farmers’ markets, or local breweries)

Promote Non-Monetary Benefits

Attracting talent doesn’t have to be a “show me the money” situation, especially if:

Working hours can be more flexible than in an urban-based organization

4 Reasons to Practice
Rural Medicine

Impact on Patients : Rural medicine allows practitioners to significantly impact the health and well-being of their communities, where health care access is often limited.

Work-Life Balance : Rural physicians report better work-life balance and lower stress levels than doctors who practice in urban settings, as well as a more affordable cost of living.

Diverse Clinical Experiences : Rural areas expose doctors to a wider variety of clinical experiences, which is often more fulfilling for health care providers.

Lifestyle Preferences : Rural practitioners enjoy a slower pace of life, less traffic, and a feeling of safety within their communities.

Sabbaticals are available for research or mission work

Local institutions offer low-interest home loans

Childcare and spousal employment opportunities are available

Well Worth the Effort

Whether Gov. Reynolds succeeds in her plan to attract more medical talent to Iowa’s rural areas remains to be seen. Most of the rural doctors currently practicing here already know that the blessings outweigh the challenges.

When Storm Lake physician Kyle Glienke isn’t serving his patients, participating in church activities, or coaching kids’ sports, he works the family farm with his father and brother. He believes farming helps him achieve work-life balance.

It’s also a way for Glienke to stay connected to his roots and relate with the experiences and hardships of his patients. Practicing broad-spectrum medicine in rural Iowa has been highly rewarding for him.

“I think I was meant to be a doctor in Storm Lake,” Glienke said. “I have a very strong feeling of purpose here.”

Sources:
Featured Image: Adobe, License Granted
Des Moines Register
Daily Iowan
Iowa Medical Society
Wolters Kluwer
University of Iowa

Memorial Day Pop Quiz

Wed, 14 May 2025 13:45:00 GMT

Memorial Day Pop Quiz

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How Much Do You Know About
America’s Most Solemn Holiday?

Memorial Day is commonly recognized as the unofficial start of summer – a three-day weekend devoted to backyard festivities and fun in the sun.

But it’s also America's most solemn holiday, a time to honor our fallen military heroes. How much do you know about Memorial Day? Take our pop quiz and find out:

#1. Memorial Day is often confused with another annual observance. Which one?

#2. Memorial Day was established to honor soldiers killed in which U.S. military conflict?

The military casualties of the other wars mentioned are:

World War I – 53,000
Revolutionary War – 6,800
World War II – 292,000
Vietnam War – 58,000

#3. By what name was Memorial Day previously known?

Remembrance Day is observed in British Commonwealth member states to honor the members of their armed forces who died during military service. Like Veterans Day in the U.S., it marked the end of hostilities during World War 1. Armistice Day is another name for Remembrance Day, although our Veterans Day was also called Armistice Day prior to 1954. (Are you confused yet?)

#4. Which of the following was a favorite picnic spot for Memorial Day celebrants in the late 1800s?

Families could visit the burial sites of their fallen loved ones and then enjoy a picnic lunch on the family plot. These meals were known as "dinner on the ground."

#5. Which town is credited with celebrating the first Memorial Day in 1866?

That finally happened two years later, in 1868.

But Waterloo, Iowa, is not without its own unique tribute to our fallen heroes. While serving together during WWII, five brothers from Waterloo's Sullivan family all perished when a Japanese destroyer torpedoed the USS Juneau. The Sullivan Brothers Iowa Veterans Museum memorializes their bravery. In addition, the U.S. Navy later named two destroyers The Sullivans , to honor the Iowa siblings.

Lest We Forget

We leave you with this poignant tribute to all those who never made it home:

Sources:
Featured Image: Adobe, License Granted
CITI I/O
Military.com
EarthShare
National Archives
Library of Congress

Atlas Obscura

The Fluoridation Debate: What's in the Water?

Thu, 01 May 2025 12:42:39 GMT

The Fluoridation Debate: What's in the Water?

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The Benefits and Risks
of Fluoride Exposure

In May 2024, a study published in the Journal of the American Medical Association concluded that prenatal fluoride exposure was associated with increased neurobehavioral problems in children and limiting fluoride exposure in pregnant women may be recommended.

In August 2024, the National Toxicology Program released a report stating that drinking water with a higher fluoride concentration than the recommended 0.7 mg was associated with lower IQ levels in children.

In September 2024, a federal judge ruled that the U.S. Environmental Protection Agency must address the impact of fluoride on public water systems. However, the ruling did not ban or otherwise limit the addition of fluoride to public water.

In November 2024, Florida Surgeon General Dr. Joseph Ladapo became the first state officer to publicly recommend that communities stop adding fluoride to their water systems.

Meanwhile, the American Dental Association remains “staunchly in support” of community water fluoridation at optimal levels to help prevent tooth decay.

These and other recent events have fueled an intense and controversial national debate around the benefits and risks of fluoride exposure. Let’s sort out the opposing views.

How It Began

Fluoride was first discovered to inhibit tooth decay in 1901. Over the next 40 years, research revealed that adding fluoride to drinking water prevented cavities and improved oral health.

In 1945, Grand Rapids, Mich., became the first city to add fluoride to its public water system. Today, nearly three-quarters of the U.S. population – about 209 million people – are served by fluoridated water, according to the Centers for Disease Control and Prevention (CDC).

Water fluoridation has been considered a cheap decay-prevention strategy and a significant public health achievement. However, new research has raised questions about both its safety and effectiveness.

Is Water Fluoridation Still Necessary?

Recent reports suggest the benefits of adding fluoride to public water systems may not be as significant as they once were.

--Article Continues Below--

While research prior to 1975 showed extensive benefits, an October 2024 report from the Cochrane Collaboration found that water fluoridation resulted in only slightly fewer cavities in children’s baby teeth. Specifically, children living in areas with fluoridated water averaged about one less cavity than those without water fluoridation.

The researchers concluded that current U.S. populations have broader access to alternative fluoride sources, particularly toothpaste, which has become widely available and more commonly used since the 1970s. As a result, they said, water fluoridation may have little to no general effect on tooth decay.

Still, proponents of fluoridation claim that it is the most cost-effective means for ensuring all communities receive the benefits of cavity prevention.

The Question of Health Equity

Steven Levy, a professor of preventive and community dentistry at the University of Iowa’s College of Dentistry, is very concerned about removing fluoride from public drinking water.

“As a society, we’ve partly forgotten how bad cavity problems were 50, 60, 70 years ago when most people, prior to that, had very few teeth. It’s unfortunate when people are quick to dismiss that,” he said.

According to Levy, there are still communities that suffer from cavity problems and who continue to benefit substantially from water fluoridation. People dealing with poverty or lack of access to dental care may not be able to prioritize oral hygiene. Toothbrushes, toothpaste, and dental floss can be too costly for them, and regular dental visits are out of the question. Water fluoridation, therefore, helps those who are “not fortunate enough to have access to individual-level fluoride exposures.”

About Dental Fluorosis

About 23% of the U.S. population is affected by dental fluorosis. This condition occurs when children consume too much fluoride while their teeth are growing, resulting in white spots or lines on the enamel.

Most cases of dental fluorosis in the U.S. are mild and primarily cosmetic. However, in countries with high levels of naturally occurring fluoride in drinking water (such as India), the condition can be severe, causing extensive damage to tooth enamel

To prevent fluorosis, the CDC recommends limiting a child’s exposure to fluoridated water and fluoride products prior to age 6.

Source: CDC

The CDC agrees. In a statement last May, the agency said: “Water fluoridation has been identified as the most cost-effective method of delivering fluoride to all members of the community regardless of age, educational attainment, or income level.”

The American Academy of Pediatrics also continues to support the use of fluoride, citing the chronic effects of cavities -- which are both common and preventable. To be sure, we’re talking about more than a toothache here. When left untreated, tooth decay can result in severe infection, heart disease, and death.

Mounting Evidence of Risk

But emerging research elevates concerns about the risks of fluoride exposure.

Much of that research was conducted in other countries. A study of pregnant women in Canada, for instance, linked fluoride exposure to l ower IQ among children ages 3 to 4 years old . Likewise, a Mexican study associated fluoride exposure with lower IQ, attention-deficit/hyperactivity disorder (ADHD), and reduced brain function among children 6-12 years old.

The risks also include dental fluorosis, a condition that can cause speckles on tooth enamel. (See sidebar, “About Dental Fluorosis.”)

Going Forward

Many questions remain. How much fluoride is safe for pregnant women and their babies? At what age do the adverse effects of fluoride manifest? How should policymakers weigh the benefits of decay prevention with the risks of compromised brain function?

As we continue to learn more about the impacts of fluoride, we must rely on the scientific data proffered on both sides of the issue and the wisdom of our elected officials to effectively address the problem.

Sources:
Featured Image: Adobe, License Granted
Journal of the American Medical Association
CourtListener
Becker's Dental Review
The Hill
Cochrane Library
CNN

Tax Season Is Debt Payoff Season

Fri, 11 Apr 2025 13:57:45 GMT

Tax Season Is Debt Payoff Season

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Using 2024 Tax Refunds Wisely

“Pay off your debt first. Freedom from debt is worth more than any amount you can earn.” - Mark Cuban

Do you know the average 2024 federal tax refund is expected to exceed $2,800? Your consumers can use that money to improve their financial health (and yours) by paying off debt.

That’s precisely what 44% of refund recipients plan to do, according to a CNBC survey of 4,300 U.S. adults. The survey also found that most Americans (53%) have no emergency fund to cover unforeseen expenses.

Choose Wisely, Grasshopper

While paying off debt may not sound as glamorous as booking a cruise or splurging on a new wardrobe, it’s a much wiser choice. Here’s how you can help your consumers choose wisely:

Remind them that using their refund to pay off their debts can prevent damaging their credit score or becoming charge-offs .

Inform consumers of the significant money they’ll save on interest and reduced monthly debt payments if they use their tax refund to pay down their credit cards. Financial radio host Dave Ramsey offers the following illustration:

April Is Financial
Literacy Month

More than half of all Americans (57%) score lower than 50% on a financial literacy test conducted annually by the Global Financial Literacy Excellence Center . And only 16% of American s scored between 75% and 100% on last year’s test.

According to the GFLEC study, consumers with very low levels of financial literacy were twice as likely to become debt constrained.

For more than 20 years, April has been recognized as National Financial Literacy Month. This annual observance originated through the National Endowment for Financial Education as part of its High School Financial Program.

Financial Literacy Month engages banks, credit unions, credit counselors, schools, and other organizations to provide educational resources to empower consumers’ financial futures.

To learn more about the need for financial literacy and ways to get involved, visit Jump Start .

It would take 14 years to pay off a $16,748 credit card at 15% interest by making minimum payments. Using a $2,800 tax refund and increasing the monthly payments to correlate with the average increase in income, the card can be paid off in less than two years, saving the consumer $5,600 in interest.

If your customer owes you more than the tax refund he received, apply the refund to the balance and then work out a payment plan with them for the remainder.

On the other hand, if the tax refund comes close to covering the debt, consider negotiating a settlement by accepting the refund as payment in full. (Note: Make sure your consumers know that the IRS may deem the unpaid portion of the debt as taxable income.)

If you’re a healthcare provider, inform your patients that legal complications resulting from medical debt can severely impact their financial well-being. In fact, more than 66% of consumer bankruptcies are caused directly by medical expenses.

If the tax refund is sizable, suggest that the consumer split the monies between paying off debt and padding their emergency fund, to help them avoid future problems.

Financial Emergency Kit

Here’s a wake-up call: Almost one-third of Americans (32%) would be unable to cover a $400 emergency.

While many experts suggest that the equivalent of three to six months’ salary is the ideal emergency fund, the truth is that as little as $500 or $1,000 set aside in a savings account can provide a significant buffer for your consumers whenever unexpected bills pop up.

In addition, healthcare providers can encourage patients to open a Health Savings Account, especially those who are enrolled in a high-deductible medical insurance plan. HSAs are a tax-free way to help patients save for future qualified medical care. Once they’re no longer incurring medical debt, subsequent tax refunds can be used to build up the consumers’ emergency fund.

Strike While the Iron Is Hot

Tax refund season is the best time to collect on your overdue accounts and help your consumers become debt-free.

Using their tax refunds to pay down their debt probably won’t elicit the same excitement as splurging on luxuries. But it will provide them with much-needed relief while positioning them to reap long-term financial benefits.

Consumers can check on the status of their 2024 federal tax refund using the IRS Where’s My Refund ? tool.

If your company struggles with overdue accounts, the CBSI professionals are ready to help you take advantage of this once-a-year opportunity.

Sources:

Featured Image: Adobe, License Granted
CNBC

News Medical
Ramsey Solutions

Investopedia

Lexington Law

Global Financial Literacy Excellence Center

Meet CBSI’s New Director of Sales and Marketing

Mon, 31 Mar 2025 15:21:07 GMT

Meet CBSI’s New Director of Sales and Marketing

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Introducing Josh Schilling

Josh Schilling, the new Director of Sales and Marketing at Credit Bureau Services of Iowa, is very proud of CBSI’s exceptional debt recovery rate. “The industry standard is 18%, and we currently have a recovery rate of 32% to 35%,” he said.

About Josh

Josh attended Upper Iowa University in Fayette, where he majored in Education. He is married and has two daughters, one who attends Iowa State University and the other who will attend Western Colorado University on a basketball scholarship.

Josh is excited to be part of the CBSI team. “Our collectors truly believe that they are helping their consumers get out of debt,” he added.

Featured Image: Adobe, License Granted

How Much Do You Know About the Ides of March?

Wed, 05 Mar 2025 16:00:00 GMT

How Much Do You Know About the Ides of March?

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Test Your Knowledge of This Ominous Day

On March 15, 44 B.C., Roman dictator Julius Caesar was stabbed to death by 60 conspirators.

The day subsequently became infamous as the "Ides of March," associated with misfortune and doom. But few people know much about it. Do you? Let's find out.

#1. Prior to the introduction of the Julian calendar in 45 B.C., the Ides of March was a day for celebration and rejoicing. Why?

#2. What is the origin of the expression "Beware the Ides of March"?

#3. Which of the following celebrities died on the Ides of March?

#4. The American jazz-rock band The Ides of March had a major hit song in 1970. What was the name of it?

A. "Keep on Truckin'"

B. "Drive My Car"

C. "Low Rider"

D. “Truckin’”

E. "Vehicle"

Answer: E. "Vehicle" was the name of The Ides of March 1970 hit song. It reached #2 on the charts and was the fastest-selling single in the history of Warner Bros. at that time. "Drive My Car" is a Beatles classic, released on their 1965 album Rubber Soul.

"Low Rider" is a song by American funk band War that appeared on their 1975 album Why Can't We Be Friends? The song reached number one on the Billboard R&B singles chart that year.

"Truckin'" was released in 1970 -- but by the Grateful Dead, not The Ides of March. In 1997, the song was recognized by the United States Library of Congress as a national treasure.

#5. Over the years, some terrible events have occurred on the Ides of March. Which of the following is NOT one of them?

#6. According to William Shakespeare, Julius Caesar's dying words were, "Et tu, Brute?" What does the phrase mean?

However, according to historians , Caesar never spoke these words. Neither was Brutus his closest friend or his uttermost betrayer. That distinction falls to Decimus Junius Brutus Albinus, a distant cousin of Marcus Brutus. History records that Caesar did not particularly trust Brutus, whereas Decimus was part of the dictator's inner circle. And it was Decimus who convinced Caesar to attend the senate meeting, luring him to his death.

Sources:
Featured Image: Adobe, License Granted
HISTORY

The Archaeologist

CNN

The Independent

National Institutes of Health

Investing.com

Interesting Literature

U.S. Presidents and Their Debts

Sat, 25 Jan 2025 13:49:43 GMT

U.S. Presidents and Their Debts

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Chief Executives Who

Fell on Hard Times

"I am miserable until I owe not a shilling."

- Thomas Jefferson

Did you know that multiple U.S. presidents struggled with personal debt?

Some presidents carried their burdensome debt with them when they entered the highest office in the land, and others were broke when they left. A few even declared bankruptcy. In honor of Presidents' Day, let's look at some of our most influential chief executives who grappled with their financial obligations:

The Sage of Monticello

A hardworking farmer, brilliant writer, visionary, and Founding Father of our country, Thomas Jefferson inherited massive debt from his father-in-law. He also lived beyond his means and was generous to a fault, frequently lending money for which he was never repaid.

The Buck Stops Here

Harry Truman was one of the poorest candidates to reach the White House, having lost his inheritance in 1915 in a zinc mine investment that ultimately went under. In 1922, his own business failed, and Truman's partner declared bankruptcy.

Truman never did, however. Like Lincoln, he insisted on honoring his financial obligations. As a result, he was saddled with debt for more than 20 years. Because his presidential salary wasn't enough for Truman to meet these obligations, Congress increased his pay to $100,000 in 1949.

Unfortunately, Truman's financial struggles continued after he left office and had to survive on an Army pension of $112.56 a month. Once again, Congress intervened, creating a pension for ex-presidents in 1958.

Source: The New York Times

At that time in our country's history, bankruptcy was not usually an option. However, a brief window of opportunity arose between 1800 and 1803, and Jefferson took advantage of it. Still, he was a poor financial manager, and money problems continued to plague him.

Land-rich and cash-poor, Jefferson devised a lottery to raise money. The winner would gain title to Jefferson's estate, including his beloved Monticello, appraised at $71,000 ($1.5 million today.) Ultimately, the lottery failed to generate the cash he desperately needed.

At the time of his death in 1826, our third president still carried $107,000 in debt – about two million dollars by today's standards.

The Great Emancipator

In 1832, a young Abraham Lincoln and his partner purchased a small general store, acquiring the inventory on credit.

Despite the booming economy, the two prairie entrepreneurs couldn't make a go of it and soon began sliding into debt. While Lincoln sold his share in the business, when his partner died, Lincoln voluntarily assumed $1,000 of his partner's debt to protect the grieving family. (That's roughly $27,000 in today's currency.)

Creditors hauled Lincoln into court, and the sheriff seized his only assets -- survey equipment and one horse. Honest Abe was still repaying that debt well into the 1840s. The burden seemed so onerous to Lincoln that he called it "my national debt."

He focused on paying off his obligations at great personal sacrifice. Lincoln worked several jobs, and he and his wife moved into a small, smoke-filled tavern where room and board cost a mere four dollars a week.

Thirteen years later, the future president and one of American history's most revered leaders finally resolved his debt.

A Hardscrabble Life

A failed farmer and rent collector prior to the Civil War, Ulysses S. Grant lived in a log cabin that he dubbed "Hardscrabble." In 1848, he met and married his wife Julia, and her father gifted them part of the family's Missouri plantation. But the operation struggled. To make ends meet, Grant sold firewood on the streets of St. Louis.

Following his brilliant military performance during the Civil War, Grant became a national hero and was elected president in 1868. He served for two terms, with Reconstruction his primary focus.

By the mid-1880s, Grant had invested most of his assets in a pyramid scheme operated by an unscrupulous business partner. The scam wiped out his life's savings.

--Article Continues Below--

Broke and dependent on friends and kind-hearted strangers to keep him financially afloat, Grant, by this time, had been diagnosed with cancer. He was now confronted with the terrifying prospect of leaving his wife an impoverished widow.

His buddy Mark Twain convinced Grant to pen his memoirs, which he did, finally completing his manuscript seven days before his death. The resulting two-volume boxed set quickly outsold Twain's Adventures of Huckleberry Finn. Julia Grant received $450,000 in royalties--equivalent to $12 million in today's currency.

It Happens

Unresolved debt can happen to anyone. The professional collectors at CBSI understand since many of them have been in the same situation. If you're looking for a collection agency with compassion for consumers, you'll find it right here .

Sources:

Featured Image: Adobe, License Granted
The Saturday Evening Post
U.S. National Park Service

Abraham Lincoln Presidential Library
White House Historical Association

History.com
Forbes

Surviving an Iowa Winter

Mon, 06 Jan 2025 14:00:09 GMT

Surviving an Iowa Winter

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How to Take the Bite Out of Jack Frost

Iowa resident Steve Lose recalls vividly the day his life changed forever.

In February 2020, an automobile accident left him trapped inside his car for 15 hours in subzero temperatures. He had broken multiple bones, and his kidneys were failing. But it was the frostbite in his extremities that caused the most severe pain.

Lose said it felt like animals were gnawing on his hands and feet.

By the time a snowplow driver finally rescued him, his body temperature had dropped to 77 degrees.

In the end, doctors had to amputate his hands and feet, but Lose was grateful to be alive.

Ninety-four percent of all temperature-related deaths in the U.S. are caused by extreme cold. According to the CDC, more than 1,500 Americans die from hypothermia each year, and the risk of death by excessive cold is significantly higher in rural areas, particularly among males.

Welcome to Winter in Iowa

Last January, a brutal arctic blast besieged the Hawkeye State, resulting in temperatures over 20 degrees below zero and wind chills of -45. Iowa hospitals and clinics saw a sharp uptick in frostbite cases, with dozens requiring inpatient care. Many of these patients were elderly or stranded motorists.

The Deadliest Time
of the Year

Researchers from the obituary website Legacy.com have revealed that more U.S. deaths occur in January than in any other month. CDC statistics confirm that more than 250,000 Americans die each January -- well above the norm for other months.

Several factors play into this figure, but not all are fully understood.

Extreme cold can exacerbate pre-existing medical conditions, particularly cardiovascular and respiratory diseases. One British researcher found that most January deaths are due to respiratory and circulatory diseases, such as pneumonia, coronary heart disease, and stroke.

In addition, people who are seriously ill may hang on during the holidays for a final opportunity to see loved ones and enjoy the emotional warmth of the season.

While cold weather is inherently deadly, it can also kill indirectly by suppressing our immune systems, making us more vulnerable to illness. (See sidebar, "The Deadliest Time of the Year.”)

Out in the Cold

When spending time outdoors this winter, an ounce of prevention is worth a pound of cure. The Mayo Clinic offers the following frostbite-prevention tips:

Limit your time outside whenever the weather is cold, wet, or windy.

Dress in multiple layers of loose, warm clothing. Choose undergarments that wick moisture away from your skin and outer garments that are both wind- and waterproof.

Wear a hat or headband that fully covers your ears, and wear mittens (not gloves).

Seek warm shelter immediately if you notice red or pale skin, prickling, or numbness.

Avoid alcohol; it will cause your body to lose heat faster.

Before venturing out in the cold, eat well-balanced meals and stay hydrated.

Keep moving to stimulate blood flow, but don't exercise to the point of exhaustion.

Once inside, immediately remove wet clothing, particularly gloves, hats, and socks.

On the Road

Before you head out on the road this winter, stock your vehicle with emergency supplies, including:

Snow shovel, ice scraper, and broom;
Sand, kitty litter, or any abrasive material to help with traction;
Jumper cables, flashlight, and flares or other emergency markers;
Blankets, a cell phone and charger, water, food, and necessary medicines.

--Article Continues Below--

In addition, the National Highway Traffic Safety Administration (NHTSA) recommends the following:

Keep your gas tank filled.
Postpone non-essential travel until roads are clear.
Even if you use a GPS, familiarize yourself with directions and maps and let others know your route and expected arrival time.

Lastly, if your winter driving skills are a bit rusty, bone up – but not like these guys:

Sources:

Featured Image: Adobe, License Granted

Collecting Debt at Holiday Time

Wed, 11 Dec 2024 22:15:00 GMT

Collecting Debt at Holiday Time

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How You Can Offer Hope to
Stressed-Out Consumers

It's the time of year for festive gatherings, family dinners — and big hits to your consumer's wallet.

While there's no perfect time of year to recover debt, the holidays can be particularly stressful for American consumers. So, what's the best way to collect your receivables during the holidays?

The Holidays and Debt

Consumers whose accounts are already in collections can easily incur even more debt over the holidays. According to a recent LendingTree survey, 34% of Americans ran up more than $1,000 of debt to pay for their 2023 holiday expenses.

Sixty-five percent of the survey respondents who incurred holiday debt in 2023 said they hadn't expected to do so, 57% said they were stressed about the debt, and 40% were plagued with buyer's remorse.

Taking Care of You

Collecting debt from stressed-out consumers can be emotionally draining during the holidays. You’ll be better equipped to offer them compassionate and effective support if you effectively manage your own stress first.

Here are some basic tips to minimize stress and maintain mental wellbeing:

Eat a balanced diet and stay hydrated.

Engage in regular exercise.

Get a minimum of eight hours of sleep each night.

Practice mindfulness, deep breathing, or other relaxation techniques.

Take frequent short (e.g., five-minute) breaks to stretch or walk around during the day. (Changing your environment, even briefly, helps your brain rest and switch gears.)

Similarly, a 2023 American Psychological Association (APA) poll found that almost 90% of U.S. adults feel overwhelmed by the holiday season. Financial issues were the primary holiday stressors, with 58% of the respondents stating that monetary concerns caused them the most anxiety.

Overall, 63% of American adults polled by the APA used negative words, such as "overwhelming" or "exhausting," to describe the holiday season.

Additional stressors can compound the problem. For some consumers, for instance, the holidays are a painful reminder of loss due to death or estrangement.

Others suffer from loneliness and depression (such as Seasonal Affective Disorder) at this time of year or dread anticipated family conflict. In addition, holiday pressure can weigh especially heavily on women, who feel they are expected to create magical (and costly) experiences for their families.

As a creditor or collector, you must be sensitive to these feelings when attempting to collect receivables at holiday time.

Keep a Cool Head

You can set the tone for your collections calls even before contacting the consumer by maintaining a composed and confident attitude. (See sidebar, "Taking Care of You.”) A calm demeanor can help soothe an anxious debtor.

Did you know that the very act of smiling improves your disposition? It also changes the tone of your voice. Smiling raises the soft palate at the back of your mouth, resulting in more fluid sound waves, making your voice sound warm, friendly, and receptive.

It’s a good idea to keep a mirror near your desk and periodically check your reflection during a collections call. Do you look tired or irritated? That will be conveyed in your voice!

If the consumer becomes emotional or angry during the course of the call, recognize that his financial fears may be exacerbated by holiday stress. Allow him to vent and listen without speaking so you can help steer the conversation in a positive direction.

Remain Flexible

Be sure to have flexible payment options available to present to your consumer. Offering multiple options, payment plans, or other arrangements will go a long way toward satisfying your company's or client's needs while alleviating consumer anxiety. Once the consumer realizes he can feasibly pay off a debt he's been avoiding, he'll begin to feel relief.

Although you may feel pressure to wrap up overdue accounts before the end of the year, remember to be patient and recognize that not everyone will be able to pay during the holidays. But be sure to follow up with those consumers after the New Year.

--Article Continues Below--

When You Need Help

Business owners, healthcare providers, and property managers deserve a happy holiday, too.

As the year draws to a close and you reassess your accounts receivable practices, you may find collecting on overdue accounts is more than you can handle on your own. If so, it's time to let the CBSI professionals carry the debt collection burden for you. We can recover what's owed to you while remaining sensitive to the various holiday stressors your consumers are struggling with.

And THAT can mean a happier holiday for everyone!

Sources:
Featured Image: Adobe, License Granted

LendingTree

American Psychological Association

Retail Dive
F orbes Advisor

How Much Do You Know About Thanksgiving?

Wed, 13 Nov 2024 21:45:00 GMT

How Much Do You Know About Thanksgiving?

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Test Your Knowledge With Our
Turkey Day Quiz

Need to break the ice over Thanksgiving Day dinner?

Bone up on your Turkey Day trivia while testing your knowledge of this uniquely American holiday with our Thanksgiving quiz. Let's get started!

#1. Where was the first Thanksgiving celebrated?

#2. What percentage of Americans celebrate Thanksgiving?

#3. How many tofu turkeys are sold each holiday season ?

#4. How fast did the Mayflower travel?

A. 20 mph

B. 10 mph

C. 2 mph

D. 100 mph

E. No one knows; speedometers had not yet been invented.

(Need a hint? Check out the video clip.)

Answer: C. The Mayflower averaged only two miles (3.2 kilometers) per hour during its historic voyage across the Atlantic Ocean. The voyage took 66 days, from the ship's departure on September 6, until Cape Cod was sighted on November 9, 1620.

#5. Why are turkey, stuffing, sweet potatoes, cranberry sauce, and pumpkin pie typically associated with Thanksgiving dinner?

#6. Which of the following continents produces almost 90% of the world's sweet potato crop?

#7. When was the first official Thanksgiving Day football game played?

#8. What is the most popular Thanksgiving side dish in Iowa?

BONUS QUESTION: True or false? The turkey was named after its country of origin.

A. True
B. False; there’s no connection between the country and the bird.
C. False, but there is a connection between the country and the bird.
D. False; in Turkey, the bird was called “Indian chicken.”
E. Both C and D.

Answer: E. The large bird doesn’t actually hail from the country Turkey, but there is a connection. During the Ottoman Empire, a bird called the guinea fowl was imported to Europe by Turkish traders. So, Europeans began to call these birds "turkeys," but in Turkey, they called the bird “Indiana chicken.” It’s also known by many other monikers worldwide. Check it out:

Now that you're a fount of Turkey Day trivia, you'll know just how to bridge those awkward moments around this year's holiday table.

Happy Thanksgiving from CBSI!

Sources:

Featured Image: Adobe, License Granted
Statista
Mashed
CNN
National Geographic
Mental Floss
Zippia
International Potato Center

Horrifying Tales from the FTC Vault

Wed, 16 Oct 2024 12:15:00 GMT

Horrifying Tales From the FTC Vault

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Most Egregious Violations in
FDCPA History

The Federal Debt Collections Practices Act (FDCPA) has safeguarded consumers from deplorable debt collection practices for more than 45 years.

The vast majority of collectors willingly comply with FDCPA regulations against abusive tactics. Among those who don’t comply, the most appalling violations read like a Stephen King novel.

In the spirit of Halloween, we share with you some genuinely horrifying tales from the Federal Trade Commission (FTC) archives.

"We're Coming to Get You – and Your Little Dog, Too!"

In 2013, the FTC shut down Texas-based collection agency Goldman Schwartz after its collectors threatened consumers with imprisonment and government custody of their minor children. The firm also was charged with contacting a woman's coworkers, claiming they would be required to pick her out of a lineup after she was arrested for failure to resolve her payday loan debt.

Our Compliance
Commitment

Here are the various ways CBSI is committed to regulatory compliance:

Our collectors are highly trained according to FDCPA, HIPAA, and CFPB guidelines to comply with all state and federal regulations.

Our compliance officer continually reviews all CBSI processes.

Our custom-made compliance management system responds proactively to the continually changing regulatory environment.

We extensively document our policies, procedures, and all consumer interactions.

We stay current on all regulations governing our business activities.

The district court permanently banned Goldman Schwartz from any future collection activity. (Here’s a list of all FTC-banned debt collectors. )

That same year, the FTC successfully sued California-based Rumson, Bolling & Associates for escalating consumer harassment to a whole new level.

One plaintiff in that case testified that the agency’s collectors threatened to arrest, shoot, and then eat her dog before dispatching police to take her into custody.

But wait – it gets worse.

Deepening Horrors

Rumson, Bolling & Associates collectors also allegedly terrorized consumers who owed family funeral bills in the most egregious way imaginable: By threatening to exhume the bodies of deceased relatives and hang them from a tree or drop them outside the debtor’s door.

According to the FTC case file , these collectors also shouted profanities and allegedly terrified consumers with their final ultimatum: “Are you going to pay this bill right now ... or am I going to have to kill you?"

[The defendant's attorney claimed that the company's owners did their best to ensure regulatory compliance and that any wrongdoing was against company policy.]

When all was said and done, the district court halted operations at Rumson, Bolling & Associates, froze the agency’s assets, ordered them to pay a $700,000 fine, and permanently banned the firm from the collections industry.

The Phantom (Debt) Strikes Again!

A 2018 FTC case involved a Charlotte, N.C., collection operation known as Lombardo, Daniels & Moss (LDM). LDM collectors routinely impersonated lawyers in an attempt to recover phantom debts from unsuspecting consumers.

The imposters threatened consumers with lawsuits and jail time unless they paid immediately by credit or debit card over the phone – for debts they did not owe. Once again, the district court ruled that the defendants be permanently banned from future debt collection activity.

In 2021, the FTC charged an Atlanta-based firm, Critical Resolution Mediation, with impersonating police officers, attorneys, mediators, and process servers, in an attempt to collect on phantom debt. The bogus collectors routinely threatened consumers with imprisonment if they failed to pay.

In addition to banning the defendants from the debt collection industry, the court also ordered that they be prohibited from making any misleading claims while selling any product or service.

--Article Continues Below--

Never on Our Watch!

At CBSI, we are every bit as horrified as you are by such appalling violations, and we applaud the FTC’s prosecution of these bad actors. As recent recipients of the Better Business Bureau Torch Award for Ethics , we work hard to ensure our reputation with consumers remains above reproach.

You never have to worry about consumer harassment when CBSI has got your back.

Sources:
Featured Image: Adobe, License Granted
Federal Trade Commission
CNN
The New York Times

Say Cheese! The Evolution of Oral Hygiene

Wed, 11 Sep 2024 16:00:00 GMT

Say Cheese! The Evolution of Oral Hygiene

How Our Ancestors Treated Their Teeth

Did You Know...

The humble toothpick is the oldest dental implement, dating back to prehistoric times.

Ancient civilizations believed that cavities were caused by tiny worms burrowing into teeth. The most common treatment for "tooth worms" was to smoke them out with a mixture of charcoal and beeswax.

In 1960, almost half (49%) of American adults could be expected to lose all their teeth. As of 2010, that figure has dropped to 13%.

For as long as humans have roamed the planet, keeping teeth healthy—indeed, keeping them at all—has presented a challenge. The practice of dentistry began around 7000 B.C., but professional dental care wasn't widely available until many centuries later.

As recently as 200 years ago, barbers typically doubled as dentists, yanking teeth as well as cutting hair. Today's familiar red-and-white-striped barber pole traces its origins to when barbers hung bloody towels outside their establishments following surgical procedures.

DIY Dental Care

For countless generations, dental care was essentially a do-it-yourself project.

Ancient peoples may not have understood that cavities were caused by bacteria (not tooth worms), but they did recognize the importance of keeping their teeth clean. For instance, in pre-toothbrush times, early ancestors would chew on thin twigs until one end frayed, creating a sort of brush. "Chew sticks" are still used in some cultures today.

Iowa Welcomed First Woman Dentist

The world's first fully accredited female dentist could credit her fellow Iowans for helping her achieve that esteemed designation.

After the Ohio College of Dentistry refused to admit Lucy Beaman Hobbs in 1861, the dean agreed to teach her privately. A year later, she relocated to Iowa (first Bellevue and then McGregor), where she spent three years practicing dentistry.

Hobbs gained professional recognition in 1865 when she was admitted to the Iowa State Dental Society and appointed as a delegate to the American Dental Association convention in Chicago.

By then, the Iowa State Dental Society had pressured the Ohio college to finally admit Hobbs as a student. Because she had already practiced successfully for several years, Hobbs was only required to attend one session before earning her DDS in 1866.

Source: Sindecuse Museum

While oral hygiene tools available to our ancestors have evolved, they bore a striking resemblance to modern implements.

Picking Through the Past

According to anthropologists, the toothpick dates back more than a million years. Over the centuries, this humble dental implement has transitioned from an everyday object to a status symbol and back to an everyday object. The earliest toothpicks were tiny slivers of wood, bone, or ivory, although crow and goose quills were also popular.

Toothpicks rose to the rank of status symbol during Victorian times when the elite would brandish picks made of silver or gold. (In 2009, an engraved ivory and gold toothpick that once belonged to Charles Dickens was sold at auction for more than $9,000.)

Toothpicking at meals was so prevalent in 19th-century social circles that etiquette books frequently addressed the topic.

But in the 1860s, the toothpick returned to its unassuming wooden roots when an American entrepreneur began mass-producing 500 million a year. Free toothpicks quickly became ubiquitous restaurant giveaways.

Today, toothpicks are no longer favored by oral healthcare practitioners due to the potential damage to gum tissue.

The First Dentifrices

Surprisingly, toothpaste predates the toothbrush. As early as 5000 BC, ancient Egyptians created a dental cream from powdered oxen hooves, myrrh, eggshells, and pumice. About 4,000 years later, the Persians added burnt snail and oyster shells, gypsum, herbs, and honey.

Homemade toothpastes and powders remained popular well after the introduction of commercially produced versions centuries later. Common mixtures included powdered orris root, charcoal, and Peruvian bark with prepared chalk and lavender oil.

The first squeezable tube of toothpaste became available in the 1880s. It was quickly mass-produced, marketed, and sold nationwide.

Fluoride entered the picture in 1954 when Proctor & Gamble launched "Fluoristan," a precursor to Crest. Today, all toothpaste brands bearing the American Dental Association's seal of acceptance must contain fluoride.

Brushing Up on Oral Hygiene

The toothbrush was invented in China during the Tang Dynasty, between 618 and 907 A.D. At that time, and up until the 15th century, bristles were made from boar's hair, while brush handles were fashioned from bamboo or bone. (Environmentally friendly boar-bristle toothbrushes are still available today.)

The prototype for the first mass-produced toothbrush was created in 1780, but the first patented toothbrush didn't arrive on the scene until 1857. Nylon bristles were finally introduced in 1938.

A year earlier, an American inventor had patented his design for an electric toothbrush, but it failed to catch on. That is until a Swiss scientist unveiled his particular model in 1954. The "Broxodent" was initially intended to assist people with limited mobility but was soon marketed to the general public.

--Article Continues Below--

Don’t Forget to Floss!

Dental floss was a relative latecomer to the oral hygiene world. First introduced by New Orleans dentist Levi Spear Parmly in 1819, the idea of running "waxed silken thread" between the teeth to help prevent disease gradually became more common throughout the 19th century.

By 1882, commercially available floss of waxed or unwaxed silk became available. Nylon floss replaced silk during World War II because of silk rationing and nylon's resistance to shredding. The modern-day floss that's become a staple in dental offices and American households is comprised of various synthetic fibers.

To all our dental industry friends
who keep us smiling…

THANK YOU!

Sources:
Featured Image: Adobe, License Granted
History.com
Oral B
Fourteenth Century Fiend
History of Dentistry and Medicine

Cyberattacks on the Rise: Be Prepared!

Wed, 07 Aug 2024 19:46:27 GMT

Cyberattacks on the Rise: Be Prepared!

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How Small Businesses Can Protect
Themselves from Bad Actors

On June 19, 2024, software giant CDK Global was the victim of a ransomware attack that took most of its services offline. As a result, business operations were crippled at more than 15,000 U.S. car dealerships, forcing employees to revert to paper-based processes.

On February 21, 2024, cybercriminals attacked Change Healthcare, preventing electronic payments and medical claims processing, forcing patients to pay out of pocket for medications, and causing healthcare providers to lose millions in revenue while threatening small practices with insolvency.

As cyberattacks continue to mount, small businesses across the country are scrambling to protect themselves. The statistics are sobering:

82% of ransomware attacks target companies with fewer than 1,000 employees, 37% of which employ fewer than 100.

In 2020 alone, U.S. small businesses experienced 700,000 cyberattacks, totaling $2.8 billion in damages.

51% of small businesses attacked by ransomware pay the money.

75% of small-business owners and managers stated they would have to cease operations if they were hit with ransomware.

Cyberattack Prevention

Cybersecurity measures are no longer optional for small businesses – they’re a necessity. Owners and managers must evaluate areas most at risk and determine how an IT outage could affect their finances and operations.

How Do They
Do It?

Here are five of the most common hacking methods cybercriminals use against small businesses:

Phishing —Phishing emails appear to originate from an authentic brand. They contain a sense of urgency, persuading the user to click on a malicious website or attachment. Phishing is commonly used to hack into accounts receivable.

Clickjacking —Clickjacking also tricks the user into clicking a malicious link; doing so allows the hacker to control the user’s device.

Keylogging —Keylogging allows hackers to record every keystroke on a user’s device, providing them to access sensitive information.

Viruses —Computer viruses, worms, and Trojan horses are software programs that can be installed in IT systems. These programs lock up files and spread quickly across entire networks. Ransomware is a virus that makes data inaccessible until a ransom is paid to the hackers.

Denial of Service (DoS)—A DoS is a hacking technique that takes down a website by overwhelming the server with fake data requests. The server cannot process all the requests and crashes.

Source: Intellicomp

Once you’ve established the high-risk areas of your organization, security experts suggest the following:

Implement mechanisms to establish redundancy, such as routinely backing up digital records and storing copies in separate locations. Also, maintain a secure off-site location for paper files.

Ensure digital files are properly encrypted, and firewall protection and antivirus software remain active at all times.

Restrict access to electronic records via user authentication and other controls to ensure only authorized personnel can access digital files.

Assess the cybersecurity protocols of vendors and other third parties. If you can’t persuade a vendor to improve its security, you may want to consider switching vendors or having a backup available.

Regularly audit your record-keeping systems for security and accessibility.

Educate your staff on appropriate documentation and record-keeping practices and make sure all employees understand their role in maintaining accurate and up-to-date records.

Designate a staff member, team, or third party to continually monitor and evaluate your cybersecurity systems.

Back to (Old) School

While prevention is the best way to prepare for a cyberbreach, small businesses must also plan for potential periods when their systems are offline. That means relying on paper and manual procedures as a backup.

IT systems can be down for days or weeks in the aftermath of a cyberattack. Prudent business owners will develop a “pen and paper plan” to enable continued operations while unplugged from technology. For instance:

Keep paper copies of your plans for emergency operations and business continuity.

Maintain a supply of Post-it notes, flip charts, and construction paper. These can be handy when navigating many workflow changes.

Maintain a binder with paper forms needed to continue operations in the event of an IT outage.

Keep a hard copy of your business policies regarding payment to ransomware attackers in case a decision needs to be made.

Keep paper instructions for billing, ordering supplies, and collecting payments.

--Article Continues Below--

Establish access controls for physical records, such as locking cabinets and maintaining access logs.

Create protocols for the secure destruction of paper files that are no longer needed.

Two-Fisted Approach

Every small-business owner is responsible for thwarting cybercrime, and vigilant preparation requires a two-fisted approach. Utilizing the best technology your company can afford – while also maintaining paper-based backup processes – ensures fiscal resilience in the event of a cyberattack.

Sources:

Featured Image: Adobe, License Granted
CyberCatch
StrongDM
Becker's Hospital Review
House Committee on Energy & Commerce
Carstens

Surviving an Iowa Summer

Mon, 15 Jul 2024 14:00:00 GMT

Surviving an Iowa Summer

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Keep Your Patients Safe
During Peak Injury Season

A Texas man was rushed to the Emergency Room after being stabbed in the abdomen at a family barbecue.

While the ER staff was examining the injury, the man coughed, and his entire dinner began gushing from the wound. The staff s pent 20 minutes suturing the hole in the man's stomach and picking barbecue and corn out of his intestine.

The particular health risks associated with summertime present some unique challenges to healthcare workers. ER visits surge around summer holiday weekends, many involving children. The higher injury risk is commonly associated with increased daylight hours and popular outdoor activities, such as fireworks, swimming, and cookouts.

Lazy, Hazy, Crazy (and Risky) Days

The most common summertime injuries and illnesses requiring emergency care include:

Bicycle injuries : Biking accidents can cause serious damage like head trauma, broken bones, bruises, and lacerations.

Paws to Consider

Leaving an animal in a hot car is prohibited in 31 states. Unfortunately, Iowa is not one of them.

The inside of a vehicle parked in the hot sun can reach 120 degrees in a matter of minutes, causing an animal to suffer heat stroke, brain damage, or even death.

If you encounter an animal trapped in a hot car, The Humane Society recommends the following:

Note the vehicle's make, model, and license plate number.

Immediately notify any nearby businesses so they can attempt to locate the car's owner.

If the owner can't be found, call the non-emergency number of the local animal control or police. Then, wait by the car for them to arrive.

Source: Humane Society

Drowning: Swimming is a particularly high-risk summertime activity for kids. According to the CDC , drowning is the primary cause of death for children ages 1 through 4 and the second-leading cause of injury-related fatalities in older children.

Burns: Summer activities such as grilling, bonfires and fireworks are notorious for causing severe burns in children and adults. In 2022, an estimated 10,200 fireworks-related injuries required emergency care.

Sun-related illnesses: There's more than one way to get burned. Excessive sun exposure causes severe heat-related illnesses like extreme sunburn, blistering, heat stroke, heat exhaustion, and heat cramps. (See "Is It Hot in Here?" below.)

Orthopedic injuries: Summer means outdoor sports and recreational activities. Soccer, basketball, baseball, and football involve sudden twisting or pivoting movements that can place excessive stress on the knee joint, resulting in anterior cruciate ligament (ACL) injuries. Other common orthopedic injuries include rotator cuff tears, muscle strains, and golfer's/tennis elbow.

ATV accidents: Crashes on all-terrain vehicles (ATVs) result in more than 800 deaths and an estimated 100,000 ER visits every year.

Spread the Word

You can help your patients minimize summertime injuries by identifying the common causes for these incidents and sharing a few summer safety tips.

Encourage cyclists and ATV enthusiasts to wear protective gear like helmets, knee pads, leather gloves, and goggles.

Remind parents of small children to closely supervise them around pools, lakes, fires, and outdoor grills.

Regarding fireworks, advise patients never to ignite fireworks while impaired by alcohol or drugs, light only one device at a time while maintaining a safe distance from people and buildings, use protective eyewear, and keep a bucket of water handy.

Encourage patients to use sunscreen, sunglasses, and a wide-brimmed hat to protect against the sun's harmful rays.

Summertime in Iowa means bugs, so advise patients to wear insect repellent, keep their lawns trimmed, and check themselves for ticks before coming inside. Note: A "bullseye rash" (a ring around the bite) is a classic sign of Lyme Disease and requires immediate medical attention.

Advise patients to always warm up before engaging in rigorous physical activity.

--Article Continues Below--

Is It Hot in Here?

Iowa summer is hot -- sometimes extremely hot.

Heat is the top weather-related killer in the United States. In 2022, more than 1,000 Iowans were treated for heat-related illnesses, 49 of whom required hospitalization. Overexertion on a hot day and too much sun exposure can push the body beyond its limits. The combination of extreme heat and humidity slows evaporation, straining the body to maintain a normal temperature.

Offering your patients the following reminders can help prevent heat-related illnesses:

Plan outdoor activities for the cooler morning or evening hours.

Drink plenty of fluids before feeling thirsty, and eat plenty of fruits.

Avoid alcohol and energy drinks, as these encourage dehydration.

Know the signs of heat-related illness: headache, thirst, nausea or vomiting, weakness, dizziness, confusion, or fainting. Anyone experiencing these symptoms should be moved to a cool place, clothes loosened, and a cool compress applied. If in doubt, call 911 immediately, as heat stroke is a medical emergency.

Never leave a child in a hot car, even with open windows. The temperature inside a parked vehicle can quickly rise to a dangerous level for both humans and pets. (See sidebar, "Paws to Consider.”)

Smooth Sailing

As a healthcare provider, your patients rely on you to help them avoid summertime health risks. Your timely advice can prevent ER visits and ensure your patients’ memories of Summer 2024 are nothing but pleasant.

Sources:

Featured Image: Adobe, License Granted
Rectangle Health
How Stuff Works
Ready Iowa
Regional Medical Center
American Red Cross
Rytel Sports Medicine

CBSI Receives BBB Torch Award for Ethics

Mon, 08 Jul 2024 14:00:00 GMT

CBSI Receives BBB Torch Award for Ethics

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Collectors Are "Passionate
About Helping People"

Credit Bureau Services of Iowa Inc. (CBSI) is a 2024 recipient of the Better Business Bureau (BBB) Torch Award for Ethics.

The BBB selects its annual award winners based on “the four C’s”: The Character of the organization’s leadership, the Culture fostered within the company, its transparent relationship with Customers, and Community impact.

Don't Call Him "Guido"

In accepting the award, CBSI President Brian Grimes recounted how, when he first began working in the collections industry, he had some concerns. “People sometimes ask if my real name is Guido,” he laughingly remarked.

About the BBB Torch Award

How Much Do You Know About Men’s Health?

Thu, 06 Jun 2024 18:51:17 GMT

How Much Do You Know About Men’s Health?

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Test Your Knowledge During
Men’s Health Month

June is National Men's Health Month, a time to remind men – and the women who love them -- of the specific health issues they face and the importance of maintaining their health.

But how much do you really know about it? Take our quiz and find out!

#1. The most common type of cancer for American males is:

#2. Men are almost twice as likely to suffer from heatstroke than women. Which of the following is NOT a sign of heatstroke?

#3. At what age does heart attack risk increase in men?

#4. Which of the following is NOT a common heart attack symptom for men?

#5. Which of the following is a symptom of prostate cancer?

However, these symptoms may also be caused by other prostate problems that are not cancer-related, such as an infection or an enlarged prostate.

#6. The fourth-leading cause of death for black American males (after heart disease, cancer, and unintentional injuries) is:

#7. Over the last several years, gonorrhea has become increasingly resistant to treatment. (See video below.) Untreated gonorrhea can result in which of the following health problem(s) in men?

A. Epididymitis (i.e., swelling of the tube leading from the male testicle to the urethra)

B. Higher risk of contracting or transmitting HIV

C. Testicular cancer

D. Both And B

E. All of the above

Answer: D. Untreated gonorrhea can cause severe and permanent health problems in both women and men. Men with gonorrhea can develop epididymitis, a painful condition of the testicles that may result in infertility.

If gonorrhea spreads to joints or the blood, it can be life-threatening. In addition, men infected with gonorrhea can more easily contract HIV, the virus that causes AIDS. And HIV-infected men with gonorrhea are more likely to transmit HIV to someone else.

#8. Which of the following is a symptom of depression commonly found in men but not in women?

How’d You Do?

If you answered at least six of the above questions correctly, you’re well aware of men’s health issues. Less than that, it may be time to bone up. Here are a few places to start:

Sources:
Featured Image: Adobe, License Granted
Men's Health Month

National Institutes of Health

Lessons from the "Blue Zones"

Wed, 08 May 2024 12:30:00 GMT

Lessons from the "Blue Zones"

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Nine Principles for a
Long, Healthy Life

A shepherd in Sardinia, Italy, walks more than five miles a day up and down steep mountain paths.

A cheerful loom weaver on the Greek island of Ikaria plies her trade daily with care and precision; time is meaningless to her.

An Okinawan householder takes daily barefoot walks on the beach and consumes a predominantly plant-based diet of rice and fresh vegetables.

In Costa Rica, a popular single mother of four celebrates regularly with her community and greets all strangers as friends with her infectious laugh.

A mild-mannered cardiothoracic surgeon in Loma Linda, California, with a spiritually based approach to life routinely socializes with members of his faith community.

What do these five individuals have in common? Two things: 1) they've all lived past 100 years of age, and 2) they each reside in a so-called Blue Zone. Indeed, these regions boast ten times as many centenarians per capita than the average population.

Welcome to the Blue Zones

In 2003, award-winning journalist and bestselling author Dan Buettner was commissioned by National Geographic to investigate areas of the world with exceptionally high longevity. These areas had been dubbed "Blue Zones" by scientific explorers a few years earlier.

Over the next several years, Buettner and his team identified five such regions across the globe:

Okinawa, Japan
Loma Linda, California (Seventh-Day Adventist community)
Sardinia, Italy
Nicoya, Costa Rica
Ikaria, a Greek island

Buettner synthesized his years of research into nine lifestyle habits that he believes other populations can adopt to "reverse engineer" longevity. Here are his "Power 9":

Healthcare in
the Zone

Physicians who practice Lifestyle Medicine (LM) will immediately recognize the similarity between LM's six pillars (plant-based nutrition, physical activity, stress management, avoidance of risky substances, restorative sleep, and social connections) and the nine Blue Zone principles.

But Blue Zone researchers encourage medical professionals to take these principles a step further by connecting their practices and patients with community-wide health-promoting activities and helping shape public policy. To this end, the Blue Zones Project facilitates physician involvement in creating more healthful environments.

More than 75 Blue Zone Project communities have already improved the health of millions of Americans by drastically lowering obesity rates and smoking prevalence in urban communities. They have also decreased healthcare expenditures for chronic illnesses and reduced absenteeism.

Click here to learn more.

#1. Move Naturally

The world's longest-lived people reside in environments that continually encourage movement in everyday activities. They move naturally throughout the day, walking wherever they need to go and managing their own homes and gardens, usually without mechanical conveniences.

#2. Maintain Purpose

Maintaining a sense of purpose can add as much as seven years to your life. Okinawans call it "Ikigai," and the residents of Nicoya, Costa Rica, call it "plan de vida," but for both groups, it means "why I wake up in the morning." In Loma Linda, volunteering is a key component of maintaining purpose in life.

#3. Downshift

All of us, even Blue Zone residents, experience some stress. When left untreated, stress results in chronic inflammation and can trigger every leading age-related disease. People in the Blue Zones maintain specific routines to shed that stress. Ikarians take an afternoon siesta, Okinawans quietly memorialize their ancestors each day, Adventists pray, and Sardinians enjoy a happy hour with friends.

#4. Apply the 80% Rule

Before each meal, the Okinawans recite an ancient Confucian mantra, "Hara hachi bu" ("eat until you are 80% full"). This 20% gap can make the difference between losing or gaining weight. Blue Zone residents eat their smallest meal in the late afternoon or early evening and then stop eating for the rest of the day.

#5. Eat Your Veggies

The cornerstone of most centenarian diets is beans – fava beans, black beans, soybeans, and lentils. Blue Zone residents also consume plenty of (usually homegrown) fresh vegetables and fruits. Pork is the predominant meat staple, but it is only eaten about five times per month in small (3-4 oz.) servings.

#6. Wine @ 5:00

Moderate alcohol consumption reduces personal risk of premature death. Except for the Seventh-Day Adventist community in Loma Linda, people in the Blue Zones drink alcohol moderately and regularly. Sardinians, for example, daily consume a regional red wine called Cannonau, which contains two to three times the level of artery-scrubbing flavonoids as other wines. And Ikarians consume at least two glasses of wine daily, primarily the locally produced 16-proof variety.

#7. Belong

Virtually all of the 263 centenarians whom Buettner's team interviewed belonged to a faith-based community. Denomination was irrelevant. Research indicates that attending faith-based services once a week prolongs life by as much as 14 years.

#8. Put Loved Ones First

Blue Zone centenarians put their families first. Aging parents and grandparents live near (or with) their families. Most have been committed to a life partner and invested in their extended families with their time and love.

#9. Connect to the Right Tribe

Maintaining social bonds is critical to longevity. The world's longest-lived people choose social circles that support healthy behaviors. For Blue Zone residents, this almost always means face-to-face (rather than Facebook) interaction. Friendships and social connections provide not only intellectual stimulation but also emotional support through hardships.

Transforming Iowa Communities

In 2013, seven Iowa communities were selected as demonstration sites for implementing Blue Zone principles via the Blue Zones Project. The following video illustrates how local grocery stores got on board:

Sources:
Featured Image: Adobe, License Granted
PBS
CNBC
New York Post
Greek City Times
Loma Linda University
News Medical

Frame of Mind - Iowa's Mental Healthcare in Dire Straits

Wed, 10 Apr 2024 12:30:00 GMT

Frame of Mind: Iowa's Mental Healthcare in Dire Straits

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State Ranks Worst in the Nation
for Psychiatric Facilities

In April 2017, Chase Nicholson, a young Iowa man experiencing a severe psychotic episode, shot and killed his parents and 24-year-old sister in their home.

Just days before the murders, Chase had suffered a severe suicide attempt and had been rushed to the ER, where he told doctors he was sick and needed to be hospitalized.

But there were no psychiatric beds available for him in the entire state. Chase was sent back home with his parents. Days later, he killed his entire family.

Last for a Long Time

At the time this tragedy occurred, Iowa ranked last in the nation for state-managed inpatient psychiatric beds. Seven years later, it's still ranked last – with only two adult beds per 100,000 residents, according to a new Treatment Advocacy Center (TAC) report published in January. (The optimal number of psychiatric beds is about 50 per 100,000.)

Between 2007 and 2016, Iowa's total number of state psychiatric beds dropped from 223 to just 64 -- which is where it stands today – even though an estimated 84,000 Iowans live with serious mental illness (SMI). SMI includes schizophrenia, severe major depression, and severe bipolar disorder.

While the TAC report tallies only state-managed psychiatric beds, private Iowa facilities haven't enough beds either.

Types of Psychiatric Facilities

Public psychiatric hospitals provide both short-term and long-term care to forensic (criminally charged) patients and those without the means to pay. These hospitals are often the only places that will accept patients with a history of violent behavior or who suffer from both SMI and complex medical issues.

Private psychiatric hospitals and the psychiatric units within general hospitals provide inpatient, 24-hour care. They generally do not accept forensic patients, and the length of stay often depends on the patient's ability to pay.

Residential care facilities provide long-term, 24-hour psychiatric care and addiction treatment in a residential setting. Prices range from $10,000-$60,000 per month for psychiatric treatment and $3,000-$10,000 per month for sober-living care.

The Iowa Department of Health and Human Services (HHS) reports 809 licensed psychiatric beds for both adults and youth at private facilities across the state. However, only 646 of those beds are staffed, further limiting access to inpatient care. (See sidebar, "Types of Psychiatric Facilities.")

Mental Illness and Suicide

According to public health experts, most suicides are related to psychiatric illness, with psychosis, depression, and substance use disorders being the most relevant risk factors.

In 2022, Forbes Advisor compared all 50 states to determine the percentage of adults who had mental illness within the past year. Iowa ranked number 10 for the prevalence of mental illness, with 24.7% of its residents reporting some mental illness and 6.3% reporting a serious mental illness.

CDC data reveals that 549 Iowans committed suicide in 2021, representing 17.5% of the state's population – three percentage points higher than the national average. In 2022, Iowa suicides rose to 582, according to the Iowa HHS.

The Governor's Plan

Improving Iowans' access to mental healthcare is now a top priority for Gov. Kim Reynolds.

Noting that more than 25% of adults with serious mental illness also grapple with substance use disorders, Reynolds lamented that there's currently "little to no coordination" between the state's 13 mental health regions and 19 substance use regions.

She has proposed consolidating these regions into seven unified districts to manage both behavioral health and substance use services. Iowa HHS would oversee the effort and establish contracts with local administrative organizations to manage each district.

Through Behavioral Health System Alignment, we will align Iowa's fractured local delivery models for substance use and mental health care into a simplified structure supporting improved statewide access to care for all Iowans.

-- Iowa Gov. Kim Reynolds

The governor has also recommended increasing Medicaid payments for behavioral and inpatient psychiatric care. In addition, the governor's plan entails refocusing state-run mental healthcare toward behaviorally complex youth and forensic (criminally charged) patients, as well as increasing access to outpatient services through Certified Community Behavioral Health Clinics.

The state legislature is currently reviewing Gov. Reynolds' proposal.

--Article Continues Below--

A Story of Hope

The proposal to revamp Iowa's fractured mental healthcare system comes at a time when mental illness and suicide rates are at an all-time high across the country. Suicide prevention advocates are working tirelessly to reduce those numbers.

Kevin Hines, a San Francisco native who suffers from bipolar disorder, travels the globe, sharing his incredible story of hope, healing, and recovery.

In September 2000, when he was 19, Hines heard voices in his head telling him to die. He took a bus to the Golden Gate Bridge and threw himself over the rail. As he was plummeting 220 feet at 75 mph, Hines instantly regretted the decision and desperately prayed to live.

Struggling to surface, he felt a creature nudging his body. Amazingly, an accommodating sea lion kept Hines afloat until the Coast Guard could rescue him.

Here's the rest of Kevin's story:

Sources:

Featured Images: Adobe, License Granted

Iowa Capital Dispatch

Des Moines Register

Treatment Advocacy Center

Iowa HHS

National Institutes of Health
Forbes Advisor

Kevin Hines Story

https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6165520/

Is AI Responsible for Denied Claims?

Wed, 06 Mar 2024 12:42:49 GMT

Is AI Responsible for Denied Claims?

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Providers Note Costly Rise in
Medical Claim Denials

Dr. Nick van Terheyden knew something was fishy.

When his own physician ordered bloodwork to diagnose the cause of van Terheyden’s bone pain, both of them fully expected his insurance plan to cover the cost. But instead, Cigna denied the medical claim as “not medically necessary.”

Dr. van Terheyden realized that was not right. His suspected vitamin D deficiency could lead to osteoporosis if left untreated. The vague wording of the claim denial indicated to van Terheyden that Cigna’s medical director, Dr. Cheryl Dopke, had not actually reviewed the case.

As it turned out, van Terheyden’s file was only one of 60,000 that Dopke denied in a single month in 2022.

Other Cigna medical directors have done the same – one issued more than 80,000 instant denials during the same time frame. Over a two-month period in 2022, Cigna doctors denied more than 300,000 claims, spending an average of 1.2 seconds on each case.

Automated Bulk Denials

The health insurance giant is now embroiled in a massive class-action lawsuit that alleges Cigna uses a computer algorithm to automatically deny hundreds of thousands of medical claims without examining them individually as required by California law. (See sidebar, “About PxDx.”)

About PxDx

Cigna's claims review system PxDx (corporate shorthand for procedure-to-diagnosis) was developed more than a decade ago by former pediatrician Alan Muney, who now advises insurers on how to save costs.

PxDx involves a list of tests and procedures approved for specific illnesses. The program would automatically deny payment if a treatment did not match a listed condition. Denials were then sent to Cigna medical directors, who would reject these claims without reviewing the patient file.

Muney and his team previously worked for United Healthcare, where they devised a similar system that allows UHC doctors to bulk-deny claims quickly.

Source: Propublica

The plaintiffs seek "statutory and punitive damages," costs and attorneys' fees, and "appropriate declaratory and injunctive relief enjoining Cigna from continuing its improper and unlawful claim handling practices."

Former Cigna employees have stated that the vast majority (about 99.8%) of patients will pay the denied claims rather than deal with the hassle of an appeal.

UHC's Legal Woes

Cigna is not the only insurance provider using artificial intelligence to issue bulk denials. United Healthcare (UHC) is battling a class-action suit claiming the company knowingly used a faulty AI algorithm to deny elderly patients coverage for medically necessary extended care.

The families of two deceased patients argue that UHC deployed AI technology known to have a 90% error rate (called "nH Predict") to deny medically necessary care to seniors. The plaintiffs also stated the insurer expected only a fraction of policyholders to appeal the denied claims, knowing patients would either pay out-of-pocket costs or forgo the remainder of their prescribed care.

They are seeking monetary damages.

Denied Claims on the Rise

In 2021, insurance companies denied about three percent of all medical claims (and 17 percent of all in-network claims) filed. In 2022, that figure rose to 11 percent, representing 110,000 unpaid claims for each average-sized healthcare system.

These denial rates are not likely to decline any time soon. According to the latest Experian Health data, 30 percent of healthcare leaders say that claims denials are increasing by 10 to 15 percent.

Legal experts anticipate more insurers will encounter similar complaints as they increasingly incorporate AI in their claims management processes. Medical professionals also advise health insurers to rein in their expectations of AI's utility.

Last year, the American Medical Association (AMA) cautioned health insurance companies to require human examination of patient records before denying medical claims. "AI is not a silver bullet," said AMA Board Member Marilyn Heine, MD.

--Article Continues Below--

How to Fight Autogenerated Denials

What can medical practitioners do about bulk AI-generated claims denials? Dr. John Lin, an Arizona urologist, offers the following advice:

Understand payer policies and rules to secure prior authorization for procedures properly. Keep track of which payers will pay for which procedure using which diagnosis.

Always appeal the denial. If your billing is outsourced, check with the billing company to ensure they aren't automatically writing off denied claims. Open communication with the coding and billing staff is vital to an effective and timely appeal.

Finally, if a particular payer continues to play games with your medical practice, Dr. Lin suggests you hit them where it hurts:

The Rest of van Terheyden's Story

After a second Cigna doctor insisted that van Terheyden's blood test was unnecessary and again denied the claim, he took the matter to an independent reviewer, as allowed by his insurance plan.

Seven months after van T erheyden's procedure, the external physician determined that "This patient is at risk of bone fracture without proper supplementations. Testing was medically necessary and appropriate."

Sources:
Featured Image: Adobe, License Granted
Medical Economics
Propublica
U.S. PIRG Education Fund
Experian
RevCycle Intelligence
Modern Healthcare

Till Debt Do Us Part?

Wed, 14 Feb 2024 21:45:00 GMT

Till Debt Do Us Part?

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How Money Issues Can
Make or Break a Relationship

Brian and Lynn never talked about money. When unanticipated expenses -- such as a medical emergency or necessary home repair -- cropped up, they relied on credit cards to pay.

Eventually, they maxed out all their cards and were $109,000 in debt. Their marriage hit rock bottom, as communication became limited to disagreements about money. They knew they needed a plan to save their family.

Marriage and Debt in America

For a significant portion of Americans, debt is a source of strife that portends calamity for the health of their marriage. Consider the following statistics:

A study from Utah State University revealed that couples who fight frequently about money are 30% more likely to divorce than those who rarely argue.

In a recent OnePoll survey, 54% of respondents stated that a spouse's debt is a justifiable reason to consider divorce.

A 2019 Harris Poll found that 35% of respondents blame finances for the stress in their relationships.

A 2022 survey by Orion Advisor indicated that 42% of U.S. couples have arguments about money; for 27% of respondents, these disagreements occur weekly or monthly.

Did You Know?

Iowa statute dictates that both parents are responsible for their children’s medical debts, regardless of marital status.

A 2022 survey by Orion Advisor indicated that 42% of U.S. couples have arguments about money; for 27% of respondents, these disagreements occur weekly or monthly.

The Four Loves

Psychologists generally recognize four different types of love: familial ("storge"), brotherly ("philia"), romantic (eros), and selfless (agape).

Storge is the love one feels for family members, such as a parent for a child. It is unbidden affection and is considered the most natural of all the loves.

Philia is the accepting love between close friends. It positively impacts health and can make us more resilient during hard times.

Eros is sexual or passionate love. This type of love is more about the person feeling it and less about the person who is the focus of it. It can result in great joy and great sorrow.

Agape love is the unconditional love of humankind. It's based on acceptance and understanding and is expressed through acts of kindness, service, and compassion. Creditors who treat consumers with empathy and benevolence demonstrate agape love.

Source: University of Utah Health

But carrying a boatload of debt does not have to be a death sentence for a relationship. As with most interpersonal relations, communication is the key to resolving money issues in a marriage. Once both partners are on the same page, with clearly defined expectations regarding budget, responsibilities and goals, they can begin to overcome their financial hurdles.

Money Talks

Discussing finances with a spouse is not easy. Money is often an emotionally charged topic, underscoring cultural or family differences and past problems. Here are some tips to get started:

Share your story. ("When I was growing up, money was . . .")

How was money handled in the household where your spouse was raised? Their experience was likely very different than yours, so you're likely approaching the issue from differing perspectives. Discovering a spouse's money history can help each partner understand the other's foundational beliefs.

Share your fears. ("My biggest financial fear is . . .")

Fear is a bad financial advisor. While some fears can motivate us to take positive action (such as setting aside funds for unexpected medical care), living in fear of financial ruin makes us feel like there's never enough. Identifying each spouse's financial fears helps to reveal their motivations.

Share your goals and dreams. ("Someday I want us to . . .")

Sharing goals and dreams can be inspirational. While your short-term goal may be to resolve your debt, what about long-term goals? Tap into your dreams if you want to start making real financial progress.

Be kind. Money mistakes happen. But as long as each spouse treats the other with kindness, forgiving each other and themselves, they can learn from past errors while strengthening their marriage.

Create a Sustainable Budget

The next step is to create a budget together that's sustainable for the entire household. The following video offers a quick tutorial:

Bonding Over Debt

While debt may never be considered a blessing, it can serve as a tool for helping couples learn how to work as a team.

According to Joy Lere, a clinical psychologist and behavioral finance counselor, debt can be "a powerful catalyst for change and growth." In Lere's experience, couples who work together to identify their shared financial challenge -- and then strategize collaboratively to overcome it -- typically can deepen their bond and strengthen the relationship.

--Article Continues Below--

The Rest of the Story

Whatever happened to Brian and Lynn, the couple that was $109,000 in debt? Using a plan they formulated together, they worked out a monthly budget for the first time in their married lives. They changed their lifestyle, drastically reducing unnecessary expenses, and devised novel ways to save and stretch their dollars.

By paying $2,000 a month, they resolved the entire balance in slightly more than four years. Brian chronicled the family's journey on his personal finance blog, Debt Discipline . He and Lynn will soon celebrate their silver wedding anniversary.

Sources:
Featured Image: Adobe, License Granted

Business Insider
CNBC
Ramsey Solutions
Huffington Post

https://www.businessinsider.com/couple-paid-off-109000-credit-card-debt-save-their-family-2019-8#money-problems-destroy-marriages-3 https://www.businessinsider.com/couple-paid-off-109000-credit-card-debt-save-their-family-2019-8#money-problems-destroy-marriages-3

https://www.businessinsider.com/couple-paid-off-109000-credit-card-debt-save-their-family-2019-8#money-problems-destroy-marriages-3

Three Doable New Year’s Resolutions

Wed, 10 Jan 2024 21:45:00 GMT

Three Doable New Year’s Resolutions

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How to Attain Your Goals
Through Baby Steps

Did you know that most Americans abandon their New Year’s resolutions within the first month?

And less than ten percent see their resolutions through to completion.

If your resolve begins to wane as February approaches, perhaps it’s time to reassess your goals. Let’s look at ways to make three of the most common resolutions more doable.

Slim Chances

When setting weight-loss goals, many of us bite off more than we can chew (if you’ll excuse the pun). Losing 50 or 80 pounds over the course of a year is reasonable and highly doable; losing it within a couple of months is not—if you want to remain healthy.

If you dive into an aggressive weight-loss program without the proper motivation, you’re setting yourself up for early failure. Try to look at the long-term picture and focus on getting a little bit healthier every day.

Regional Resolutions

A recent YouGov survey of past New Year’s resolutions reveals some interesting regional differences.

For instance, Midwesterners are the most concerned about losing weight (46%) and the least concerned with quitting alcohol (1%). Here’s how the stats line up for the most popular resolutions:

Source: YouGov

For instance, eliminating all processed foods from your diet may not be doable, but restricting them certainly is. Here are some small changes that can make a big difference:

If soft drinks are your weakness, try switching up to flavored, unsweetened sparkling water and save the Pepsi for special occasions only. (Even so-called “diet” sodas have been shown to cause weight gain.)

Do you crave the crunch of potato chips or high-carb crackers? Reach for an apple or a handful of lightly salted nuts instead.

If chocolate is your thing, opt for a small amount of dark chocolate with at least 70% cocoa content. Milk chocolate contains the wrong kinds of fat, twice as much sugar, and less than a third of the fiber found in its darker cousin.

Choose whole-wheat pasta; it’s more filling than conventional pasta, and you’ll eat less.

Wherever possible, add more vegetables to your meals. Their natural fiber will make you feel full and help curb the tendency to snack. (Not a vegetable lover? Try cauliflower “mashed potatoes .”)

A realistic program for permanent weight loss involves baby steps. Aim for losing 1 to 2 pounds per week.

No Pain, No Gain

According to the most recent Forbes Health/OnePoll survey , getting in shape is the #1 New Year’s resolution for 2024. It doesn’t have to entail a gym membership — although it certainly can! Any activity that gets your body moving will be an improvement.

If you’ve been sedentary for years, get approval from your doctor before embarking on an exercise regimen. (See “ The Exercise Prescription .”) Then, invest in a good pair of walking shoes that provide the proper support. The benefits of walking are manifold: lower body fat and improved circulation, joint health, bone density, blood pressure, and mood.

Begin by walking just 10 minutes a day at a comfortably brisk pace. (A good gauge is you can talk but not sing.) Do this for one week, allowing one day for rest or mild strength training (such as squats). For Week 2, repeat the regimen, but increase your walking time to 15 minutes per day. Increase your walking time by 5 minutes each week. By Week 5, you’ll be walking 30 minutes daily, six days a week -- the recommended amount of daily aerobic exercise for optimal health.

Here are a few more suggestions to keep your exercise program on track:

If you happen to have at-home fitness equipment, it’s time to use it for something besides a clothes hanger. It will help you incorporate exercise into your daily routine (e.g., walking on a treadmill while watching your favorite program or reading while riding a stationary bike).

Some people feel more motivated to exercise with a friend . If you’re one of them, ask a buddy to meet you for a scenic walk or to join a water aerobics class.

Set a workout milestone, such as walking for two weeks in a row, and then reward yourself with a massage or a new article of clothing when you meet it.

Don’t punish yourself if you miss a workout. Instead, consider it a rest day, and remember there’s always tomorrow.

The Buck Stops Here

If one of your New Year’s resolutions is to get out of debt in 2024, there are several baby steps you can take to achieve your goal. The key is to stop creating new debts until the old ones have been satisfied. (Some debts, like medical bills, may be unavoidable, but you can at least have a plan to pay them off before incurring new credit card debt, for instance.)

Once you’ve stopped incurring new debt, make a list of all your debts, from smallest to largest. This means gathering all your bank statements, credit card statements, and any correspondence from creditors. Include interest rates in your calculations, as these can change your monthly figures.

Pay off the smallest balance first. This practice, called the snowball method , was first popularized by financial expert Dave Ramsey. It will give you the motivation and momentum to tackle the larger debts. (For details, see the infographic below.)

Work on cutting your expenses. For instance:

--Article Continues Below--

Review your auto insurance annually, comparing quotes online. Consider increasing your deductible or eliminating collision coverage for an older vehicle.

Check with your local library to see if they offer free access to online entertainment like Libby, Kanopy, or Hoopla Digital, so you can eliminate online streaming fees.

Prepare meals at home instead of eating out (Even fast food is more expensive than home cooking.) You can stretch your food budget by purchasing produce in season, store brands, and items with longer shelf life.

Reduce your energy bills by adjusting your thermostat, taking shorter showers, setting your refrigerator to 37 degrees and your freezer to 0 degrees, washing clothes in warm or cold water, and using smart power strips.

Paying off your debt may seem nearly impossible, but it’s highly doable if you take baby steps.

Sources:
Featured Image: Adobe, License Granted

Inside Out Mastery
Mayo Clinic
Everyday Health
Nerd Wallet

Coping With Holiday Blues

Tue, 12 Dec 2023 19:23:04 GMT

Coping With Holiday Blues

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When the Most Wonderful
Time of the Year Isn’t

The holidays are supposed to be the most wonderful time of the year, with "everyone telling you be of good cheer." But for many people, this season is difficult and emotionally exhausting.

For years, medical professionals have documented increased rates of depression during the holidays. According to the National Alliance on Mental Illness (NAMI), 64% of patients diagnosed with mental illness reported that their conditions worsened at this time of year.

Blue Christmas

Several factors contribute to the holiday blues. Festivities and social interactions can result in stress caused by the pressure of multiple responsibilities. Sometimes, complicated memories of Christmases past can cause anxiety about family gatherings.

Other common causes of holiday-time depression include:

Physical and mental fatigue

Financial stress

High expectations caused by the exaggerated portrayal of the holidays on TV and social media

Travel stress due to crowded airports, traffic jams, and the effects of jet lag.

Feeling SAD

Clinical depression with a seasonal pattern is known as seasonal affective disorder (SAD). SAD often appears in the late fall and can last until early spring.

The disorder is more common in northern climates, correlating with changes in photoperiod during the wintertime. With SAD, a person's limited exposure to natural light impacts body rhythms and neurochemical balance.

SAD affects about 6% of the U.S. population. Even people who do not usually struggle with depression can experience SAD temporarily during winter.

Treatments for SAD may include light therapy, psychotherapy, Vitamin D supplements, and medication.

First holiday after the passing of a loved one

Loneliness

Another contributing factor is the shorter photoperiod in the Northern Hemisphere at holiday time. (See sidebar, “Feeling SAD.”)

No Downtime for Healthcare Professionals

Healthcare is one of the few industries without downtime or a more relaxed pace during the holidays. (Of course, retail is another one.) While everyone else is occupied with caroling, opening gifts, and spending time with loved ones, medical staff are busy caring for patients. In fact, these months are often particularly hectic for them.

Most care providers naturally become even more empathetic to their patients' suffering during the holiday season, resulting in emotional and physical exhaustion. Consequently, caregivers themselves often struggle with the holiday blues.

Coping Strategies

Here are some ideas to help care providers and other holiday workers manage stress during this hectic season.

Plan Ahead Whenever Possible

One of the most challenging aspects of holiday work is missing out on time with friends and family. Whenever possible, plan ahead for holiday gatherings or even arrange alternative days for celebrations.

Are you scheduled to work Christmas Day? With a little planning and coordination, you can organize an alternative time to celebrate. A genuine holiday is whenever you and your favorite people can be together.

Keep It Real

You may feel pressured to be extra cheerful at this time of year, but maintaining a realistic approach to the holidays can help manage expectations.

For instance, remember that the holiday season lasts only weeks within your entire year. When you're feeling overwhelmed by it all, take a few deep breaths and know that "this too will pass."

Does seeing other people's holiday photos cause you to engage in unhealthy self-comparison? Take a break from social media. Seek out winter activities (solo or with others) that aren't associated with the holidays, such as ice skating or skiing.

Finally, it's okay to say "no" if you feel yourself being stretched too thin.

Decorate Your Workspace

Just because you'll be spending the holidays working doesn't mean you can't spruce up your environment with some holiday cheer, even if you're employed in a medical environment. So long as it doesn't interfere with patient care, holiday decorations can help brighten the moods of both staff and patients.

--Article Continues Below--

Limit Overtime

Enticed by the lure of holiday pay and extra shifts, overly ambitious caregivers can become exhausted and then end up scrambling to find a last-minute replacement. The result is more stress for themselves and their colleagues who must fill the shifts.

You may have the best of intentions when picking up overtime or holiday shifts, but remember the gift of your presence (as opposed to your presents) is what your family and friends cherish most.

Enjoy Holiday Perks

Take advantage of any holiday perks your organization provides, such as free meals on Christmas or New Year's. If your employer doesn't offer these perks, you can create your own festivities, such as a staff potluck dinner or a Secret Santa gift exchange.

Take Care of You

Caregivers in particular must take extra measures to remain healthy during the hectic holidays. The additional stress, combined with less sleep and the peak of cold and flu season, makes taking care of you essential. Listen to your body. In addition to staying active, hydrated, and well-rested, take a few moments to center yourself through meditation, prayer, or just a few deep breaths.

Some industries -- such as healthcare -- must operate 24/7, 365 days a year. Working on holidays is often expected. But you needn't miss out on your favorite holiday traditions if you plan ahead. And by keeping realistic expectations, limiting your overtime, and practicing self-care, you can still be a source of holiday cheer for your patients, colleagues, and loved ones.

Sources:

Featured Image: Adobe, License Granted

National Alliance on Mental Illness
GH Resources
Health Partners
Relias

How Rude! Incivility on the Rise

Wed, 08 Nov 2023 19:15:00 GMT

How Rude! Incivility on the Rise

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Is Rudeness the New Epidemic?

"Attention! Our employees have the right to be treated with dignity and respect at all times.
They should be able to do their jobs without being physically or verbally abused. Most people respect this.
Thank you for being one of them."

( Sign posted in Atlanta's Piedmont Hospital)

Healthcare is just one service industry that has witnessed an alarming increase in rude behavior by the people they serve. Consider the following all-too-common incidents:

A retail employee who greeted a customer with “good morning” was told, "I do not need you for anything. Leave me alone. If I need you, I will call you. You are here to serve, not to talk with me."

A restaurant patron berated a waitress to tears because she didn't bring the customer's salad precisely as she ordered it.

A passenger yelled at a car service driver, "What are you waiting for?! Get your act together!” He then shoved his luggage at the driver and stormed out.

In 2022, 68% of nurses reported verbal abuse during the pandemic. The consensus is that these numbers are increasing, even though the public health crisis has abated. Bad behavior toward frontline workers -- regardless of the role or industry -- has become the norm rather than the exception.

Offensive Driving

In 2022, Forbes Advisor surveyed 10,000 licensed drivers, comparing all 50 states for aggressive driving (such as being forced off the road, cut off on purpose, and yelled at, insulted, or threatened).

The top 10 states with the most aggressive drivers were:

1, Arizona

2. Rhode Island

3. West Virginia

4. Virginia

5. Oklahoma

6. Alabama

7. Connecticut

8. Illinois

9. Texas

10. Ohio

Iowa ranked among the top 10 states with the most polite drivers. (See " Is Iowa Nice Real? ")

The 2023 National Consumer Rage Survey revealed that customers are becoming increasingly aggressive in their attempts to solve problems with businesses. For example, 43% of the respondents admitted to raising their voice to show displeasure, compared to 35% in 2015. The survey also found that the percentage of customers seeking revenge against businesses has tripled over the last three years.

What's Behind the Rise in Rudeness?

The increase in incivility reaches across all areas of human interaction. It seems poor behavior is having a moment in our society right now. For instance, violent road rage increased 135% between 2018 and 2022. (See sidebar, "Offensive Driving.”)

Dr. Christine Porath has studied incivility for about two decades, surveying all types of workers worldwide. According to her reports, nearly half of workers polled in 2005 had been treated rudely on the job at least once a month. This figure rose to 55% in 2011 and 62% in 2016.

In 2022, Dr. Porath surveyed more than 2,000 frontline workers across more than 25 industries and found that 76% reported experiencing rudeness at least once a month.

Porath believes that the No. 1 reason for societal incivility is stress. The continually accelerating speed of change and information delivery breeds impatience, resulting in unrealistic expectations of those who serve us. In addition, the pandemic-related transition to remote work reduced face-to-face interaction, resulting in fewer opportunities to develop empathy with one another.

A 2022 University of California study revealed that anxiety, anger, and sadness are the three emotions most strongly associated with increased incivility. According to Dr. Keith Humphreys, a psychiatry professor at Stanford University, people are easily set off by innocuous requests when they are under these stressors.

The Rudeness Contagion

And then there's the contagion factor. In the following video clip, Dr. Porath explains how incivility spreads swiftly throughout communities like a virus.

Responding to Rudeness

But responding appropriately to unabashed rudeness can be challenging, as one medical professional can attest when a patient greeted him with "HEY, A**HOLE!!" as soon as he walked into the ER. "I hadn't even started my shift yet, and he wasn't even my patient," the hospital staffer said.

Rude behavior is sometimes understandable in healthcare settings, where patients are physically and emotionally weakened. On the other hand, it's important to set boundaries. Behaving rudely once can be viewed as a mistake. Doing so repeatedly is a choice.

One way healthcare providers are responding to bad behavior is by adopting policies to help set expectations from the get-go. Hospitals in Boston, Houston, Pittsburgh, and Washington, DC, recently implemented codes of conduct to protect their staff from verbal abuse or disrespect from patients and visitors. More facilities will likely follow suit.

A recommended technique for all service industries is coaching frontline workers on de-escalation tactics and providing scripts for employees to use when responding to incivility. Avoid the temptation to combat rudeness with rudeness. Doing so only perpetuates the cycle of incivility.

--Article Continues Below--

Here are some tips for defusing a tense situation:

Get Them Talking. Customers sometimes raise their voices or act rudely to get your attention. But if you engage them in light, empathetic conversation, they'll know you're listening.

Stay Calm and Don't Argue. Remaining composed during a stressful encounter can help calm the customer or patient. On the other hand, arguing with them can cause the situation to deteriorate to a point where they become aggressive or leave.

Use Positive or Neutral Language. Positive language can change the way the brain responds to stress. So use only positive or neutral words, regardless of the language they use with you.

Apologize Without Admitting Fault. "I'm sorry for the frustration this situation has caused you."

A calm, confident person delivering brief, clear information is the best way to bring these situations back in line. As one physician commented in the Journal of the American Medical Association , being kind but firm is essential when encountering rudeness.

She suggests: 'I care about you as a person, but I will not tolerate offensive behavior. Now let's focus on how I can help you today."

Sources:
Featured Image: Adobe, License Granted
Atlanta Journal-Constitution
Becker's Hospital Review
Relias

Harvard Business Review
American Medical Association
Medjobs

Mastering the Art of Negotiation

Wed, 11 Oct 2023 13:30:00 GMT

Mastering the Art of Negotiation

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Tips to Improve Your Debt-Resolution Skills

Negotiating with people who owe you money, whether patients or other consumers, is not an exact science – it's an art.

You won't find a mathematical formula that works for every scenario. Successful negotiators always create a strategy but don't rigidly adhere to a predetermined plan. Instead, they remain flexible. Here are a few guidelines to consider when negotiating debt repayment with a consumer.

Research, Then Identify

Familiarize yourself with the facts about the account. conduct some internal research to be prepared to discuss the situation completely.

Learn to Recognize Stallers

Can you recognize when a debtor is stalling and has no intention of paying an overdue account balance? Here are some signs to look for:

The consumer ignores phone calls, emails, and letters, or their voicemail greeting claims they're always on vacation. You're being ghosted.

The consumer alleges a minor cost discrepancy in an attempt to hamper the collection process and escape paying the bill.

The consumer deflects blame by claiming they never received the invoice or they already sent payment.

The best strategy for handling stallers is the three-strike rule: If they offer excuses on three or more occasions, send the account to collections.

After researching the account, you'll be in a better position to identify the overdue consumer as one of three types:

Intends to pay
Wants to pay but is not yet able
Does not intend to pay

Listen to Find Out Why

How did this collection situation get out of control in the first place? Sometimes, simply asking the consumer about what went wrong, you'll learn that it's only a temporary problem or that help is on the way.

If so, you could structure a moratorium to help the consumer get through the rough patch before resuming regular payments. By understanding what went wrong in the first place, you can help find the best solution.

Actively listen to the consumers who want to pay you and strive to understand their personal circumstances. Allow them to air any grievances they may have. Doing so will help build trust and optimize your chances for recovery.

Negotiate as Equals

Treating the consumer as an equal will make them far more amenable to working with you. To find some common ground for negotiation, you must establish a level of respect.

Begin by asking the debtor to suggest terms that would work for them. If the proposal is unacceptable, counter the offer by suggesting a substantial down payment followed by monthly payments for the remainder.

For example, suppose the consumer offers to pay $25 monthly to cover a $500 debt, but your company's guidelines would consider such an offer unsatisfactory. In that case, it's up to you to turn the proposal into an acceptable arrangement.

You could offer to accept $50 monthly over six months if the consumer makes a $200 good-faith payment now. The consumer may either accept your offer or counter with payments of $40 per month instead. Either way, the negotiation is now moving in the right direction. Always work toward higher payments over a shorter term, but remain flexible.

Confirm and Finalize

Once you reach an agreement with the consumer, committing the terms to a written contract signed by both parties improves your chances of successful debt resolution.

After the consumer has remitted the first payment, end the conversation on a positive note. Reassure them that the payment arrangement places their account back in good standing with your organization.

At the same time, you also want to clarify the ramifications of failing to abide by the agreement. Tell them their account will be referred to collections if they breach the terms. This is your trump card -- one you must adhere to, no matter what relationship you have developed with the debtor.

--Article Continues Below--

Send in the Pros

If you've reached a stalemate in your negotiations with a past-due customer or patient, it's time to call in the professionals.

At CBSI, our collection professionals are skilled negotiators. Working within your organization's approved parameters, we maximize debt recovery by employing preparation, empathy, and creative problem-solving techniques. Contact us .

Sources:
Featured Image: Adobe, License Granted
Forbes
PDC Flow

The Exercise Prescription

Wed, 06 Sep 2023 13:00:00 GMT

The Exercise Prescription

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Is Physical Activity the Best
Medical Treatment After All?

Lucas Carr is on a mission to improve the health of Iowans through exercise.

“There is no medicine in existence that has all the benefits of this one thing,” Carr said. The associate professor of Health and Human Physiology at the University of Iowa is chair of UI’s Exercise Is Medicine® (EIM) program.

Exercise as Medicine

First launched in 2007, EIM is a global health initiative designed to increase awareness about the health benefits of physical activity and integrate exercise into the healthcare system.

Primary care doctor Robert Sallis, MD, chairs the national Exercise Is Medicine initiative. He’s “underwhelmed” by the medical status quo, and he believes doctors can help many more of their patients by simply following this three-step protocol:

Ask about exercise at every appointment.

Treat physical activity as a vital sign and make a note of it.

Prescribe exercise as a fundamental part of every treatment plan.

How the States
Stack Up

Insurance analysts at Quote Wizard recently rated all 50 states for physical activity levels based on the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) data. Here’s what they found:

Colorado, Utah, and Washington are the most physically active states.

Alabama, Mississippi, and Arkansas are the least physically active states .

Iowa was the 31st most physically active state.

Twenty-four states showed a decline in physical activity over the last three years.

Since 2020, physical activity increased the most in New Jersey and decreased the most in Maine.

Click here to view the complete rating list.

Specifics are important for Dr. Cate Collings, president of the American College of Lifestyle Medicine. She recommends that physicians provide patients with an exercise prescription that spells out precisely what to do, for how long, and how often. Practitioners must specifically tailor prescriptions to treat the patient's condition.

Locally, Professor Carr is working to ensure that Iowa healthcare providers are on board. He’s got his work cut out for him.

Why Doctors Don’t Prescribe Exercise

Recent studies revealed that American doctors recommend physical activity to only one-third of their patients with high blood pressure and 18% of those with diabetes.

Research published in the Medical Journal of Australia identified two key barriers to prescribing exercise:

Lack of medical school training and
The doctors’ own level of physical activity.

The first obstacle may finally be changing as medical schools and residency programs begin to include training on exercise and other healthy behaviors in their core curricula.

According to a recent Wall Street Journal article , the universities that now incorporate "lifestyle medicine" into their training programs include Brown, Harvard, Stanford, the University of Oklahoma, historically Black colleges and universities, and schools of osteopathic medicine.

Student interest groups are active at more than 100 U.S. campuses, and more than 200 residency programs include a lifestyle-medicine curriculum.

Walk With a Doc

But prescribing exercise does not guarantee the patient will follow through.

Cardiologist David Sabgir of Columbus, Ohio, was frustrated with his patients’ reluctance to take that first step. So in 2004, he started walking with them. A year later, he launched Walk With a Doc , a nonprofit organization that pairs patients with doctors for walks. Today WWAD has chapters in 34 countries and hosts 130,000 walks per year.

In addition to the exercise benefits, Sabgir credits the effort’s success to group bonding and spending time outdoors.

--Article Continues Below--

More Than Exercise Needed for Weight Loss

However, if the main reason for starting an exercise regimen is merely to lose weight, most patients will be disappointed.

Most studies indicate moderate aerobic exercise without a change in dietary habits typically produces little or no weight loss. In fact, to achieve any meaningful weight loss through exercise alone, study participants had to burn a minimum of 400 calories per session five or more days per week.

That correlates to 90 minutes per day of brisk walking -- or 30 minutes of running eight-minute miles -- for a 150-pound person. Exercisers who can achieve that level of physical activity are often dismayed to discover that their bodies compensate by boosting their appetite and dialing down their metabolism.

The Fountain
of Youth?

A new study published in the Journal of Physiology suggests that exercise may reverse the effects of aging by helping to reprogram cells. Researchers who analyzed genes within the muscle fibers of aged mice found evidence of cell rejuvenation following exercise.

“Exercise is the most powerful drug we have,” said Kevin Murach, assistant professor at the University of Arkansas and one of the study’s authors.

Of course, the benefits of physical activity extend well beyond weight loss. And while moderate exercise may not melt away the pounds, it can prevent weight gain and increase muscle mass.

How to Get Involved

If you’re a healthcare provider interested in helping your patients become more active, EIM provides resources to get you started:

The EIM Summary Sheet offers a quick overview of Exercise is Medicine® and recommended physical activity guidelines.

EIM's Health Care Providers' Action Guide is a step-by-step tool to help providers integrate physical activity into their medical practices.

A series of patient handouts, Rx for Health, is tailored toward sedentary patients of all ages and those with various medical conditions.

Professor Carr hopes to get all Iowa care providers on board.

“A lot of times, it’s a matter of convincing hospital administrators that this is an important thing that we should be doing for every patient at every visit,” Carr said.

Sources:
Featured Image: Adobe, License Granted
University of Iowa
The Gazette
Medical Journal of Australia
Time
Journal of Physiology

How Professional Collectors Resolve Medical Debt Disputes

Wed, 09 Aug 2023 22:30:00 GMT

How Professional Collectors Resolve Consumer Debt Disputes

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Dispute Resolution
Requires Skill and Empathy

What should you do when a consumer disputes a debt? Should you allow a collection agency to handle the dispute or attempt to resolve it internally?

Some situations are best left to the professionals. Here's why: Reputable collection firms not only budget the time required to handle disputes, but they also extensively train their staff in best practices for dispute resolution.

Let's look at how professional debt collectors handle disputed accounts.

Walk a Mile in Their Shoes

A reputable collection agency will err on the side of caution and take all potential disputes seriously. They'll place themselves in the consumer's shoes and treat them as they would want to be treated. And they'll treat all situations equally, even with little or no information.

Most agencies do not differentiate between written and verbal disputes. Therefore, to avoid the potential for legal issues, the best collectors will identify all types of consumer objections as "disputes." Doing so ensures that these situations are adequately addressed right from the start.

The infographic below illustrates the process consumers are advised to follow if they receive a call about a debt they do not recognize:

Resolution Process

Any disputed account, whether past due or not, requires the debt collector to obtain proper documentation from the client. This extra information is critical to helping the collection agent determine the dispute's legitimacy.

For instance, it's important to provide the collector with a copy of the bill when the account is placed. Doing so helps avoid confusion with the consumer and significantly speeds up the dispute process.

Whenever a collector and consumer can review the bill together over the phone, they can often clear up any confusion. Simply explaining the bill's details may be all that's required to resolve a debt.

If the disputed account is significantly past due and has already been placed in "collections," the agent should first confirm that the consumer received a Debt Validation Letter. (See sidebar, "About the Debt Validation Letter.”)

If the consumer's mailing address is incorrect, they may not have received this important notice within the specified validation period. If the consumer claims they never received the validation letter, a reputable collector will give the consumer the benefit of the doubt. This simple good-faith gesture can make the consumer more amenable to resolving the debt. The collector will then authorize the issue of a debt verification letter pursuant to Fair Debt Collection Practices Act (FDCPA) regulations.

When attempting to resolve the dispute, the collector must ask questions and listen attentively to find a solution. If communication with the consumer is clear and open, it's easier for the collector to pinpoint the issue that requires resolution.

From there, the collector can review alternatives based on common ground, and propose solutions. After the collector and the consumer agree upon a solution, both parties should commit to a resolution deadline.

About the
Debt Validation Letter

The Debt Validation Letter must be sent within five (5) days of initiating contact with a consumer about his debt. With the adoption of Regulation F in November 2021, the Debt Validation Letter must now include the following information:

The total amount owed.

The name of the original creditor.

A statement indicating that the collector assumes the debt to be valid unless the consumer disputes it before the expiration date specified in the letter (30 days after first contact).

A statement indicating that the collector will verify the debt by mail if the consumer writes to dispute the debt or request more information before the 30-day expiration date specified in the letter.

A statement indicating that the collector will provide the consumer with information about the original creditor if the consumer requests it prior to the 30-day expiration date specified in the letter.

A statement indicating that the debtor may find additional information about consumer protections on the CFPB's website, and the website address must be included.

Source: Consumer Financial Protection Bureau

Client Communication

Reputable collection agencies will work directly with the client to resolve the dispute. Apprising creditors of a collection dispute as it unfolds can help them avoid similar situations and make collecting on future accounts easier for everyone.

Sources:

Featured Image: Adobe, License Granted
PDC Flow

Credit Guru

Employers to Staff: “We Need You Back in the Office”

Mon, 17 Jul 2023 13:11:05 GMT

Employers to Staff: “We Need You Back in the Office”

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Gentle Approach,
Hybrid Models
Help Lure Workers Back

With the lifting of COVID restrictions, American employers are eager for employees to leave their Zoom meetings behind and return to the workplace. But is that a realistic expectation?

Many companies are taking the bull by the horns and mandating that workers return to the office at least part-time. (See sidebar, "Companies Mandating Return to Workplace.”) Last November, Elon Musk began requiring staff at Twitter and Tesla to return to the workplace for at least 40 hours per week, or consider their “resignations accepted.”

Other firms, such as RCM giant Access Healthcare, are taking a more gentle approach. (See "Making It Work" below.) A study by workplace design firm Unispace reveals that 72% of all surveyed companies have some sort of return-to-work mandate. Most employers believe that corporate culture, collaboration, and innovation suffer when staff members are not gathered together in an office environment.

Companies Mandating

Return to Workplace

Here are some of the major U.S. companies now requiring their staffers to return to the workplace at least part-time:

Amazon – Employees must spend at least three days per week in the office.

Disney – Employees must work from offices four days a week.

JP Morgan – Half of all employees, including all executives, must work from the office five days per week. The rest must work from the office several days per week.

Starbucks – Employees within commuting distance are required to return to the office at least three days a week.

Uber – Employees in 35 of the company's locations must work from the office at least half of the time.

Source: Business Insider

Making It Work

But bringing employees back into the workplace after two years of working remotely is a challenge. Much has changed in the interim.

So when Access Healthcare wanted 9,000 employees in their various India locations to return to the office, the company carefully designed a strategy to encourage them. Instead of forcing the workers back with threats of termination, they projected the return as a collaborative effort to improve productivity.

"The entire process of bringing people back to work was very gradual," said Jacob Jesuroon, Senior Vice President of Human Resources. "We didn't position the office as a place of work, but we positioned the office as a place where people can collaborate."

Once Access Healthcare employees began returning to the worksite to collaborate, the next step was engagement. The company spread the word on social media, where employees could see their friends returning to the office, helping them develop trust in returning, too.

Many of the company's staff members had moved back to their hometowns two years ago so they could work remotely when the pandemic began. So now they had financial concerns about moving back to the city.

The company opted to ease the transition by arranging accommodations for these employees. They also developed a mobile app for administrative support and provided back-to-work counseling which included COVID safety training to alleviate health anxiety.

On the Clinical Side

For America's clinical workers, the pandemic exacerbated pre-existing financial stress, burnout, and mental health challenges. The result was nearly 334,000 medical staffers quit in 2021 alone.

Providers are now working hard to lure them back. They're offering better pay and work flexibility. Hospitals are implementing new safety measures and mental health resources to help clinicians cope with the daily stresses of their jobs. Some medical facilities are also hiring more support staff to take some work off these employees' already-full plates.

New Workers Benefit Most

Employment experts at Scoop Technologies believe returning to the worksite particularly benefits new employees, especially Generation Zers and younger Millennials. These workers must learn the ropes and be able to communicate with more established employees if they are to assimilate and truly understand the company's culture.

According to a 2023 study by the Greater Des Moines Partnership , workers in central Iowa understand the importance of workplace collaboration, training, and development. The study was based on a survey of more than 2,000 employees from 20 Des Moines-area organizations representing various industries.

Jenae Sikkink, Senior Vice President for the Partnership, noted that "young workers [in their 20s] understand the importance of being together. They're focused on culture, relationship building, and learning from others."

--Article Continues Below--

Remaining Flexible

But is it reasonable to expect employees to return to the workplace full-time after experiencing two years of working remotely?

According to the Des Moines study, workers want flexibility above everything else. Employees surveyed want to work from home 60% of the time and 40% from the office. Conversely, employers want their employees in the office 60% of the time and working remotely 40% of the time.

Requiring staff to work onsite every day could backfire, causing employees to seek more flexible job opportunities. As a result, many firms are adopting a "structured hybrid" work model, which sets specific expectations on when employees will work from the office.

Those expectations can vary, such as requiring a minimum number of days onsite, requiring specific days, or requiring a minimum percentage of time employees must be in the office. Of those options, requiring employees to come into the office a minimum number of days each week is the most popular. About 66% of large companies (with 50,000 or more employees) are adopting structured hybrid work and dramatically shifting away from fully remote work situations.

A Truce?

Some workforce development experts regard hybrid work policies as a kind of "truce" between bosses and their workers. Clearly, jobholders still value the workplace, but it must evolve to meet their needs. Prudent employers will work to balance in-office demands with the work flexibility employees will not easily relinquish.

Sources:
Featured Image: Adobe, License Granted
Fortune

Economic Times

Business Record

NPR

Providing Multi-Generational Healthcare

Wed, 07 Jun 2023 13:45:00 GMT

Providing Multi-Generational Healthcare

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Generational Differences Matter When
Engaging Patients

Just as each generation of patients expresses unique preferences for music and fashion, different generations seek different experiences in healthcare. Practitioners must understand these generational variations if they are to provide the most effective care.

Let's explore the preferences for each demographic group, as well as the best ways to engage them.

Generation Z

Birth Years: 1997 to 2012

Gen Zers were born into the hyper-connected world of social media and texting. They practically live on their mobile devices, and most have regular access to at least five screens (smartphone, TV, laptop, desktop, and iPad).

This young age group is the most racially diverse generation to date. They’re concerned about stress and often rank their mental health as poor. But they are unlikely to visit the doctor because of the cost, inconvenience, and lack of time. Instead, they’ll seek alternatives, such as wearable devices or supplements.

Of all the generations, Zers are the most likely to take preventative care into their own hands.

How to Engage Them

Generation Zers are looking to technology for healthcare engagement. They want:

Iowa's Shifting Demographics

Iowa’s median age has increased from 30 years old in 1980 to 38.3 years old in 2020, and 17.7% of Iowa’s population is older than 65 – the eighth-highest percent in the U.S. This number is expected to continue to grow as more as more Baby Boomers reach this milestone.

At the same time, 40% of the state’s forecasted 2045 population will be younger than 30. Millennials currently account for the majority of Iowa’s population, followed by Baby Boomers.

The figure below indicates Iowa’s estimated population by age for 1985, 2015, and 2045:

Sources: Iowa Dept of Transportation , U.S. Census

Telemedicine
Online scheduling and payment options
Wearable devices
Easy access to health data

To effectively engage this cohort of patients, you need more than just a website; you need a solid online presence. Adopting best SEO practices and creating a Google Business profile will display your site more prominently on search results. Integrating online scheduling and payment options will also boost your online presence and improve the patient experience.

For Gen Zers, convenience is king. A dedicated patient app allows them to perform simple tasks, such as viewing lab results, requesting prescription refills, or paying bills without a phone call or office visit. If your practice does not offer telemedicine, you’re missing out on an excellent opportunity to attract young patients without increasing overhead.

Millennials

Birth Years: 1981 to 1996

Millennials are the largest adult generation, partly due to the increase in young immigrants. However, they’re also the lowest users of traditional healthcare.

Like Gen Zers, Millennials want digital options in healthcare. They’re entirely comfortable with mobile devices, but about a third prefer the computer for online transactions. They typically maintain multiple social media accounts.

In addition to easy access to medical records and online scheduling, Millennials want the option of online chats with medical professionals. They also tend to make healthcare decisions based on emotional experiences.

As a result, a single negative experience will likely cause them to switch providers. They have high regard for peer input and current patient testimonials. They’re looking for deep, genuine connections with their doctors.

How to Engage Them

As with Gen Zers, engaging Millennial patients requires that healthcare professionals immerse themselves in digital technologies. Telemedicine, online payment and scheduling options, social media chats, and various mobile apps must be employed when facilitating patient-provider interactions.

Social media is vital to engaging this cohort of patients. Most social media apps offer instant messaging services so you can engage your patients in real-time. They also allow you to tailor your content to this demographic, providing immediate answers to prospective patients’ questions.

In this way, social media helps create brand awareness and forge a bond between your practice and your patients or potential patients.

Generation X

Birth Years: 1965 to 1979/1980

Generation X patients make frequent trips to the doctor – for themselves, their children, and their aging parents. When it comes to selecting healthcare providers, 75% of Gen X'ers are the primary decision-makers. However, compared to Baby Boomers and the Silent Generation, Gen X'ers report the highest dissatisfaction rate.

X'ers are digitally savvy, but they’re looking for personalization and compassion with each encounter – not just convenience. Trust is of paramount importance to them. They generally trust their individual providers, but not medical establishments per se.

Generation X tends to highly trust a health system’s website or direct mail marketing and this group is comfortable with traditional media (TV, radio, newspapers) providing healthcare information. They are not as trustful of social media, however.

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How to Engage Them

When making healthcare decisions, Generation X patients rely on various sources of information and carefully analyze all their options. As the most highly educated demographic, they want intelligent content and meaningful communications. You can appeal to them through an engaging website, as well as direct marketing and other traditional media outlets.

Many Gen Xers work full-time, comprising 33% of the U.S. workforce. So they seek convenience and ease of scheduling appointments for in-office visits. Extra appointment time options, such as evening and weekend hours, would be an important step toward satisfying this patient group.

Baby Boomers

Birth Years: 1946 to 1964

This aging demographic relies on healthcare providers often for existing and developing conditions. Almost 40% of Baby Boomer patients visit their doctors three to six times yearly, and 22% see the doctor seven or more times per year.

Boomers are interested in high-quality, individualized care. They tend to ask many health-related questions and research health topics online. Perhaps surprisingly, they often utilize patient portals to communicate with their providers.

Baby Boomers are more loyal to their healthcare provider than younger age groups are. They’re inclined to maintain physician loyalty as long as they receive quality care and coverage. They value practices with strong positive reputations because word-of-mouth recommendations are important to them.

Unlike the younger generations, Boomers are likely to follow health advice and care instructions from a physician they trust.

How to Engage Them

When engaging Boomer patients, balancing traditional and digital media is essential. While many still embrace television and print media (34% read at least one magazine daily), most patients are also active online.

Many seniors still prefer paper communications for billing statements, event invitations, and information about new procedures. Concerning appointment reminders, some Boomers want a person-to-person phone call, while others prefer a text – as long as the message is personalized.

The Silent Generation

Birth Years: 1929 to 1945

Silent Generation patients are the most frequent users of the healthcare system. Like Baby Boomers, they rely on their doctors’ advice. They are the most likely of all to follow doctors’ orders to the letter. They respect medical authority and firmly believe in good service. They seek credible health professionals and won’t trust just any expert.

The Silent Generation holds static views that are not likely to change. They stick to traditional health advice. They’re inclined to be uncomfortable with the technological shift within the health industry.

How to Engage Them

Because these patients depend heavily on their physicians’ opinions, providers must keep all instructions clear and explicit. This may require teaching them how to access the patient portal or enlisting a family member to help.

Engaging this patient demographic also means ensuring they’re properly cared for between office visits. Work to understand their living situations and support systems. Then, help them become more comfortable with healthcare technology while still delivering the quality of personal service they associate with traditional care.

Sources:
Featured Image: Adobe, License Granted
Patient Engagement Hit
Nebraska Health Network
Etactics
Meditab
Mercury Healthcare

Health Anxiety in an Anxious World

Wed, 10 May 2023 19:45:00 GMT

Health Anxiety in an Anxious World

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Anxiety Disorder Worsened by
COVID, Computers

Doris spends every free moment googling various diseases and their symptoms. She devotes hours to online searches, even staying up all night, terrified about what she might discover.

Evan focuses intently on every bodily sensation, continually scanning for signs of illness. His anxiety keeps him from leaving the house.

Trudy has just received a clean bill of health from her doctor. While attempting to fall asleep that night, her mind drifted back to something he said: “Tumors can form at any time.” Ridden with anxiety, she climbs out of bed and begins researching brain cancer. Within an hour, she’s convinced she has it.

None of these patients have ever been diagnosed with a serious illness, yet their suffering is very real. Their common disorder is health anxiety, the preferred term for what used to be called “hypochondria.” They obsessively and irrationally worry about having a serious medical condition. In a sense, these patients are being held hostage by their own bodies.

"I Got That”

Health/illness anxiety is relatively common, affecting some 4% to 5% of the population. But experts suspect the disorder is underreported; the actual figure may be closer to 12% — or even twice that amount.

The condition can be debilitating, leaving its victims unable to function or enjoy life. They obsess over normal bodily functions such as breathing and heartbeat, skin blemishes and other physical irregularities, and any bodily discomfort. They misinterpret normal or benign symptoms as something far more severe.

Or they may display no symptoms at all – until they hear about a specific disease or affliction. These patients may repeatedly pursue medical exams and procedures for reassurance. But they're less likely to seek mental health treatment because they're convinced their symptoms are physically based.

What Is Cyberchondria?

The term “cyberchondria” was coined in the mid-1990s by the British press. It refers to a clinical phenomenon of compulsive online health searches that worsen anxiety or distress.

Cyberchondria is strongly correlated with symptoms of health anxiety, although whether this disorder poses a unique public burden remains unclear. According to researchers at Imperial College London, the condition is leading to a health anxiety epidemic in the United Kingdom.

Source: Comprehensive Psychiatry

A doctor's reassurance provides only temporary relief, then new thoughts and physical sensations emerge, and the cycle repeats itself. It's like having a car alarm go off whenever a pedestrian walks by.

Health anxiety occurs on a spectrum; general anxiety can quickly develop into a full-blown psychosomatic illness. When patients are preoccupied with bodily sensations, those sensations intensify and last longer.

As they imagine the worst, their bodies’ internal alarms create anxiety symptoms: racing heart, difficulty breathing, jitters, lightheadedness, nausea, sweating, headaches. These symptoms then fuel their imaginations, worsening the situation. The thoughts may be false, but the symptoms are real.

Along Comes COVID

For patients already susceptible to illness anxiety, the COVID pandemic threw gasoline on the fire.

Compared to past disease outbreaks, health researchers noted some unique features that made the pandemic particularly troubling for these anxiety sufferers:

The highly transmissible and fatal nature of the virus.

The protocols for self-monitoring, hand and surface sanitization, and social disruption.

The fact that some COVID symptoms, such as shortness of breath, mimic anxiety.

The isolation factor compounded the problem, as homebound sufferers were stripped of their usual coping strategies. In addition, the inescapable news coverage and limitless reports exacerbated pandemic anxiety, as individuals sought out more and more online information.

As the global emergency diminishes, many health officials have declared a shift from pandemic to endemic . But for health anxiety sufferers, it really doesn’t matter.

Physician Guidelines

George Washington University clinical psychologist Dr. Lynne S. Gots offers the following tips for primary care physicians when treating patients with health anxiety:

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Use patient-centered interviewing techniques by asking open-ended questions. Allowing the patient an extra two to three minutes to express his concerns will help build trust with a demographic that is often very mistrustful of doctors.

Schedule longer visits with a health anxiety sufferer. This additional office time will result in fewer calls and emails between appointments.

Schedule follow-up appointments on an agreed-upon timetable. A patient with health anxiety might initially need to visit your office once every four or six weeks to address their concerns. Eventually, as the patient becomes better able to tolerate waiting, the frequency of office visits can decrease.

Order diagnostic procedures and specialist referrals only when clinically indicated. Health anxiety can consume medical resources unnecessarily, even leading to complications from invasive procedures. If the patient’s doubts about a condition persist, ask him to return for a follow-up in one month.

Clearly explain why you think a symptom does not warrant concern. When a patient suffering from health anxiety googles “headache,” he fixates on “brain tumor,” not “eyestrain” as a potential cause.

Speak with the patient in person when discussing test results or medication. It’s better not to rely on other staff or an online patient portal to communicate this information to someone with health anxiety.

Always take the patient’s concerns seriously. Serious illnesses do occur in patients with health anxiety.

Once you've ruled out physical illness, it's time to employ some Cognitive Behavioral Therapy (CBT). CBT has proven to be the most effective treatment for health-related anxiety.

The following video clip demonstrates simple CBT strategies for managing a patient with high health anxiety levels:

The Center for Integrated Healthcare offers additional tips for referring anxiety patients to mental and behavioral health professionals.

Sources:
Featured Image: Adobe, License Granted
Anxiety & Depression Association of America
WebMD Health News
ABC Radio National
Harvard Medical School
KevinMD.com

The New Opioid Crisis: Counterfeit Pills

Wed, 05 Apr 2023 13:30:00 GMT

The New Opioid Crisis: Counterfeit Pills

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“Fentapills” Fueling Surge in
Overdose Deaths

In July 2021, 17-year-old Sebastian Kidd was preparing for soccer season and his senior year at Carlisle High School In Des Moines.

Having sustained past injuries, including several concussions and a broken collar bone, Sebastian was self-medicating with oxycodone. He took half a pill on July 29th to help him sleep.

He never woke up.

Unbeknownst to Sebastian, the pill was a counterfeit, laced with a lethal dose of fentanyl.

Unfortunately, this tragic story -- every parent’s worst nightmare – is repeated daily across Iowa. Statewide drug overdose deaths climbed more than 25 percent between 2019 and 2021, according to the Iowa Department of Public Health (IDPH). Opioid use alone claimed the lives of 258 Iowans in 2021 and just slightly fewer (238) in 2022.

Fueled by Fentanyl

According to Gabbie Ruggiero, opioid response coordinator for the non-profit Employee and Family Resources, this tragedy is fueled by the proliferation of fentanyl. “In 2021, for the first time, fentanyl in opioids were [sic] causing more deaths than meth[amphetamine],” Ruggiero said. Like Sebastian Kidd, young Iowans are purchasing “fentapills” -- drugs disguised as Xanax or Percocet that are, in fact, illicitly manufactured fentanyl pressed into pill form.

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IDPH estimates that the number of fentanyl-related deaths jumped from 31 percent of all drug overdoses in 2016 to 87 percent of these deaths in 2021. This statewide increase corresponded with a national crisis in fentanyl overdose.

“We’re dealing with a different disease now than we were in 2018. In 2018, it was diversion of legitimate prescriptions. Now, it’s fentanyl poisoning or fentanyl murder.” - Rep. Michael Burgess, M.D. (R-TX)

In September 2021, the Drug Enforcement Administration (DEA) warned Americans about a nationwide surge in fentanyl-laced counterfeit pills, mass-produced by criminal drug networks, killing unsuspecting victims. In May 2022, the CDC reported 71,238 fentanyl-related deaths in 2021.

Saved by Naloxone

The synthetic drug naloxone (often known by the brand name Narcan ^® ) blocks opiate receptors in the nervous system and temporarily reverses the effects of an opioid overdose.

Naloxone typically restores the victim’s normal breathing within two to three minutes. A Penn State University study has shown that naloxone administration saves the lives of more than 75 percent of opioid overdose victims.

Since 2016 Iowa pharmacists have been allowed to dispense naloxone without a prescription. This life-saving medication can be administered by anyone and is available as a nasal spray or injection. Access to free naloxone is available through Naloxone Iowa .

Governor’s Response to Fentanyl Crisis

Iowa Gov. Kim Reynolds has proposed the following changes to combat the state’s fentanyl crisis:

Increasing penalties for the manufacture or delivery of fentanyl, including more serious charges, longer sentences, and higher fines against individuals with smaller amounts of the drug.

Doubling or tripling sentences for fentanyl crimes involving minors or resulting in death or serious injury.

Expanding distribution of naloxone (to reverse opioid overdose) to include all law enforcement agencies, EMS programs, fire departments, school districts, licensed healthcare providers, county health departments and the IDPH.

Source: Office of the Governor of Iowa

What Healthcare Providers Can Do

As a healthcare provider, you may wonder what you can do to protect your patients from this newest opioid crisis. Here are a few suggestions:

Talk to your patients about the changing illicit drug supply and risks associated with fentanyl-laced counterfeit pills.

Prescribe naloxone to patients with opioid use disorder (OUD) and individuals who use illicit drugs.

Co-prescribe naloxone to patients receiving opioids and benzodiazepines.

Consider shifting to a value-based care payment model. This can improve access to care for patients suffering from OUD, reducing the risk that these patients will seek illegitimate sources of medication.

Share the following video with your families, staff and school districts:

Sources:
Featured Image: Adobe, License Granted

NBC News
CDC Health Advisory
Iowa Dept of Public Health
El Paso Times

Is “Iowa Nice” Real?

Wed, 15 Mar 2023 14:00:01 GMT

Is “Iowa Nice” Real?

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Why Iowans Are Some of
the Nicest People

From an early age, Iowans are taught to be nice and to mind their manners -- not to mention their moms, scoutmasters, and 4-H leaders.

People from other states have noticed how nice Iowans are. Sometimes, they’re baffled by it. Truckers have said that Iowa drivers are much more likely to slow down and make room for them.

We Think We’re Nice, Too

Not only do folks from other states think we’re remarkably nice, but we think so, too. According to a 2021 Des Moines Register poll , 58% of Iowans think the residents of our state are nicer than people from other states. Another sizable group (36%) sees no difference between Iowans and other folks, but only 4% think Iowans are rude.

Poll respondents who consider Iowans especially nice represent every demographic of age, race, income level, and political affiliation. Most urban, suburban, small-town, and rural communities stated that Iowa has more than its share of nice people.

But why?

Country Charm

One explanation for Iowan’s niceness could be the state’s high percentage of rural residents compared to other states, since country folks are generally regarded as the most neighborly.

A recent Pew Research Center poll found that rural residents are more likely to know all or most of their neighbo rs. What’s more, they’re also more likely to trust their neighbors (such as by providing neighbors with a set of keys to their home).

More than Affordable

Forbes recently included Iowa among its Cheapest States to Live in for 2023 . That could help account for Iowans’ niceness.

The study considered each state's cost-of-living index, average salaries, and housing availability.

The Forbes researchers found Iowa housing costs 24% below the national average. And unlike most other states that made the list, Iowa was singled out as relatively prosperous, with a strong economy and a poverty rate lower than the national average.

Low-Pressure Zone

Not only is Iowa listed among the top states for affordability, low crime and quality of life, but our urban areas are more relaxed than those in other states. In 2016, Iowa City was named the "Least-Stressed City in America." Both Des Moines and Cedar Rapids were also recently listed among the country’s most stress-free cities.

A 2022 WalletHub study rated Iowa among the top 20 Happiest States In America . Perhaps a low-stress environme nt contributes to Iowans’ overall happiness, which in turn makes them nicer? There’s data to back up this idea.

Who Is the
Average Iowan?

According to government statistics, the “average” Iowa resident is a 38-year-old Caucasian female.

She is married with one child, and her annual household income is $65,429. She graduated from high school and probably attended college but did not complete her degree.

She and her family reside in their own home, valued at $193,341. She works in education or healthcare, and her daily commute is about 20 minutes.

Source: U.S. Census

If You’re Happy and You Know It…

Researchers in Great Britain have identified a type of “positive feedback loop” between kindness and happiness. Study participants who engaged in a single kind deed were found to be happier than those who did not.

They were also more likely to perform another act of kindness. In other words, kindness makes us happy, and happiness makes us kind.

At CBSI, We’re Iowa Nice

As “The Collection Agency That Cares,” we at CBSI pride ourselves on being Iowa nice. It’s the embodiment of who we are.

Our fair, compassionate approach to debt collection works -- our recovery rate is double the industry average. We treat our clients and their consumers as we want to be treated: with kindness, respect and empathy.

When you retain CBSI as your collection partner, you’ll receive a higher rate of return on overdue debts, your good name will remain intact, and your customers will be happier for having resolved their financial obligations.

What could be nicer than that?

Sources:

Featured Image: Adobe, License Granted

Des Moines Register

Pew Research Center

Scholaroo

Journal of Social Psychology

WalletHub

The Fat of the Land: Iowa Obesity a Growing Concern

Wed, 08 Feb 2023 19:00:00 GMT

The Fat of the Land: Iowa Obesity a Growing Concern

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Primary Care Doctors Are Key to
Effective Treatment

More than one-third of Iowa’s adult population is obese – 36.4 percent, to be exact, according to the latest CDC * figures. We’re now the 11th most obese state in the country.

An additional 34.3 percent of Iowans are overweight but not obese. In other words, only 29.1 percent of our state’s adult residents are within a normal weight range.

Nationwide, obesity climbed sharply during the last decade, but the highest increases occurred in only a handful of states -- including Iowa, where the rate jumped more than eight percentage points.

* The CDC collects obesity data from two different sources. State obesity figures (reported here) are based on self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS). National obesity figures use National Health and Nutrition Examination Survey (NHANES) data based on measurements taken during physical examinations. As a result, the national figures are higher and considered more accurate.

Why Here?

Obesity is a complex disease, encompassing biological, psychological and environmental factors. Even so, research indicates that too many calories and too little physical activity are most often the primary culprits. Americans as a whole consumed 20 percent more calories in 2020 than they did in 1983.

Here are some of the other factors that likely contribute to Iowa’s particularly high rating:

Rural Population

Our state’s population is still about 36 percent rural – more than double the national average. Rural areas experience higher obesity rates than the nation as a whole. These less populated communities often lack facilities and infrastructure to encourage physical activity, as well as access to affordable, healthful food. (See "Food Insecurity" below.)

And healthcare facilities located in rural areas are less likely to employ nutritionists and other weight management experts.

Food Insecurity

Almost half of the Iowans who experience food insecurity are obese. While that may appear contradictory on the surface, these residents are typically "overfed but undernourished," according to Dr. Nicole Gilg Gachiani, former chief physician at Broadlawns Medical Center in Des Moines.

Obesity Figures
at a Glance

Here's how the latest Iowa obesity statistics compare with extrapolated national data:

Many of them rely on food banks and pantries where much of the donated food is high in carbohydrates and fats but low in protein and other vital nutrients.

Prevalence of Fast Food

Iowa is among the top 10 states in the country with the most fast-food restaurants per capita (4.7 per 10,000 residents). Busy executives, college students, and hectic families often rely on fast food because of its convenience. Journalist and food researcher Michael Pollen estimates that 20 percent of American meals are eaten in cars.

But this convenience comes with a price tag. The World Health Organization has identified a definite correlation between increased fast-food sales and higher body mass index (BMI) within a community.

Social Contagion

Then there's the social contagion factor. Research confirms that counties with a high obesity rate tend to perpetuate obesity via “social contagion.”

A 2018 USC study illustrated this phenomenon. By examining military families (who relocate frequently).

The researchers found that families assigned to installations in counties with higher obesity rates were about 25 percent more likely to become obese or overweight than those assigned to areas with lower obesity. They concluded that unhealthful eating, sedentary lifestyles, and being overweight are more socially acceptable in communities where obesity is common.

All the above factors combine to create an ideal environment for obesity to flourish. According to Rhea Farberman, policy research director at Trust for America’s Health , Iowa's obesity rate is at "crisis level."

What's Being Done?

Iowa officials have developed several programs over the years in an effort to curb the state’s obesity issue. Here are two of the most current initiatives:

--Article Continues Below--

Iowa Stops Hunger

Public and private organizations joined forces last fall and created the Iowa Stops Hunger Coalition to address food insecurity across the state. Insurers and healthcare providers are coordinating with nutrition partners to provide healthful food, nutrition education, and support in eight counties that Iowa HHS has identified as lacking reliable access to affordable, nutritious food.

Iowa Medicaid administers the coalition’s pilot program, which specifically targets mothers with young children residing in food-insecure areas.

Physician, Heal Thyself

Doctors are not immune from the obesity epidemic. A Johns Hopkins survey found that 51 percent of primary care physicians are obese or overweight.

Additional studies have shown that obese patients are less likely to accept nutrition advice from an overweight physician, and overweight physicians are less likely to offer it.

The Association of American Family Physicians (AAFP) recommends the following for overweight primary care doctors:

Regularly visit your own physician and adopt a healthier lifestyle.

Share your personal weight goals and achievements with your obese patients.

Create an office environment that promotes healthy lifestyles (e.g., include healthful food options in vending machines and initiate lunchtime walking programs).

5-2-1-0 Healthy Choices Count !

Fifteen Iowa counties recently received $265,000 in government grants through the state’s 5-2-1-0 Healthy Choices Count! program, an obesity prevention initiative launched in 2017 aimed at encouraging healthful habits in school-age children. (The numbers in the program’s name refer to five servings of vegetables per day, a maximum two hours of recreational screen time, one hour of physical activity, and zero sugary drinks.)

Information about how individual communities are utilizing these grants can be found HERE .

How Doctors Can Help

The Harvard T.H. Chan School of Public Health recommends the following best practices for primary care physicians:

Routinely measure BMI in all adult patients.

Order appropriate lab tests for patients who are overweight or obese.

Prescribe a long-term treatment strategy, including:

Diet and lifestyle counseling
Weight loss medication, when appropriate
Bariatric surgery for severely obese individuals, when appropriate.

Healthcare providers in rural areas can also help develop obesity prevention programs within their communities.

The Rural Obesity Prevention Toolkit provides resources to help identify regional factors that promote obesity, convene partners to address those issues, and apply proven obesity prevention strategies.

Speaking With Patients About Obesity

Primary care physicians are not always comfortable addressing their patient's obesity. Weight is a very sensitive subject for many patients, but particularly the obese. However, it's an area that cannot be ignored when caring for an individual's overall health.

The following video clip offers practical advice on how to discuss obesity with patients:

Sources:

Featured Image: Adobe, License Granted

CDC

Trust for America’s Health

USCDornsife
National Institutes of Health

Rural Health Information Hub

This Year, Resolve to Improve Your Practice’s Financial Health

Wed, 18 Jan 2023 20:44:59 GMT

This Year, Resolve to Improve Your Practice’s Financial Health

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Think of All You Could Do
With Recovered Funds

What could your medical practice do with all the money recovered from overdue accounts? Hire more staff? Invest in new technology? Pay your suppliers? Expand your facility?

By retaining a medical collection agency to recover payment on the past-due accounts, you’re taking the first step toward boosting the health of your business. So you can continue to provide exceptional patient care without a hitch.

Healthy Finances

Here are just some of the ways a professional collection agency can enhance a medical center’s finances:

Primary Care Practices
Still Feeling the Pinch

A recent survey from the Larry A. Green Center, in partnership with the Primary Care Collaborative, revealed that the number of primary care practices reporting layoffs, skipped salaries, and temporary closures has remained constant since the onset of the COVID pandemic.

Earlier, a 2020 Medical Group Management (MGMA) survey had reported that medical practices averaged a 55% decrease in revenue and a 60% decrease in patient volume directly related to the pandemic.

Source: Fierce Healthcare

Debt collection is all collection agents do. It’s their livelihood. By using proven collection methods they maximize recovery on your overdue accounts. That’s revenue you can use to ensure continued smooth operation of your practice – or to invest in your future growth.

Freeing up your valuable time and resources allows you and your staff to focus on addressing your patients’ medical needs.

Sometimes partnering with a professional collector is all that’s necessary to prompt consumers for payment. Past-due accounts are quickly resolved, and the valuable patient relationship is preserved.

Medical debt collectors utilize advanced technology and tools your practice or facility most likely does not possess. They can remain in continual communication with delinquent accounts through various channels.

By recovering debt quickly, you’ll significantly reduce the number of bad debt write-offs at the end of the year.

The Risk of Going Solo

On the other hand, attempting to collect these accounts on your own is fraught with potential financial (and legal) pitfalls.

–Article Continues Below–

The Compl iance Minefi eld

The federal and state regulatory environments are ever-changing; compliance can be a minefield for the inexperienced.

A reputable consumer collection agency will know the ins and outs of compliance. They continually review their processes and work to ensure their collectors are highly trained in accordance with all state and federal regulations.

Medical Collections
Are Different

Medical practices face unique payment challenges compared to businesses in other service industries. For example:

Patients often fail to prioritize their medical bills, especially if the bills are unexpected and not in the budget.

The cash flow that healthcare practices depend on comes from both patients and insurance carriers, so providers must plan on multiple payment sources for a single invoice.

The sensitivity of the doctor-patient relationship necessitates that medical debt collectors possess exceptional soft skills, as well as a firm understanding of the medical billing process.

Getting Professional Support

In addition, without professional help, you’re far less likely to recover monies owed to you.

Skilled debt collectors are trained negotiators who can handle your patients with tact and treat them with respect. Reputable collection agents will educate your patients and work with them – not against them -- to resolve the outstanding debt.

What’ve You Got to Gain?

At CBSI , our collectors are experts in handling sensitive financial matters. Many of them have also had an account in collection at one time or another, so they understand it’s not a situation most people choose (particularly where medical bills are concerned).

At the same time, we recognize that you have the right to be paid. A medical practice without a secure cash flow will not remain in business for long.

We at CBSI have recovered almost a quarter of a billion dollars for our clients! It’s what we do all day long. You really have nothing to lose (and a whole lot to gain) by retaining us to collect on your past-due accounts.

Why not make 2023 the year you resolve to improve your practice's financial health?

Sources:
Featured Image: Adobe, License Granted
Forbes
Healthworks Collective
Nolo

Working Remotely Benefits Both Employers and Staff – Even in Healthcare

Wed, 07 Dec 2022 20:37:50 GMT

Working Remotely Benefits Both Employers and Staff – Even in Healthcare

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More Providers Offering Remote/Hybrid
Opportunities for Non-Clinicians

Over the past few years, the boom in telemedicine has proven that the healthcare industry can operate (even thrive) under non-conventional working arrangements.

The pandemic forced medical facilities to transition much of their administrative staff to work from home. According to a 2022 Medical Group Management Association (MGMA) poll, almost 60% of medical group practices shifted their teams to remote or hybrid work in 2021. With today’s continued demand for employment flexibility, healthcare providers are now looking for more ways to implement long-term remote work options, particularly for non-clinicians.

Advantages to Employers

Here are a few reasons more medical employers are relying on remote workers as a long-term staffing solution:

Repurposing Space

As medical providers rely more on remote workers, many will choose to transform their physical office space. Areas formerly dedicated to staff who now work remotely can be repurposed as specialty clinics, outpatient imaging, or examination rooms.

In New York, for example, the state’s largest healthcare provider, Northwell Health, has identified about 500,000 square feet of space that will be converted from support service offices into revenue-generating clinical space, helping them achieve their financial goals.

Improved Performance and Productivity

S tudies indicate that remote employees work the equivalent of one more day per week and are 47% more productive than their in-office counterparts.

Working from home empowers employees to function in a way that suits them on their own time. With fewer distractions from other staff members, productivity and performance improve. Remote work also enhances work/life balance, alleviates burnout, and improves overall morale.

Larger Recruiting Pool

By shifting to remote work, healthcare employers can recruit nationally. Qualified candidates need only have reliable internet connectivity, allowing providers to hire the best talent regardless of location.

In addition, staff retention improves because employees who work remotely are more likely to stay with the companies that let them do so. Owl Labs and Global Workplace Analytics recently surveyed more than 1,200 full-time U.S. workers. They found that remote workers are 13% more likely than onsite staff to stay in their current job for the next five years.

Likewise, a 2022 Zapier report revealed that 32% of knowledge workers have already quit a job because they were not allowed to work remotely, and 61% would leave their current position to accept a fully remote opportunity. (See infographic below.)

Reduced Overhead Expenses

Providers who rely on remote workers pay less in overhead expenses, such as utilities, cleaning services, taxes, and office space. (See sidebar, “Repurposing Space.”) According to Dave Rietsema, founder and CEO of HR software firm Matchr, “Companies can save up to $11,000 per employee in terms of overhead costs if they switch to remote work.”

--Article Continues Below--

Making It Work for You

Healthcare organizations that have successfully transitioned to a more remote or hybrid work model offer the following suggestions:

Identify Suitable Positions

Non-clinical positions abound in the healthcare industry and many of these jobs can be performed remotely with relative ease. These include:

Medical Employers Who’ve
Plunged into the

Remote Worker Pool

Here are just a few of the larger healthcare providers who have successfully transitioned to remote and/or hybrid work for all or most of their non-clinical staff:

Cleveland Clinic (many national and international locations) Transitioned almost 8,000 non-clinical staff to remote or hybrid work.

Northwell Health (78 locations in New York) Implemented a 100% hybrid work environment across all non-clinical departments.

ID Care (10 locations in New Jersey) Transitioned 60 non-clinical staff to remote or hybrid work.

Patient intake coordination
Utilization and claims management
Medical records management
Community relations
Marketing
Call center work
Medical billing and coding
Information technology
Accounting and finance
Human resources

For example, the Los Angeles-based AltaMed network successfully transitioned more than 1,000 call center, medical management, IT, and human resources staff to a remote-work model.

Maintain Security and Privacy

Because healthcare entails using confidential personal data, employers must maintain appropriate security.

Fortunately, security systems have evolved from strictly on-premises technology to cloud-based solutions. As a result, IT departments no longer need to fully control all devices. Healthcare organizations can use cloud-based security applications without assuming control of a user’s device. These tools can manage multiple systems regardless of where they originate.

Other security options include virtual private networks (VPNs) and encryption with multifactorial authentication. Providers should also reassess each process involving confidential information within the context of a remote-work paradigm.

Reinforce Employee Engagement

Developing and sustaining camaraderie with colleagues can be a challenge when working remotely. So healthcare providers seeking to embrace the remote-work model must be culturally driven, with an emphasis on communication and connectivity.

Some practices have integrated employee engagement exercises into their routines, such as monthly in-person team meetings, virtual happy hour, and informal get-togethers. The idea is to create a level of engagement that helps build trust between individuals.

Going Forward

American businesses—including care providers—will likely never return to an all-onsite workforce. It’s more probable that workers everywhere will expect increased remote-work flexibility. Prudent healthcare organizations must thoughtfully implement long-term work-from-home solutions if they are to remain competitive.

Sources:
Featured Image: Adobe, License Granted
Forbes
MGMA
HealthTech Magazine
Fortune
Northwell Health

4 Mistakes That Can Inflate Your Company’s A/R

Wed, 02 Nov 2022 16:37:18 GMT

4 Mistakes That Can Inflate Your Company’s A/R

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How to Avoid Errors and
Unnecessary Write-Offs

High accounts receivable mean one thing: Consumers, patients, or insurance companies are not paying in a timely manner.

Did you know that bills outstanding for more than 90 days are worth less than half their original value? High A/R is a key indicator that you need to improve your company’s overall revenue cycle.

Here are four of the most common red flags that suggest your A/R is too high:

Poor Communication

Effective communication channels are an essential part of getting paid on time. Haphazard communications result in erratic customer payments. Keeping a customer communications log can help maintain a healthy information flow.

Routinely review your records for accuracy, and ask for updated information with each customer contact. Bills mailed (or emailed) to the wrong address only contribute to late payments.

The Precertification Predicament

It’s estimated that up to 80% of denied medical claims are due to failure to obtain proper precertification.

Once the claim is denied, the provider must try to obtain authorization retroactively. This can result in a long process of more denials, appeals, and reviews.

Medical practices without the time and resources to devote to precertification should consider outsourcing this task to a company that specializes in healthcare revenue cycle management.

Source: PracticeSuite

Send statements and invoices immediately after services are rendered or goods are received by the consumer. Then follow up with regular reminders.

Use A/R automation software and electronic invoicing to establish a recurring billing schedule and stay on top of customer communications. According to the Federal Reserve , 92 percent of electronic invoices are paid on time, compared to 45 percent of paper invoices.

Billing Errors

S taff members who don’t understand revenue cycle management are likely to make billing errors. This is especially true for medical practices, where employees can forget to verify or preauthorize insurance. (See sidebar, “The Precertification Predicament.”)

A well-trained A/R staff is your strongest line of defense for preventing billing and coding errors. This requires a two-pronged approach: 1) hiring only the most qualified workers and then 2) providing them with ongoing training.

If your company or medical practice has neither the time nor the resources to hire and train qualified A/R staff, you’ll want to consider outsourcing your revenue cycle mana gement.

Unnecessary Write-Offs

Regularly review write-offs to identify any errors. For instance, you can enable staff to closely monitor contractual write-offs by providing easy access to the company fee schedule. (Medical office staff should also check the reimbursement schedule from each primary claim payer.)

Many non-contractual write-offs are avoidable (e.g., missing a deadline or administrative errors). A monthly review of both contractual and non-contractual write-offs can help significantly improve your company’s revenue cycle.

When bills are deemed uncollectible, they become bad debt write-offs. The IRS requires that all collection efforts be exhausted before the debt may be written off. This brings us to the fourth mistake that can inflate a company’s A/R…

Low Collection Rate

A low collection rate is usually the result of two factors: 1) inadequate collection procedures and 2) a general failure to prioritize collection efforts.

Internet Usage in Rural America

Rural America has made significant gains in adopting digital technology over the last decade.

A 2021 survey by Pew Research Center revealed that 72 percent of rural residents have a broadband internet connection at home. That’s a 9 percent increase since 2016.

Source: Pew Research Center

Here are a few ways to address a low collection rate :

Encourage payments at time of service.

Offer multiple payment options and keep consumer credit card information on file.

Update billing information during every contact.

Offer incentives, such as a 10% discount, for early payment (e.g., paying within ten days when usual payment terms run up to 30 days).

Thoroughly explain financial responsibility to patients or other consumers, and offer to negotiate a payment plan.
Analyze monthly financial reports to identify problems.

Train staff members on proper collection procedures.

Finally, if your company’s internal collection rate is consistently subpar, or you don’t have the trained staff required to effective collect on overdue accounts, it’s time to retain a collection agency for help.

CBSI is ready when you are.

Sources:
Featured Image: Adobe, License Granted
Pay stan d
RevCycle Intelligence
American Medical Associa tion

Getting Paid on Workers' Comp Claims

Tue, 18 Oct 2022 12:37:15 GMT

Getting Paid on Workers' Comp Claims

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Workers’ Compensation Can Be a
Big Headache for Healthcare Providers

Collecting on workers’ comp claims is an exasperating exercise for healthcare providers. While these claims represent only a small percentage of a practice’s total A/R, they can present some of the biggest headaches.

What with different terminology, numerous logistical hoops, and specialized collection forms, it’s easy for providers to become discouraged when attempting to collect on these claims.

Workers’ compensation is a government-regulated program designed to reimburse lost wages and medical costs for work-related injury or illness. Although it may resemble standard health and disability insurance programs, it's quite different when collecting on claims.

Iowa’s Work-Related
Injuries

According to the Bureau of Labor Statistics, more workplace injuries and illnesses are reported in Iowa each year than the national average. In 2020, Iowa-based private industry employers reported 34,000 nonfatal workplace injuries and illnesses, resulting in an incidence rate of 3.3 cases per 100 FTE workers.

Iowa was among 20 states that had an incidence rate significantly greater than the national rate of 2.7 cases per 100 FTEs. The state’s higher-than-average incidence rate has remained consistent over the past several years.

Iowa industries with the most work-related injuries and illnesses were manufacturing and health services.

www.bls.gov/regions/midwest/news-release/workplaceinjuriesandillnesses_iowa.htm

https://www.bls.gov/regions/midwest/news-release/workplaceinjuriesandillnesses_iowa.h

Source: Bureau of Labor Statistics

Rules Upon Rules

Standard commercial health insurance basically uses the same rules, processes, and procedures for each claim. Workers' comp, on the other hand, varies by state: fifty states, 50 different ways of handling claims.

The result is a myriad of fee schedules, rules, reports and treatment plans that providers must understand in order to follow the rules precisely. Failure to do so will likely result in a rejected claim.

Not Your Typical
Insurance Claim

Worker's compensation is highly specialized. Insurance companies that offer it do not sell standard plans, and traditional insurance carriers don't provide worker's comp. Healthcare providers who submit worker’s comp claims to the wrong payer or administrator risk violating state filing requirements.

These claims also require an understanding of the program’s special terminologies and unique collection forms. For example, in the world of standard health insurance, the patient is typically the policyholder. Not so in the workers’ comp world, where the patient’s employer is the policyholder.

In the workers’ comp world, the explanation of benefits (EOB) becomes an explanation of review (EOR). Claims are identified by claim or case file number instead of healthcare ID. There’s no deductible or copay linked to the worker’s comp claims.

More importantly, providers must accept compensation paid through workers’ comp as payment in full. Billing patients for any outstanding balance is illegal.

Before filing a claim under workers’ comp, the healthcare provider must obtain a First Report of Injury Form from the patient’s employer. The provider must complete the medical section of this form when the patient first seeks treatment for the work-related injury or illness. Failure to obtain this pre-authorization can adversely impact the reimbursement process.

--Article Continues Below—

Follow-Up Is Critical

Once all the necessary forms and authorizations have been properly prepared and submitted per state requirements, you’ll want to follow up regularly to ensure the timely processing of reimbursement.

After reimbursement, the provider must then check the accuracy of each payment, to ensure the payer is using the correct fee schedule. Any over-payment or under-payment means the provider must promptly file an appeal.

Standard Insurance
vs. Workers’ Comp

Should You Consider Outsourcing?

It’s easy to see how providers may indeed struggle to get paid for workers’ compensation claims. With so many rules and procedures that must be followed to the letter, practitioners could end up losing money in the long run.

But not every aggravating job must be handled internally. There are plenty of healthcare RCM companies that specialize in workers’ compensation claims. Outsourcing may be your best bet if you're devoting too many resources in attempting to collect on these claims. It could minimize problems for your staff while also freeing them up for more meaningful work.

The following healthcare RCM companies specialize in managing workers’ comp claims:

Sources:
Featured Image: Adobe, License Granted
Continuum
Becker's Hospital Review
Thomas, Coon, Newton & Frost

How’s Your Bedside Manner?

Wed, 07 Sep 2022 16:15:00 GMT

How's Your Bedside Manner?

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Tips for Improving the
Doctor-Patient Relationship

The relationship between doctors and their patients can profoundly impact medical outcomes positively or negatively.

Here are three key factors that can influence this relationship.

#1. Open Communication

Research studies prove that a physician’s ability to communicate information is every bit as important as the information itself. No wonder 65% of medical schools teach communications skills, and this training is regarded as a core competency in accreditation settings.

The Four Models

In 1992, two physicians, Ezekiel and Linda Emanuel, proposed four models for the doctor-patient relationship:

1. Paternalistic – The doctor acts as the patient’s guardian, promoting the patient’s wellbeing, independent of the patient’s current preferences.

2. Informative – The doctor acts as a competent technical expert, supplying relevant factual information, and implementing the patient’s chosen medical intervention.

3. Interpretive – The doctor acts as a counselor or advisor, interpreting and elucidating relevant patient values, advising the patient and implementing the patient’s selected intervention.

4. Deliberative – The doctor acts as a friend or teacher, helping the patient to determine and choose the best health-relative values that can be realized in the clinical situation.

Source: Journal of the American Medical Associatio n

Effective verbal and nonverbal communication can positively impact a patient’s symptoms, pain control, emotional health, and blood pressure levels. Likewise, miscommunication and a poor bedside manner can have severe negative implications.

Medical practitioners can facilitate open communication with their patients by remembering these guidelines:

Take the time to sit down and establish eye contact with your patient.

Listen without interrupting, so you can determine what your patient already knows.

During examinations, explain what you’re doing and reassure your patient.

Speak slowly and deliberately.

Keep your explanations clear and straightforward.

Empathize with your patient by acknowledging and validating his feelings.

Allow your patient time to formulate his thoughts.

Note your patient’s facial expressions and body language.

2. Shared Decision-Making

Doctors and their patients must collaborate on their medical decisions. The decision-making process should be shared with patients right from the onset. That way, all decisions will reflect the patient’s beliefs and values, not just the doctor’s medical expertise.

Even relatively small decisions should involve shared decision-making. For instance, "I can prescribe a medication to help with your symptoms, but I suspect they may go away on their own if you wait a while. Which would you prefer?"

Collaborative decision-making results in increased patient satisfaction and loyalty. Patients feel empowered in this process, enabling their doctors to provide more personalized care.

3. Doctor-Patient Trust

Trust is fundamental to any physician-patient relationship. To achieve the best medical outcome, patients must believe their doctors are working in their best interests.

A 2017 study found that a patient’s trust in his practitioner is even more critical than his satisfaction with a given medical treatment. Patients who trust their doctors feel better overall, have fewer medical complaints, and enjoy a higher quality of life.

You may be surprised that almost half of all patients fail to follow a doctor's recommended treatment. Why? Because they’re filtering these instructions through the competing demands on their time and energy, as well as their existing belief systems.

They then decide if the recommended treatment is desirable (or possible), given the demands of their everyday lives.

The patients who are more likely to follow the doctor’s recommendations and instructions are the ones who trust their physicians. These patients are also more satisfied with overall quality of care and more likely to continue with that particular care provider.

Doctor-patient trust hinges on several factors. Here are three of the most important:

The physician’s willingness to listen,

The patient's belief that the doctor appreciates his ability to make informed decisions, and

The patient’s comfort level when engaging in health-related dialogue.

--Article Continues Below--

Besides actively listening and maintaining eye contact, doctors can also build trust through light touch, when appropriate. (To avoid any misinterpretation, it's usually best to do this when someone else is in the room.) A hand on the shoulder demonstrates an understanding of the patient's stress or pain.

Impact on the Future of Healthcare

Healthcare continues to become more personalized and patient-centered. In the future, the doctor-patient relationship will increasingly shape medical outcomes. Doctors can break down potential barriers to this more customized approach by understanding the factors influencing the relationship with their patients.

A physician’s bedside manner can make or break a treatment plan. How’s yours?

Sources:
Featured Image: Adobe, License Granted
Duke Personalized Health
Journal of the American Osteopathic Association
University of Washington Medicine
American Association for Physician Leadershi p

Inflation: Bad for Patients & Not So Good for Providers, Either

Wed, 10 Aug 2022 12:38:00 GMT

Inflation: Bad for Patients, and Not So Good for Providers, Either

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The Effect of High Inflation on
Your Ability to Collect

With the U.S. inflation rate now higher than it’s been in 40 years, healthcare providers are wondering what the impact will be on their revenue cycle if patients are unable to pay their medical bills.

A combination of the global supply chain crisis, unexpected demands for certain goods (think, toilet paper), and the increased amount of currency in circulation have created a “perfect storm” for rampant inflation.

But regardless of its causes, what effect can you expect inflation to have on the cash flow of your medical practice?

Problem for Providers

Here are a few reasons high inflation is troublesome for medical practitioners:

Is All Inflation Bad?

Many people believe that all inflation harms everyone financially, but this is a misconception.

In fact, a small and predictable rate of inflation is generally considered not only acceptable but good. That’s because it offers a hedge against something far worse: deflation.

If the inflation rate hovers too close to zero, the risk of deflation (negative inflation) is increased. And that’s when a deflationary spiral can turn hard times into an economic recession or depression.

Inflation will increase operating costs, especially labor. The current staffing shortages have already resulted in higher staff salaries, overtime pay and temporary worker costs. High inflation will exacerbate these challenges.

More patients will delay elective care or default on their medical debts, as they struggle with the higher cost of basic necessities.

The money received from patients who have arranged payment plans -- particularly, longer-term plans -- has decreasing value over time. (In other words, cash now is worth more than cash later).

Impact to Patients

While high inflation rates can have some positive effects on some consumers, most of the repercussions to your patients will be negative.

For instance, as inflation increases, so does the interest rate. This means that consumers who are paying car loans and mortgages at a fixed rate of interest will benefit, since the money they’re paying back is worth less than the money they borrowed. But this benefit will probably be nominal unless they also receive an inflationary wage increase.

In addition, patients who owe on variable-interest loans -- such as those with significant credit card debt -- will end up paying out more because of the higher interest rate.

Also, your patients must spend more on their basic necessities, leaving less money to apply toward their medical bills. Purchasing power decreases whenever prices increase but wages don’t. With less money available to pay their financial obligations, patients are more likely to default on loans of all types, including their medical debt.

How Should You Respond?

If you’re concerned about the impact of inflation on your health center’s bottom line, here are a few suggestions:

Payroll Expenses

You can keep a lid on labor expenses and address staff shortages by automating more processes. Online self-scheduling and registration allows patients to handle these administrative tasks themselves, reducing the need for valuable staff time. The latest tools pre-fill patient information, limiting the risk for errors.

Countries with Highest
Inflation Rates

Venezuela — 284.4%
Sudan — 260.2%
Lebanon — 208.1%
Syria — 139.0%
Zimbabwe — 96.4%
Suriname — 61.5%
Turkey — 61.1%
Argentina — 55.1%
Iran — 34.7%
Ethiopia — 34.7%

Source: Trading Economics

Billing

Help your patients to better understand their medical bills and payment options. ( See “ Improve Collectability with Patient-Friendly Billing® . ”) And keep your invoicing timely to help minimize revenue cycle issues.

Payment Options

Provide upfront estimates, with links to appropriate payment plans and methods.

This would not only keep recovery cash flowing, it could also motivate patients to proceed with elective care they might otherwise have deferred.

Make sure your payment plans are flexible and accommodating. Offer multiple payment tools, such as an online portal, to simplify ease of payment. You may also consider:

A prompt-payment discount for paying within a certain time frame;

Extending the payment term;

Allowing patients to pre-pay in installments prior to a large, planned medical expense (such as childbirth); and

Offering some basic services at a flat rate for self-pay patients.

Rely on Us

Surging inflation increases the risk your patients will default on their medical bills. In times like these, it’s important to partner with a collection service that knows the ins and outs of medical collection like no other. That's CBSI.

And our compassionate approach to collection results in a recovery rate that far outpaces the industry. When it comes to debt collection, we’re here to do the heavy lifting – so you can focus on more important matters.

Sources:
Featured Image: Adobe, License Granted

Experian

Healthcare Financial Management Association
Khan Academy
Christian Science Monitor

Patient Friendly Billing ® is a proprietary trademark of the Healthcare Financial Management Association (HFMA).

Medical Claim Denials Continue to Climb

Wed, 06 Jul 2022 18:00:00 GMT

Medical Claim Denials Continue to Clim b

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How to Prevent Denied Claim s

Medical claim denials increased by 17% in 2021.

According to the most recent Medical Group Management Association (MGMA) poll, nearly 70% of healthcare leaders cite the rise in denials, indicating that the pandemic has caused more rejections. In 2020 a Healthcare Revenue Cycle Denials Index revealed that claim denials had climbed by 23% over the previous four years. That analysis examined more than 102 million claims submitted by 1,500 U.S. hospitals.

The highest denial rates were concentrated in two regions that were hardest hit by the pandemic – the Northeast and the Pacific coast.

Pre-Pandemic Problem

Although the pandemic has aggravated the problem, the increase in medical claim denials began before the COVID outbreak, according to 2019 data. An American Hospital Association (AHA) 2020 report confirmed that 89% of hospital administrators had witnessed an increase in denied claims over the last three years. About half of those respondents described the increase as “significant.”

According to the AHA, claim denials not only impact revenue performance for care providers, they also affect the quality and accessibility of patient care. ( See box below, "Claims Denials Fueling Burnout.")

Preventable Issues

Eighty-five percent of the denied medical claims are potentially avoidable, the research suggests. Even worse, according to studies by Change Healthcare, 48% of revenue lost from these denials are not recoverable.

Claims Denials
Fuel Burnout

More clinicians are experiencing burnout because private health insurance carriers abuse practices such as prior authorization and medical claim denials, according to a pre-pandemic American Hospital Association (AHA) survey.

The survey asked more than 200 hospitals and healthcare systems, including several hundred executives, about the ways in which claims denial practices and pre-certifications impact their operations.

In addition, since 2020, COVID-related staffing shortages have made these issues "increasingly urgent," an AHA spokesperson said.

Source: Becker's Hospital Review

The largest portion of those claims are denied because of inaccurate or incomplete data, insufficient explanation of benefits, and incorrect or incomplete prior authorizations.

In other words, this revenue loss was preventable.

Why Are Claims Denied?

Insurance carriers usually deny claims for the following reasons:

No Prior Authorization

Failure to obtain prior authorization for treatment is one of the top reasons for claim denial, according to the AHA. Staff members who are responsible for submitting insurance claims must know which insurance carriers require prior authorization for which treatments.

Pre-certification requirements impose a significant burden on medical offices. According to the American Medical Association (AMA), 86% of physicians’ offices rate the burden of prior authorization as “high” or “extremely high.” Offices typically must devote two business days per week just to addressing these requirements.

Inadequate Information

Another common mistake that leads to denied claims is providing inadequate information to the insurance carrier. Omitting the smallest detail (such as demographic information, treatment date, or date of onset) can result in claim denial.

Coding Errors

Referring to an obsolete codebook, or otherwise using incorrect codes occurs often.

The result is a denied claim and lost revenue. Failure to provide proper documentation when coding and submitting claims can cause insurance companies to assume the services were not performed.

Duplicate Billing

Whenever a staff member fails to remove a claim from a patient’s account after it has been resubmitted, duplicate billing is often the result. Duplicates are usually detected and flagged by claims processing systems; if the original claim is identified as a duplicate, the claim could be denied.

So simply preventing duplicates is not enough. Original claims need to be properly coded with the required modifiers and documentation so that the bill is identified as an original.

--Article Continues Below--

Bad Timing

Even when the claim is legitimate and properly coded, it can still be denied if it’s not submitted in a timely manner. (For example, did you know the Affordable Care Act reduced the deadline window for submitting Medicare claims from 15-27 months to 12 months after the date of service?)

Furthermore, different insurance carriers have different deadlines. If you fail to meet these defined deadlines you’ll lose some serious revenue.

No Cover age Verification

Health insurance is continually changing all the time. Which means coverage eligibility must be verified every time medical services are provided. Tedious? You bet. But doing so could save your practice a significant amount of money down the line.

Tackle It from the Front

You can help prevent denied medical claims by addressing front-end issues. Don’t assume that inaccurate or incomplete information will be fixed on the back end. It’s best to nip these potential denials in the bud. Here’s how:

Train office staff to take the time at registration and pre-registration to ensure patient information is accurate and complete.

Keep your charge description master current, to ensure that correct charges are always being used.

Verify that your billing software and claim edits are up to date.

Regularly communicate claim denials received on rejection reports. This will guarantee that corrections are implemented in a timely manner and will help avoid additional claim delays.

Sources:
Featured Image: Adobe, License Granted
RevCycle Intelligence
American Hospital Association
Becker's Hospital Review
Right Patient

MGMA

Why Isn’t My Patient Paying This Bill?

Wed, 08 Jun 2022 19:35:12 GMT

Why Isn’t My Patient Paying This Bill?

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The Many and Varied Reasons for
Non-Payment of Debt

There are multiple reasons why your patients may not be willing or able to pay their medical bills. These reasons typically fall into four categories: Circumstantial, Emotional, Intellectual and Criminal.

Let’s explore each.

Circumstantial

The vast majority of patients with overdue accounts belong in this category. These patients may want to pay their medical bills, but they’ve fallen on hard times. Consumers in all walks of life have been adversely impacted by the COVID-19 pandemic and its economic aftermath.

Empathy goes a long way when trying to connect with these patients. Effective medical collectors will first listen to the their stories and gather as much information as possible. Then – together with the patient – they can devise a payment plan.

Patients Delaying
Healthcare

A 2018 CarePayment survey revealed the various ways consumers are neglecting their healthcare needs due to financial stress. Specifically:

61% of Americans have no money saved to cover their healthcare expenses.

64% have avoided or delayed medical care in the last year due to expected costs.

44% would not receive needed medical care, even if it put their health at risk, if their out-of-pocket expenses would exceed $500.

69% of those surveyed reported that their deductible was at least “somewhat difficult” to afford, with 22% reporting “very difficult” or “impossible.”

It also helps to remind these patients that their current financial situation is temporary.

Emotional

Patients are sometimes ruled by their emotions, blaming their debt on other people. When patients fail to take ownership of their situation, they may either deny the debt or become angry about it.

Debt Denial

Indications of debt denial include:

Underestimating the amount owed.
Refusing to answer collection calls.
Refusing to open bills or stuffing them in a drawer.

Unfortunately, this kind of behavior only leads to more debt with the accruing of interest charges and late fees. Emotional patients rationalize their mistakes as a way to protect their egos. But reality always sets in, sooner or later.

Debt-Anger Syndrome

Rather than panic or deny, these patients get mad.

They’re angry with the healthcare providers who continually send them bills. They’re angry with the postal carrier who delivers those bills. They’re angry with their employers for not paying them more. They’re angry with their spouses, their kids and themselves. They’re basically just mad at life.

Angry patients need to know that, once they have a plan to dig out of their financial hole, they can start feeling better right away.

Intellectual

Intellectual patients are often disorganized. They may possess a higher degree of education, but have little understanding of finances. In the grand scheme of things, their debts may seem trivial to them. Showing them why they owe the debt in the first place is often helpful.

It’s often fairly easy to encourage intellectual patients to the account right away.

--Article Continues Below--

Criminal

There’s no proven method for identifying patients who have no intention of paying their bills. However, the number of accounts and types of debts the patient incurs might provide a hint about his intentions.

For instance, substantial medical debt usually isn’t a red flag. But if the patient also has excessive credit card debt, that could indicate a pattern.

Are You Offering Multiple Payment Options?

The more payment options you offer your patients, the greater your chances of being paid. Here are a few you may wish to consider:

Co-branded, personalized financing services for healthcare providers (such as AccessOne or CarePayment).

Prompt-payment discount (e.g. 10 to 20 percent) for paying within a certain time frame.

Increased payment periods for patients suffering through hard economic times.

Prepayment arrangement for large, planned medical expenses such as childbirth.

Basic services offered at a flat rate to uninsured or other self-pay patients.

An online payment portal that’s easily accessible via mobile device.

Overcoming Objections

There are steps you can take to overcome patient objections to paying their bills. Reputable collectors often can move quickly to resolving an overdue account by putting the consumer at ease.

Professional collectors will:

Validate the patient’s feelings. If the patient is feeling anxious, hopeless, or angry, a reputable collector will listen and express empathy.

Help the patient feel better about the situation. Patients’ financial hardships are almost always temporary. Remind them of that. Help them to recognize that the creditor and collector are not their enemies, but rather their allies – working together to resolve the debt.

Let the patient know what can be done to help. Offering a flexible, zero-percent interest payment plan should be central to possible solutions. In fact, Journal of Health Care Finance has indicated that such payment arrangements not only allow patients to pay their medical bills, but also result in public health benefits and contribute to the financial well-being of care providers.

For example, compared to patients without access to affordable payment plans, patients with zero-interest plans are:

Less likely to avoid medical care because of the cost, and

Better able to pay for necessities like food or heat.

Need Help?

Would you like to offer alternative payment plans to your patients, but don’t know where to start? The medical collection professionals at CBSI can help. Contact us today!

Sources:

Featured Image: Adobe, License Granted

PDC Flow

Journal of Health Care Finance

Debt.org

State of Decay: Dental Care in Rural Iowa

Wed, 11 May 2022 21:27:35 GMT

State of Decay: Dental Care in Rural Iowa

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Access to Dental Care Seriously
Limited for Rural Iowans

Vadim, a 26-year-old California truck driver, was headed to New York when he started feeling pain on the left side of his mouth. He pulled over in Oklahoma to see a dentist, who diagnosed a tooth infection and prescribed antibiotics.

The pain temporarily subsided -- but then increased. After he delivered the load in New York, Vadim felt too weak to drive back alone, so his brother joined him. By the time they reached Utah, he had to be taken to a hospital and placed on oxygen.

The infection spread to his blood and lungs. Doctors administered stronger antibiotics and placed him on dialysis.

Four days later, he was dead.

While deaths from tooth infection are relatively rare these days, many chronic diseases are nevertheless directly attributed to poor dental health – particularly in rural communities. In fact, rural Americans are twice as likely to lose their adult teeth as their urban counterparts. For these residents, tooth decay and periodontal disease are commonplace, despite being largely preventable.

Obstacles to Dental Care

What makes rural America so vulnerable to dental disease? A number of factors come into play, creating a tangled web of disparity. Here are the most prominent reasons:

Acute Provider Shortages

Because dentists often graduate with heavy debt, they tend to establish practices in populated areas where they can attract more paying patients. Rural areas offer too few paying customers for a practice to be profitable.

Furthermore, in high-poverty areas (such as many rural districts), most potential patients are covered only by Medicaid, resulting in low profit-margin payouts for dentists. (See "Fewer Dentists Accepting Medicaid," below.)

With such a severe shortage of dental providers, rural residents must travel farther to obtain oral care. This results in a significant burden on those without adequate transportation.

Fewer Dentists Accepting Medicaid

Iowa’s dental Medicaid rates have not changed in 20 years, reimbursing only 30-40 cents for every dollar of care provided. As a result, fewer Iowa dentists are now accepting Medicaid.

Dental HPSAs in Iowa

A dental HPSA (Health Professional Shortage Area) is an area or population federally designated as having an acute shortage of dental practitioners.

Eighty-six of Iowa’s 99 counties are designated dental care shortage areas. For 77 of them, the dental HPSA includes the entire county.
Twenty-one of these 86 counties are considered high priority (e.g., they have one or less than one full-time dentist, or their dentists are all aged 60 or older).
Only 12 of Iowa’s HPSAs are in “metro” areas (i.e., they have an urban core of 50,000 or more people). The remainder are rural.
Twelve percent of Iowa’s population resides within a dental HPSA.
Four Iowa counties have no dentists, and three counties have no full-time dentists.

Sources:
Rural Health Information Hub
Kaiser Family Foundation
Iowa FIND Project

And while every adult Medicaid member is enrolled in the state’s Dental Wellness Plan, the annual benefit maximum is limited to $1,000 per year (excluding preventative, diagnostic or emergency services).

Higher Poverty Rate

The rate of poverty is higher in non-metro areas. Rural residents living in poverty can afford neither dental care nor dental insurance. Even for those residents who are employed, research indicates that employers in rural areas are less likely to offer dental insurance than those in more populated areas. (See "Fewer Dentists Accepting Medicaid," above.)

Older Population

Rural America comprises a higher percentage of people age 65 and over. Most of these residents are not employed and are less likely to carry dental insurance. Because they are older and sicker than urban dwellers, rural Iowans rely more heavily on Medicaid and Medicare. Traditional Medicare does not include dental benefits and, of course, fewer dentists are now accepting Medicaid.

Strategies for Bridging the Care Gap

The disparity in dental care between metro and rural populations is not new, although it has become more pronounced as the U.S. population ages. Over the years, numerous strategies for addressing the dental care gap have been proposed.

Active Recruitment

Actively recruiting new dentists to fill gaps in underserved communities is crucial in light of the current shortage and imminent retirement of many practicing dentists.

Efforts such as The FIND (Fulfilling Iowa's Need for Dentists) Project do just that. Working with the University of Iowa College of Dentistry and the Iowa Department of Public Health, as well as professional and civic organizations, The FIND Project has helped to repay loans and establish private practices for 56 Iowa dentists over the past 20 years.

The Iowa Area Development Group (IADG) is also actively involved in helping to procure local funding and low-interest loans for the establishment of dental care offices in rural communities.

--Article Continues Below--

Dental Therapists

A dental therapist is a midlevel provider who assists a dentist in much the same way that a nurse practitioner assists a doctor: by performing the common, lower-level procedures, enabling the dentist to focus on more complex cases.

Dental therapists are an emerging healthcare trend that can both increase access for underserved populations and drive down dental costs. They are trained in routine preventive and basic restorative services, and are authorized to practice under the dentist’s “general supervision.”

This means they may travel and treat underserved populations across the state, even if the dentist is not present.

The I-Smile™
Program

The I-Smile™ Program , sponsored by the Iowa Department of Public Health (IDPH) is a statewide initiative to connect Iowans in all 99 counties with dental, medical, and community resources.

The program’s 23 designated coordinators collaborate with local dentists to establish dental homes for underserved Iowa populations and also partner with community leaders in recruiting new dentists.

A 2018 federal study recommended that individual states should “evaluate emerging healthcare occupations, such as dental therapy, and consider ways in which their licensure and scope of practice can increase access and drive down consumer costs while still ensuring safe, effective care.”

As of October 2021, 13 states have authorized the use of dental therapists; Iowa is not one of them. (For a more in-depth examination of how dental therapy can benefit Iowa, see the white paper “ Iowa Needs Dental Therapists .” )

Medicaid Reimbursement Rate Increase

Fewer Iowa dentists are accepting Medicaid because the plan’s reimbursement rates are so abysmal they don’t even cover the costs of basic procedures. Neighboring states of Minnesota and Wisconsin had the same problem, which is why they recently increased their dental reimbursement rates by 98% , so underserved populations can get the care they need.

Most Iowa dental practices are small businesses operating on fairly tight budgets. They’re happy to give back to the community, and often do so through multiple charity programs. But they are forced to limit or exclude new Medicaid patients because they cannot afford to do otherwise.

Increasing the state's reimbursement rate would enable more dentists to provide preventative care to rural Iowans, reducing both the number of dental emergencies, as well as the distance patients must travel to receive care.

Mobile Oral Health Programs

Mobile oral health programs have been successfully developed and widely used in other predominately rural states.

Portable dental clinics, such as mobile dental vans, travel to various rural population centers to provide preventive care, x-rays, and other dental procedures.

The following video clip highlights the mobile program operated by Delta Dental to expand dental care access for children throughout the rural areas of South Dakota:

Sources:
Featured Image: Adobe, License Granted
Health Journalism
We Are Iowa
Rural Health Information Hub
Tax Education Foundation of Iowa
Des Moines Register

Let’s Talk: Communicating With Consumers in Default

Wed, 13 Apr 2022 13:55:25 GMT

Let’s Talk: Communicating With Consumers in Default

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How to Make Collection Calls
Less Daunting

A young woman had fallen upon hard times and missed a payment on an overdue debt. So she called the collection agency in order to work out an adjustment to her repayment plan.

But rather than receive compassion or empathy, the debt collector berated her. “You need to figure out how to pay it right now," she was told.

Because the young woman had nothing to offer besides grocery money, she asked if the payment could be deferred until she received her next paycheck. She was told that was “unacceptable.”

The conversation went downhill from there. It finally ended with the collection agent screaming, “What the heck is wrong with you?! [Only she didn’t say “heck.”] You need to pay this debt! If you can’t work with us, we’ll take you to court!” Then she hung up.

This nightmare true story is a shocking example of how NOT to handle a collection call. Let’s explore some more reasonable and effective techniques.

Have a Plan

Collection calls are not easy. The collector must work to maintain (or rebuild) trust while seeking a resolution that meets the needs of both parties. This process cannot be approached haphazardly; it requires a plan.

Regulation F
Restrictions

Regulation F , a revision to the Federal Debt Collection Practices Act (FDCPA) which became effective last November, places the following restrictions on the number of times debt collectors may attempt to call consumers:

Collectors may not attempt to call more than seven times within seven consecutive days. Any call that is placed and connected is considered an attempt to call, including voicemails, ringless voicemails, and limited-content messages.

Collectors are limited to one debt-related conversation with a consumer within a seven-day period.

First of all, an effective collection process uses multiple channels (phone, text, email) over a period of several weeks. The key is to persist without becoming overly intrusive.

Attempting multiple contacts every day, or utilizing aggressive automated dialing campaigns, will not only backfire, it could be illegal. (See sidebar, "Regulation F Restrictions.")

While it’s true these tactics can result in an occasional payment, the risk of damage to the consumer relationship – as well as the risk of noncompliance – is simply too great.

Different people will respond differently to your attempts to contact them. Some will readily work with you to resolve the unpaid account. Others may be evasive, irate, or scared (maybe even abusive).

It’s important to keep in mind that the vast majority of patients and consumers want to pay their bills. It’s your job to help them do just that.

Defusing an Argument

What should you do if you encounter an angry or hostile consumer?

First of all, resist the temptation to retaliate! Try to defuse the situation instead. The following strategies have proven helpful:

Let ′Em Vent

Allowing consumers to vent their frustrations does not mean you’re losing control of the conversation. Rather, it’s an intentional means of defusing their anger in order to move toward your goal of payment. Sometimes people just want someone to listen.

Don’t argue with patients or try to prove them wrong. Tell them you understand how exasperating things can be.

Four Tips for

Empathetic

Listening

Be nonjudgmental.
Give the consumer your undivided attention.
Listen to both facts and feelings.
Restate and paraphrase.

Source: Crisis Prevention Institute

Admit Mistakes

If a consumer is angry because of a situation due to an error on your end, own up to the mistake. Then apologize. A simple apology may catch them off guard and neutralize their hostility. Then you can proceed to correct the error (or at least, begin the correction process).

Acknowledge Their Value

Long-term patients or other customers need to know how much you appreciate them. If the patient has a history of paying on time, tell them how much you value that. Help them feel important. Most people are not inclined to argue with someone who’s validating their worth.

Perfect the Process

Once you have a process in place, it’s important to continually review and revise it, based on any data you can gather.

Then, don’t hesitate to make adjustments as needed.

For example, you might need to alter the content of your communications, the communications channel you’re using, or the types of repayment terms you offer. Flexibility is key. Be aware that successfully identifying the strategies and techniques that work best for you and your patients may take some time.

Send in the Cavalry

Are your internal A/R staff members at their wits’ end attempting to collect on overdue accounts? Do you think they may be doing more harm than good? If so, it’s time to bring in the pros.

--Article Continues Below--

CBSI’s respectful, solution-focused services produce far better results than harsh demands. Our in-house compliance officer is continually reviewing our processes. And our custom-made compliance management system ensures we’re always current with the ever-changing regulatory environment.

Knowing the best way to communicate with your consumers in default is what we do.

Problem solved.

Sources:
Featured Image: Adobe, License Granted
Entrepreneur
InsideARM
PDC Flow

Improve Collectability with Patient-Friendly Billing®

Wed, 09 Mar 2022 16:10:29 GMT

Improve Collectability with Patient-Friendly Billing ^®

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How to Provide a Positive
Patien t Experience on
the Back End

Maintaining a profitable medical practice can be very difficult when patients don’t pay their bills.

At the same time, confusing, inaccurate or unfriendly billing methods can prevent patients from remitting timely payment.

Patient-friendly billing can improve your chances of being paid on time. The Healthcare Financial Management Association (HFMA) has identified a serious need for financial information to be communicated in a “clear, concise, correct and patient friendly” manner. (See sidebar, “The Patient Friendly Billing ^® Project.”)

This need has been heightened by the COVID pandemic, causing an increase in patient demands for multiple payment options, price transparency, and patient-friendly medical billing.

Best Practices for Medical Billing

Providing your patients with a positive billing experience can boost your approval ratings on social media sites and generate word-of-mouth referrals. In fact, surveys indicate that 88% of patients with a “highly positive” billing experience would recommend a medical practitioner to their friends.

The Patient Friendly

Billing ^® Project

The HFMA’s Patient Friendly Billing ^® project offers numerous downloadable resources to help care providers improve their medical billing processes. These include:

Consumerism in Health Care
Reconstructing Hospital Pricing Systems
Patient Financial Communications Best Practices
Patient Friendly Billing Project: Case Studies in Customer Service

What’s more, almost 80% of patients who were satisfied with their billing experience pay their bills in full or over time.

You can increase the likelihood of a positive billing experience by adopting the following best practices:

In Their Shoes

When designing your billing process and financial communications, consider the patient’s perspective. For example, offer the option to include a family member or other advocate in the financial conversation with your patient.

It’s also a good idea to provide them with contact information for financial assistance programs at their final outpatient visit or when being discharged from an inpatient facility.

Keep all communications courteous and respectful. If at all possible, do not convey financial information during the medical encounter. This should be a separate conversation.

Consolidate Your Billing

You can streamline the billing process and prevent duplication by coordinating with other healthcare providers and insurers.

Even if your practice is not yet sufficiently integrated to provide this service, you can still work with your healthcare partners to develop a consolidated statement. Patients can feel confused and frustrated when they receive multiple bills for what they perceive as a single care event, The result is often slow pay or no pay.

Say What You Mean

Use easily understood terminology and formatting in your financial communications.

When medical state ments are written in clear, jargon-free language, patients can immediately identify the purpose of the communication. For example, place balance information toward the top of the statement, so patients can quickly determine what they need to do.

--Article Continues Below--

Be Concise

Keep billing communications succinct. Provide the minimum amount of detail needed to relay your message. Long, drawn-out statements are a both confusing to the patient and a waste of time for the provider.

Accuracy, Accuracy, Accuracy

Make sure your staff double-checks all statements for accuracy. These bills should never contain incomplete information, typos or other errors.

Does Your Practice Have a Designated Billing Rep?

You can enhance your billing process by designating a single customer service contact to address patients’ billing questions.

Connecting with one particular individual who is knowledgeable in all financial aspects of their care significantly reduces the possibility of patient ill will or frustration.

Elevating this service even further, the designated representative could offer to contact government agencies, insurance companies, or other healthcare providers on the patient’s behalf.

Sending the wrong medical bill is one surefire way to lose that patient to a provider who’s better organized.

Patient Feedback

Gather patient feedback regarding your billing practices, so that you can continually review and improve your methods. Some of the most effective feedback tools are email surveys, website comment forms, and social media interaction.

Why It All Matters in the End

Your medical office staff represents your practice during the patient’s first and last encounter with your organization.

Initial conversations during registration are critically important; however, if the patient’s final experience is negative, his opinion of your overall service will be a poor one – even if the experience on the front end was positive.

Patient-friendly billing can improve the back end of this process to enhance patient satisfaction, reinforce patient loyalty and generate referrals. But it also increases the likelihood of timely payments, significantly reducing your risk of bad debt.

Patient Friendly Billing ^® is a proprietary trademark of the Healthcare Financial Management Association (HFMA).

Sources:
Featured Image: Adobe, License Granted
RevCycle Intelligence
Healthcare Financial Management Assn
Medical Group Management Association
Patient Engagement Hit

Are You Ready for Value-Based Healthcare?

Wed, 09 Feb 2022 18:55:42 GMT

Are You Ready for Value-Based Healthcare?

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Is VBC a Good Fit for Your
Medical Practice?

If you’re a healthcare provider, the type of care and reimbursement model you choose for your medical practice matters.

Most providers use a fee-for-service (FFS) system, where they’re paid according to the number of services they provide. With FFS, physicians are incentivized to see as many patients as possible, as quickly as possible. The more tests and procedures they prescribe, the more they are paid.

Value-based care (VBC), on the other hand, focuses on quality over quantity. VBC is rapidly becoming the wave of the future.

What Is Value-Based Care?

Value-based care is a method of motivating healthcare providers based on the quality of care as determined by their patients’ health outcomes. It’s designed to ensure that practitioners tend to their patients’ medical needs to the best of their ability -- and in as few visits as possible. The purpose of VBC is four-fold:

Source: Healthcare Association of New York State

Improve the quality of healthcare
Improve the patient experience
Reduce healthcare costs
Improve the care team’s experience

Unlike traditional FFS, VBC is data-driven. Healthcare providers must track and report specific metrics (such as facility readmissions and population health) in order to ascertain health outcomes. Current government regulations strongly favor VBC over traditional care and reimbursement models.

VBC Payment Models

There are four main types of VBC payment models available for healthcare providers.

Accountable Care Organization

An Accountable Care Organization (ACO) is a network of care providers with varying specialties who voluntarily collaborate to offer a system of coordinated care to their patients. ACOs were originally intended for Medicare beneficiaries, but many have now expanded to include all insured patients. ACOs are designed to prevent redundant and unnecessary services, and also reduce medical errors.

When an ACO is able to provide quality care at reduced cost for patients, the savings is shared by all of the providers within the network. Of course, the opposite is also true: They all share in the losses if the quality of care is inadequate. In that regard, providers assume some financial risk when joining an ACO. Those who do not meet the VBC standard may have to repay Medicare or a private insurer.

Bundled Payments

With bundled payments, patients pay a single price for an entire episode of care, even if multiple providers are involved in the treatment. Providers are reimbursed collectively for the pre-determined costs to treat a specific condition, regardless of the number of practitioners, procedures or care settings. Payment is based on the treatment outcome.

VBC in Iowa

The state of Iowa is in the process of implementing three separate strategies to support the transition to value-based care:

A real-time system to alert ACOs when one of their assigned members has been admitted/discharged as an inpatient, or has visited an emergency room.

A statewide technical assistance program to help stakeholders transition to value-based payment; and

Development of community care teams to identify and coordinate community resources that address the social determinants of health.

Source: Change Healthcare

For example, if a patient undergoes surgery, a single payment to the surgeon, anesthesiologist and care facility would be bundled together instead of paying each provider separately. This payment would be based on historical prices.

As with ACOs, there are certain financial risks associated with bundled payments. If the treatment costs are above the target price for a particular episode of care – for example, because of medical complications -- the excess cost must be covered by the healthcare provider. Likewise, whenever treatment costs are kept below the bundled price, care providers share the savings.

Patient-Centered Medical Home

While it may sound like a place, a Patient-Centered Medical Home (PCMH) is actually a model for primary care. These groups are similar to ACOs in that they involve a collective of healthcare providers working to deliver all-inclusive medical services to their patients.

According to the U.S. Department of Health and Human Services, a PCMH is defined by five primary features:

Comprehensiveness
Patient-Centeredness
Care Coordination
Accessibility
Quality/Safety

However, unlike an ACO, a PCMH is a care delivery model, not a reimbursement model. The PCMH offers a centralized care setting for managing all the patient’s various needs. These patients develop one-on-one relationships with their care providers. The care providers, in turn, take into account both medical and environmental considerations when identifying the patients’ needs.

The PCMH model has proven to be particularly effective in coordinating care for patients with complex chronic disease. Medical facilities can become PCMH certified through several differing accreditation programs .

--Article Continues Below--

Capitation

Capitation is another value-based payment model. With capitation, healthcare providers receive fixed fee per patient, which is paid in advance. This fee is based on various factors, such as demographic data, number of patients involved, and range of services provided. In capitation, physicians are paid whether or not the patient seeks care.

Rural communities, which often have difficulty attracting and retaining primary care providers, can particularly benefit from capitation programs. Capitation offers these providers both the flexibility to customize care for their communities and a sense of financial security.

Benefits of Value-Based Care

Should you consider adopting a value-based care for your practice? Here are some of the benefits:

VBC Challenges

One of the main challenges practitioners face when transitioning to value-based care is effectively tracking the required metrics. If they are to accurately calculate healthcare costs, providers must track a bevy of data (staffing, population health figures, clinical information, patient acuity, etc.).

Most of the technology and internal processes currently in use are designed to accommodate the fee-for-service model. So choosing the best technology partner when transitioning to VBC will be important. For a comparison of VBC services and vendors, click here .

Another common challenge concerns the organization’s internal culture, which could be resistant to adopting VBC. Providers must undergo a paradigm shift from “volume and claims” to “value and health outcomes.” Such a shift requires training and a reasonable adjustment period for a smooth transition.

Improved Patient Satisfaction

Value-based care is all about patient satisfaction. When providers offer more personalized treatment solutions, they ensure a more positive patient experience. Satisfied patients are more likely to return and/or recommend a medical practice to others.

Improved Care Coordination

In VBC, incentives and advanced technologies help coordinate care with multiple providers. Better patient outcomes result when practitioners collaborate to improve overall health.

A Healthier Society

When healthcare costs are affordable and medical providers personalize their services, patients with chronic conditions are more likely to address their medical issues early on. VBC works to create a more financially stable population that seeks treatment for chronic illnesses through the best available care methods.

The Future of Healthcare

The Department of Health and Human Services continues to offer incentives to care providers who transition to value-based payment models. (One such incentive increases the Medicare Part B base payment rate by as much as nine percent, with the possibility of additional lump sum payments.)

In the current landscape of ever-increasing healthcare costs, VBC is quickly becoming a critical part of the prudent provider’s strategy to contain costs while generating revenue.

The providers who have already started to shift their focus from care and treatment to prevention and health maintenance are positioning themselves for the future.

Sources:
Featured Image: Adobe, License Granted
RevCycle Intelligence

Health IT Analytics
Software Advice
CapMinds
Agency for Healthcare Research and Quality

How Bad Is the Physician Shortage?

Wed, 05 Jan 2022 16:01:00 GMT

How Bad Is the Physician Shortage?

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Rural and Low-Income Areas

Now Face Crisis Levels

Did you know…

In 2021, there was a shortage of about 46,000 doctors in the U.S.
By 2034, that number is expected to climb as high as 124,000; up to 48,000 of these will be primary care physicians.
Rural and low-income areas will be hardest hit by the increasing doctor shortage.
About 40% of Iowans reside within the 77 counties currently designated as “rural,” and are medically underserved.

In June of 2021, the AAMC (Association of American Medical Colleges) released its latest report on the impending U.S. physician shortage, and the picture looks pretty bleak. Even before COVID hit, our country was facing a potentially serious doctor shortage; the pandemic has only exacerbated the workforce challenge. Here are the reasons most often cited for this shortfall:

Growing U.S. Population

The U.S. population increased by nearly 8% over the past decade. That's the slowest growth rate since the 1930s, and yet it still represents an increase of almost 27 million people. And while the U.S. birth rate dipped by 4% during the pandemic, an increase in immigration resulted in overall population growth.

What Is an HPSA?

The Department of Health and Human Services (HHS) federally designates geographic areas, populations, or facilities that suffer from an acute shortage of health care providers as HPSAs (Health Professional Shortage Areas).

In doing so, HHS uses three criteria to identify these groups:

Ratio of population to provider

Percentage of population with income below the Federal Poverty Level

Travel time to the nearest healthcare source outside the HPSA.

In 2020, Iowa had a total of 353 HPSAs for primary care, mental health, and dental care. Nationally, more than 20,000 HPSAs have been designated.

In October of 2021, HHS reported that about 32,000 additional practitioners are needed to meet the needs of these communities.

Aging Population

More than 54 million Americans are currently age 65 and older. With 10,000 people joining their ranks every day, that number is projected to increase by about 18 million within the next decade. By 2032, seniors will outnumber children for the first time in U.S. history.

This aging population necessitates an increased demand for physician care. Older adults often suffer from multiple chronic health problems, such as heart disease, arthritis, diabetes, and hypertension. According to report by the National Institutes of Health , about 85% of senior adults suffer from at least one chronic condition that requires specific treatment and medical care.

Aging Physicians

It’s not just the population in general that’s aging. Ten percent of U.S. doctors are older than 65. The AAMC expects that number to double over the next decade. Right now, more than 30% of practicing physicians are over 60. Even so, physicians often delay retirement, compared to average American workers.

There are two reasons for this: 1) They’re in school for such a long time, they get a late start on developing their own practice, and 2) they usually enjoy their work.

However, as the number of older doctors starts to dwindle, the remaining practitioners can easily become stressed and overworked, as they endeavor to satisfy the demand for services. Burned-out physicians may choose to reduce their workloads in the interest of self-preservation.

Impact of COVID

And then there’s the crushing effect of COVID-19 on the U.S. healthcare community. In 2020, more than 3,600 medical staff members died from COVID, 17% of which – at least 613 – were doctors.

In addition to the fatalities, the ongoing battle with this pandemic continues to take a physical and emotional toll on physicians, leaving them fatigued and vulnerable to infection. More than a year later, Iowa hospitals are still routinely combatting the virus.

The economic uncertainties related to the pandemic also have taken a toll on physicians. During the height of the outbreak, thousands of practitioners called it quits. Both hospitals and doctors’ offices lost billions in revenue when elective medical procedures were suspended. At that time, surveys indicated that almost half of U.S. physicians were seriously reconsidering their career or practice.

--Article Continues Below--

Federal Cap on Residencies

The Centers for Medicaid and Medicare Services (CMS) compensate hospitals every year to hire medical residents. The number of practitioners for any given year is ultimately determined by the number of residencies. The 1997 Balanced Budget Act established a cap on the number of annual residencies supported by CMS. Which means this funding has been frozen at 1996 levels for 25 years.

To address the issue, the Resident Physician Shortage Reduction Act of 2021 ( HR 2256 ) was introduced in Congress last March. If approved, this bill would increase the number of residency positions paid by CMS by 2,000. Qualifying hospitals would include those in rural areas and HPSAs. HR 2256 is still under committee review.

Is There a Fix?

Experts have suggested several steps public health officials can take to equalize the distribution of healthcare services and help alleviate the physician shortage. These include:

Promoting new technologies, including telemedicine.

Recruiting more nurse practitioners, clinical nurse specialists, and physician assistants, and expanding their scope of practice.

Inducing providers to practice in shortage-prone areas by adjusting physician reimbursement policies.

Encouraging retired physicians to reenter the workforce.

Enabling medical students to graduate early.

Encouraging medical school graduates to pursue residencies in primary care (e.g., internal medicine, pediatrics, and family medicine ) in the most medically disadvantaged areas.

Advocating the passage of HR 2256 to increase the annual number of residencies paid by CMS.

Sources:

Featured Image: Pixabay
AAMC

New York Times

MedPage Today

Advisory Board

Health Resources and Services Administration

Iowa Department of Public Health

What to Do When Your Patient Files for Bankruptcy

Wed, 01 Dec 2021 15:00:00 GMT

What to Do When Your Patient Files for Bankruptcy

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Understand Your Rights and Responsibilities

You’ve just received notice that one of your patients has filed for bankruptcy. What should you do?

The answer depends, at least in part, on the type of bankruptcy that was filed.

While there are actually six different types of bankruptcy available under the U.S. Bankruptcy Code, only two of these are commonly used by consumers: Chapter 7 and Chapter 13.

What Is an
Automatic Stay?

Once a bankruptcy petition is filed, all creditors are prohibited from attempting to collect from the petitioner. This is called an "automatic stay."

Creditors who violate the automatic stay are deemed to be in contempt of court. As a result, the bankruptcy court can impose fines, assess attorney's fees, and order the creditor to pay damages.

In community property states , however, the collection of debts that were jointly incurred may still be pursued without violating the automatic stay.

For example, if an individual files a bankruptcy petition, and the petitioner was married at the time the debt was incurred, the creditor may pursue collection from the non-petitioning spouse.

In both Chapter 7 and Chapter 13, medical debt owed to physicians, hospitals and other healthcare providers are typically classified as “non-priority unsecured debt.” Often, but not always, debtors lack sufficient assets or disposable income to pay any of these unsecured creditors.

Chapter 7 Liquidation

In a Chapter 7 bankruptcy, the debtor’s financial obligations are virtually erased (with a few exceptions). In order to be eligible for a Chapter 7, the petitioner must have little or no disposable income.

The bankruptcy notice issued by the U.S. Bankruptcy Court includes information about a “341 Meeting" with the bankruptcy trustee. In a Chapter 7, the purpose of the 341 meeting (also known as a "Meeting of Creditors") is to determine if the debtor owns any unprotected assets. If so, these assets will be liquidated and the proceeds distributed to creditors.

After the 341 Meeting, all creditors will receive a notice from the court, indicating whether the debtor’s bankruptcy case was determined to be an “Asset” or “No Asset” Chapter 7. If the case is deemed "No Asset," then as an unsecured creditor, you will not receive any payment. (You can, however, pursue any amount owed by the patient's insurance company.)

On the other hand, in an "Asset" Chapter 7 bankruptcy, unprotected assets are sold to repay creditors, and unsecured creditors may be included in the distribution. To be eligible for this payment, you must file a Proof of Claim.

This document informs the court of your claim to receive a portion of the asset distribution. The Proof of Claim must be filed prior to the deadline stated on the Chapter 7 Notice of Assets sent to you by the bankruptcy court.

Chapter 13 Reorganization

Chapter 13 reorganization is designed for debtors who have a regular income and who do not qualify for Chapter 7 liquidation. It consists of a three-to-five-year repayment plan, and must include a proposed payment to unsecured creditors. This figure is based on the debtor’s disposable income.

Should You Attend the
341 Meeting of Creditors?

A 341 Meetings of Creditors is held for every type of bankruptcy. Despite the name, most creditors do not usually attend these meetings, particularly if the debts are unsecured.

The exception would be if the debtor owes you a significant sum, and you believe there is a discrepancy between the information stated in the bankruptcy petition and the information in your patient financial records.

As with Chapter 7, all creditors listed in a Chapter 13 bankruptcy will receive a "Notice of Bankruptcy Case Filing" and 341 Meeting. The purpose of this meeting in a Chapter 13 is to determine if the repayment plan proposed by the debtor is feasible and should be approved by the trustee.

Proof of Claim in a Chapter 13

In order to be paid in a Chapter 13 bankruptcy, you must file a Proof of Claim. Once the court confirms the debtor's Chapter 13 plan, individual claims are paid out based on debt priority.

Need a
Proof of Claim?

Has your patient filed for bankruptcy while CBSI was working on the account?

We can prepare and file a Proof of Claim on your behalf!

That is, secured debts are typically paid first, followed by so-called priority debts (e.g., domestic support obligations and taxes). Lastly, general unsecured debts are paid out, in accordance with the proposed amount approved by the bankruptcy court.

Preserving the Relationship

Depending on the state in which you practice, a bankruptcy may offer you the legal standing to sever your relationship with the patient. However, dismissing a patient without a proposed plan of care is typically not advised.

You’ll want to consult legal counsel in this matter. Many healthcare providers elect to maintain the patient relationship, despite the bankruptcy filing, out of ethical considerations, particularly if treatment is ongoing.

Let Us Know

If you receive a Notice of Bankruptcy regarding one of your patients, and you're a CBSI client, please notify us ASAP. Typically, we will have received the notice as well. However, there are occasions where we have not been included on the debtor’s mailing matrix.

Sources:
Featured Image: Adobe, License Granted

Nolo

Michigan State Medical Society

In Case You Missed It...Deadline Approaching!

Tue, 16 Nov 2021 12:47:00 GMT

In Case You Missed It...Deadline Approaching!

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Regulation F Becomes Effective
November 30

For the past couple of months, we at CBSI have been preparing our clients for the roll out of Regulation F on November 30 of this year. In case you missed those updates, here’s a recap of the new debt collection rule and what we will need from you:

Electronic Communications

Debt collectors may contact consumers via email and text messaging, but only if given expressed or implied consent to do so.

Every text or email sent by a debt collector must contain a clear and conspicuous “opt-out” notice.

Telephone Communications

Debt collectors may not attempt to call a consumer more than seven times within seven consecutive days.

Debt collectors are limited to one debt-related conversation with a consumer within a seven-day period.

Validation Notice

Regulation F requires three changes to the debt validation notice :

The notice must specify a particular date on which the validation period expires.
The notice must provide the website address for the Consumer Financial Protection Bureau ( https://www.consumerfinance.gov/consumer-tools/debt-collection/ ).
The notice must include an itemization date .

What We Will Need From You

At CBSI, we will be using the last date of service (DOS) as the required itemization date. Once Regulation F becomes effective on November 30, 2021, we will need the following:

The account balance on the last DOS , even if it is the same as the account balance at the time of placement with us.

Separately itemized interest charges and fees. ( If you are charging interest or fees, please call our office. New limitations on these charges require proper disclosures and/or agreement.)

The placement amount. (This would be the DOS balance minus the total amount of consumer payments, write-offs, credits or insurance payments credited to the account.)

Client Portal

When entering account information on our Client Access Web Portal, you must now enter the amount due on date of service, interest, fees and placement amount. You must complete each field, even if the amount is zero.

Placement Files

Clients using placement files will need to add an additional field for the account balance as of the last date of service.

Permission to Contact

Please incorporate “permission to contact” language on your patient intake form, including a reference to collecting payment for services provided.

If you have any questions about Regulation F
and its potential impact to your business,
please do not hesitate to contact us .

Sources:
Featured Image: Adobe, License Granted

Consumer Financial Protection Bureau
InsideARM
American Bar Association

Regulation F to Take Effect November 30

Wed, 13 Oct 2021 23:32:00 GMT

Regulation F to Take Effect November 30

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What You Need to Know
About the New Rule

As discussed in our last article , Regulation F, the first major update to the Fair Debt Collection Practices Act, is scheduled to take effect on November 30 of this year. Here’s a recap of the new rule and what we will need from our clients:

Electronic Communications

Debt collectors may contact consumers via email and text messaging, but only if given expressed or implied consent to do so.

Every text or email sent by a debt collector must contain a clear and conspicuous “opt-out” notice.

Telephone Communications

Debt collectors may not attempt to call a consumer more than seven times within seven consecutive days.

Debt collectors are limited to one debt-related conversation with a consumer within a seven-day period.

Validation Notice

Regulation F requires three changes to the debt validation notice.

The notice must specify a particular date on which the validation period expires.
The notice must provide the website address for the Consumer Financial Protection Bureau ( https://www.consumerfinance.gov/consumer-tools/debt-collection/ ).
The notice must include an itemization date .

What We Will Need From You

Permission to Contact

Please incorporate “permission to contact” language on your patient intake form, including a reference to collecting payment for services provided. (See form at left, “Permission to Contact,” for suggested language.)

Itemization Date

At CBSI, we will be using the last date of service (DOS) as the required itemization date. As of November 30, 2021, we will need the following:

The account balance on the last DOS, even if it is the same as the account balance at the time of placement with us.

Separately itemized interest charges and fees. (If you are charging these, please reach out to our office to discuss. New limitations on these charges require proper disclosures and/or agreement.)

The placement amount. (This would be the DOS balance minus the total amount of consumer payments, write-offs, credits or insurance payments credited to the account.)

Client Portal

Placement Files

Clients using placement files will need to add an additional field for the account balance as of the last date of service.

As always, if you have any questions about Regulation F and its potential impact to your business, please do not hesitate to contact us.

Sources:
Featured Image: Adobe, License Granted

Consumer Financial Protection Bureau
InsideARM
American Bar Association

Regulation F: What’s It All About?

Wed, 15 Sep 2021 13:00:00 GMT

Regulation F: What’s It All About?

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New Debt Collection Rule Clarifies FDCPA,

Addresses Electronic Communications

(The following is provided as an overview of the new regulation,
and is not intended to be a full and exhaustive explanation.)

In recent months, there’s been a lot of buzz around the collection industry about new legislation known as “ Regulation F .” What exactly is it, and how will it affect your business? Let’s start with some background information...

The Consumer Financial Protection Bureau (CFPB) was established in 2010 for the purpose of enforcing federal consumer laws – including the 1978 Fair Debt Collection Practices Act (FDCPA).

In late 2020, after many years of extensive work and lengthy commentary, the CFPB issued Regulation F, its long-awaited revision to the FDCPA. Currently scheduled to become effective early in 2022, Regulation F is the first major FDCPA update in 40 years. The new rule was published in two parts, both of which focus on debt collection communications.

Part 1 - Communication Technologies

Part 1 of the new rule, published in October of last year, consists of 653 pages. It addresses the use of new communication technologies (text, email and social media) to collect a debt, and it sets restrictions on telephone communications. In doing so, Regulation F establishes guidelines that provide a “ safe harbor ” to debt collectors.

Email Messages

Debt collectors may contact consumers via email if the person’s email address was obtained and used by the original creditor to communicate with the consumer about the account. However, the creditor must send advance notice to the consumer (via written or electronic communication) regarding the debt collector’s future email communications.

Consumer Preferences
Are Key

Under Regulation F, attempting to communicate with a consumer about a debt using a method he or she has requested NOT be used -- or for which he or she has opted out -- is considered to be "harassing, oppressive or abusive conduct," and is strictly prohibited.

Text Messages

Debt collectors may contact consumers via text messages, but only if the consumer has expressed or implied consent to do so. In addition, debt collectors must reconfirm said consent every 60 days by utilizing a complete and accurate database to verify that the consumer’s cell phone number has not been reassigned.

Social Media Messages

Debt collectors are not prohibited from using a consumer’s social media channels in an attempt to collect a debt.

However, they are prohibited from using social media communications that are viewable by the general public or by the consumer’s social media contacts.

Opt-Out Notices

Every text or email sent to a consumer by a debt collector must contain a clear and conspicuous “opt-out” notice. The method for opting out of further such communications must be simple and reasonable, no fees may be charged for opting out, and no additional information may be solicited other than the consumer’s communication preference.

Telephone Communications

The first wave of Regulation F also addresses telephone communications, setting restrictions on the number of times a debt collector may attempt to call a consumer regarding a debt. Specifically:

Debt collectors may not attempt to call a consumer more than seven times within seven consecutive days. Limited-content messages, voicemails, and ringless voicemails are all considered attempts to call. In other words, any placed and connected call is considered an attempt to call.

Debt collectors are limited to one debt-related conversation with a consumer within a seven-day period.

Part 2 – Model Validation Notice

Part 2 of Regulation F, issued in December 2020, focuses primarily on the Model Validation Notice.

The FDCPA already requires that debt collectors send a validation notice to consumers within five days of initiating contact with a consumer about his debt.

Regulation F clarifies the type of information which this notice must include and provides a model for creditors and collectors to use. There are three particular changes which Regulation F requires for validation notices. (These changes are indicated in the graphic below.)

1. Instead of stating that the consumer has 30 days to dispute the debt or request more information about the debt, collectors must now specify a particular date on which the validation period expires.

2 . The notice must inform the consumer that additional information about consumer protections is available on the CFPB’s website, and the website address must be included.

3 . The notice must include an itemization date, which the CFPB defined as one of five reference dates a debt collector can use to determine the amount of the debt:

The date of the last statement that was provided to the consumer by a creditor;
The date the debt was charged off;
The date the last payment was applied to the debt;
The date of the service or other transaction for which the debt was incurred; or
The date of a final court judgment with regard to the debt.

What It All Means to You

Debt collectors rely on their creditor-clients to provide the account information which the collection agency must disclose to the consumer. Once Regulation F becomes effective, it will be even more important that creditors provide collectors with certain information to help expedite collection under the new rule.

Permission to Contact

For instance, it's a good idea to incorporate “permission to contact” language on your patient intake form. This language should include a reference to collecting payment for services provided. Here’s a suggestion:

I consent to receive telephone calls, text messages and email messages from [YOUR BUSINESS NAME], and from any business associates with which [YOUR BUSINESS NAME] has contracted, at the phone number(s) and email address associated with my account (including wireless telephone numbers), so that [YOUR BUSINESS NAME] and its business associates may provide healthcare information, service my account, and/or collect any amounts owed for services provided. I understand that I may be charged for calls and/or texts by my wireless carrier, and methods of contact may include prerecorded or artificial messages and/or use of an automated dialing system.

Also, if you want us to contact your consumers via email, Regulation F requires that you notify them in advance that we will be sending them email communications.

Itemization Date

As outlined above, the “itemization date” which is used to ascertain the amount of the debt – and which must be included on the validation notice -- can be one of five possible dates.

At CBSI we believe the transaction date (i.e., date of service) would be the most reasonable date to use. So once Regulation F becomes effective, here is what we will need from you for each account:

The total amount owed as of the last date of service. (This will be our itemization date.)

Any adjustments (credits/insurance payments, interest, fees, etc.) applied toward this amount since the last date of service.

In this way, you can help ensure that our debt recovery efforts on your behalf can continue to exceed your expectations. As always, if you have any questions about the new legislation and its potential impact to your business, please do not hesitate to contact us.

Sources:
Featured Image: Adobe, License Granted
Consumer Financial Protection Bureau
InsideARM

American Bar Association

Caring for an Aging Population

Wed, 11 Aug 2021 17:00:00 GMT

Caring for an Aging Population

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How Will Providers Adapt to an
Older Patient Base?

Looking through blurred eyeglasses, with cotton balls in their ears and cumbersome leather gloves on their hands, a group of Florida medical students were asked to perform the simple tasks of buttoning their lab coats and counting out pills.

They found the assignment to be nearly impossible. It was an “aha” moment.

These students were participating in aging sensitivity training -- learning first-hand about some of the common physical limitations experienced by older patients. The Florida program is one of many across the country designed to help prepare tomorrow's doctors face an anticipated tidal wave of aging patients.

Blame It on the Boomers

The driving force behind the country’s aging populace is the huge generation of Baby Boomers who swelled the ranks of the young in the 1950s and 1960s, and flooded the workforce as they entered adulthood 20 years later. Now many Boomers are well into their retirement years.

Now many Boomers are well into their retirement years. Consider the following:

By 2030, when every Baby Boomer will be age 65 or older, one out of every five U.S. citizens will be of retirement age.

By 2035, Boomers will outnumber children for the first time in U.S. history.

This aging population is expected to impact healthcare services in a number of ways

More Geriatricians Needed

Geriatricians not only monitor and coordinate treatment for the many afflictions older citizens must endure, but they also help seniors determine ways to maintain or enhance their well-being and quality of life.

Medical Collections
Decrease with Age

A 2018 federal study indicated that, although healthcare use and spending increase significantly with age, medical collections actually decrease substantially as patients get older.

Researchers found that patients in their late 20s were almost three times as likely to have an unpaid medical bill sent to collections than were patients in their late 60s. In addition, the average size of medical debt dropped nearly 40% from ages 27 to 64.

Source: Health Affairs

Right now there are only about 7,300 certified geriatricians practicing in the U.S. By 2025, at least 30,000 will be needed to meet the demand for services.

One big reason fewer students pursue geriatrics is money. According to Salary.com, the median annual salary for a geriatrician in 2021 is $204,155, compared with $224,414 earned by the average internal medicine doctor, and less than half what the average orthopedic surgeon earns ($498,080).

Medicare, the primary payer for senior adults, typically offers lower reimbursement rates than private insurance providers. The need to pay off medical school debt often motivates new doctors to pursue the higher-paying specialties. So public health officials may need to increase financial incentives for medical students to choose geriatrics as a career.

Some states, like South Carolina, are doing just that by establishing debt-relief programs for new doctors who agree to treat senior adults in the neediest communities.

Another deterrent to practicing in geriatrics is the nature of the work itself, which typically involves the treatment of chronic diseases, most of which are not curable. There is very little opportunity for medical heroics in a geriatric practice.

Of course, not every senior adult needs a geriatrician. But federal data indicates that about 30 percent of them do right now, and their numbers are climbing. In Retooling for an Aging America: Building the Health Care Workforce, the U.S. Institute of Medicine (IoM) Committee on the Future Health Care Workforce for Older Americans recommended the following:

The enhancement of payments to geriatric specialists,

An expansion of the Geriatrics Academic Career Award (GACA) program to promote geriatrics education at accredited medical schools, and

The institution of scholarships, loan forgiveness, or other financial incentives to assist with the high cost of tuition among all types of healthcare professionals who care for older adults.

--Article Continues Below--

Although these recommendations were made in 2008, a 2020 update of the committee’s report revealed that the situation has not changed. As a result, “The 2008 IoM framework and recommendations remain relevant and constitute an important roadmap to complete unfinished goals.”

Team-Based Care

Caring for older adults often requires the collaboration of health professionals across multiple fields. Which is why team-based care has become an emerging trend in geriatrics. In fact, the AMA recommends using physician-led team-based care when addressing the increasingly prevalent chronic conditions of an aging population.

The best geriatric care teams utilize both clinical and non-clinical staff to provide a better patient experience. Physicians, nurses, care managers, nurse practitioners, physician assistants, dietitians, pharmacists, social workers and mental health professionals work together with counselors, receptionists and community workers to deliver comprehensive care to aging patients. Personnel from other specialties are sometimes added also, depending on the individual needs of the patients.

Geriatrics Training for All

With the demand for geriatric services expected to surge, and so few geriatricians available, tomorrow’s healthcare providers will require more training in elder care, regardless of their intended field of practice.

Iowa's Seniors

The proportion of Iowa's population that is over 60 is growing while the proportion that is under 60 is shrinking. The U.S. Census Bureau estimates that 27% of Iowa's population will be over age 60 by the year 2030 -- an increase of 34% since 2012.

539,830 -- The estimated number of Iowa residents age 65 and over in 2018. This age group accounted for 17.4% of the state's total population . Iowa ranks 17th nationwide in the percentage of residents age 65 and older, while the state's overall population ranks 32nd in the nation.

687,787 -- The projected number of Iowans age 65 and older in the year 2050. According to Woods & Poole Economics Inc., this age group will constitute 20.3% of the state's total population at that time.

Source: State Data Center of Iowa

As a result, more medical schools will incorporate the care of older adults into all of their preclinical studies. One way this can be achieved is through online training.

For instance, the Mayo Clinic College of Medicine has developed an online curriculum which allows medical schools instant access to 26 cases that address the fundamentals of senior care.

And Aquifer Geriatrics tests competencies in medication management, palliative care, and the ability for self-care. The curriculum is appropriate not only for primary care residents, but also for physician assistants and nurse practitioners.

In addition, it will become increasingly important in the coming years that medical practitioners in all fields maintain competence in geriatric principles.

Every U.S. state requires some type of Continuing Medical Education (CME) courses in order to maintain licensing. However, only one – California – currently requires geriatric education.

But as the demand for senior care increases, more states are expected to include a geriatric component to their mandatory CME for all providers.

Dr. Mary Tinetti is the chief of geriatrics at the Yale School of Medicine. She envisions an elite workforce of geriatricians who would train entire institutions in the specifics of caring for seniors. According to Tinetti, “The most important thing geriatricians can do is make sure all their other colleagues understand” how to properly care for older adults.

Her colleague, Dr. John Moriarity, an associate professor of medicine at Yale, agrees there’s an enormous need to provide geriatric training to PCPs.

“Primary care providers are on the front lines and will be the initial point of contact for many patients with geriatric syndromes,” he said.

With 10,000 Americans turning 65 every day, this is the future of healthcare.

Sources:
Featured Image: Adobe, License Granted

Assoc. of American Medical Colleges

National Center for Biotechnology Information

American Geriatrics Society

The New York Times

American Academy of Family Physicians

Understanding the Fair Credit Reporting Act – and Proposed Changes

Wed, 14 Jul 2021 16:45:00 GMT

Understanding the Fair Credit Reporting Act – and Proposed Changes

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How Collection Agencies Ensure
FCRA Compliance

Credit reports are used not only to determine a consumer’s eligibility for a loan or credit card, but also to qualify him for a job, insurance or residential lease. The information reported to credit bureaus can impact both the consumer’s credit rating and livelihood.

So having an error-free credit report is crucial. To address this need, the Fair Credit Reporting Act (FCRA) was passed in 1970. Over the years, there have been several modifications to the original act; the most recent is currently awaiting approval by the Senate.

Let’s look at how the current FCRA applies to debt collection, as well what the proposed changes would mean.

FCRA Basics

The FCRA is designed to protect consumer privacy, ensure that information supplied to the credit bureaus is accurate, and offer consumers a means for disputing inaccurate data. As furnishers of consumer information to credit bureaus, debt collectors have specific responsibilities under the FCRA’s “Furnisher Rule.”

FCRA Violations

One of the objectives behind the proposed changes to the FCRA is to reduce the number of violations. Some of the most common include:

Furnishing and reporting old information, or reporting an account as active when it was closed by the consumer.

Mixing consumer information because of identical or similar names or similar Social Security numbers.

Failing to follow FTC guidelines for handling disputes.

Pulling a consumer credit report for an impermissible purpose (e.g., to determine the amount of assets before filing a lawsuit).

Providing consumer information to unauthorized persons or businesses.

Specifically, they must:

Provide information that is accurate and complete, and
Investigate any consumer disputes pertaining to the accuracy of information they provide.

Ensuring Accuracy

It is illegal for debt collectors to furnish consumer information which they know or "have reasonable cause to believe" is inaccurate. Ensuring the accuracy of consumer information involves several steps. These include:

Establishing policies and procedures to verify the identity of the consumer;

Establishing controls to ensure the integrity of consumer data;

Maintaining consumer records for a reasonable amount of time;

Providing the date of the consumer's original delinquency and establishing procedures to prevent re-aging of accounts and duplicate reporting; and

Correcting and updating information as needed.

Consumer Disputes

If a consumer disputes information provided by a debt collector to a credit bureau, the collection agency must:

Advise the credit bureau that the information is disputed;

Conduct a reasonable investigation of the dispute;

Review all relevant information provided by the consumer with regard to the dispute;

Report the results of its investigation to the consumer before the applicable expiration period;

Promptly notify the credit bureau of the investigation's findings with regard to any inaccurate information that was furnished, and provide necessary corrections.

Proposed Changes to the FCRA

Last year, the U.S. House of Representatives passed the Comprehensive Credit Reporting Enhancement, Disclosure, Innovation, and Transparency Act , (known as the CREDIT Act). The bill now must be approved by the Senate.

While the CREDIT Act is primarily aimed at credit bureaus, data furnishers – such as collection agencies – will also be affected. The Act proposes several reforms, including:

--Article Continues Below--

Implementing easier processes for correcting credit report errors and consumer appeals;

Providing relief for student loan borrowers who have poor credit;

Requiring that paid or settled medical debts be removed from consumer credit reports;

Extending the time before medical debt may be reported and banning the report of any debt incurred for medically necessary procedures;

The CREDIT Act and

Medical Debt

The proposed changes to the FCRA as encompassed in the CREDIT Act specifically address medical debt in three ways:

Credit bureaus are required to remove fully paid or settled medical debt from a consumer's credit report.

Credit bureaus are prohibited from reporting debts arising from a medically necessary procedure.

For all other medical debts, credit bureaus must delay one year before the debt is listed on a consumer's credit report.

Restricting the use of credit scores for employment purposes;

Reducing the amount of time any adverse credit information can remain on a consumer credit report (four years for delinquencies instead of seven years, and seven years for bankruptcies instead of 10); and

Shortening the reporting periods for delinquencies from seven years to four years and for bankruptcies from 10 years to seven years.

Trust CBSI

At CBSI, we take FCRA compliance very seriously. That's why our compliance officer continually reviews our processes, ensuring that we proactively respond to the changing environment.

We extensively document all interactions with consumers. We've never been involved in an FCRA violation. And our compliance protocols ensure that we never will be.

Our collectors are highly trained to comply with ALL state and federal regulations, including FCRA, FDCPA and HIPAA. You need never worry about regulatory compliance when the professionals at CBSI have got your back.

Sources:
Featured Image: Adobe, License Granted
https://www.consumerfinancemonitor.com/2020/02/06/comprehensive-credit-act-moves-to-senate-after-passing-in-house/ https://www.consumerfinancemonitor.com/2020/02/06/comprehensive-credit-act-moves-to-senate-after-passing-in-house/

Consumer Finance Monitor
Boston University
I nsideARM
Federal Trade Commission

Dental Practices Best Methods to Improve Your Revenue Cycle

Thu, 24 Jun 2021 21:08:00 GMT

Dental Practices' Best Methods to Improve Your Revenue Cycle

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CBSI Revenue Cycle Webinar

(6-23-21)

This 30-minute webinar explores the best ways dental professionals can improve their revenue cycles without compromising the confidentiality, sensitivity and compassion so critical to the dental field. Discussion topics include debt recovery challenges specific to dental practitioners, credit reporting restrictions, and practical tips for effective accounts receivable,
during the coronavirus pandemic.

Tom Barrett:

Welcome, everyone, to our webinar, "Best Practices to Improve Your Revenue Cycle While Maintaining Patient Integrity." A few housekeeping notes: we will leave time at the end of the webinar to answer questions. Please type your questions into the question box at the bottom of your screen. We will also make a recording available to everyone who attends early next week. Let me introduce to you Brian Grimes, president of CBSI, and Megan Covert, sales and marketing associate. Brian?

Brian Grimes:

Good morning and welcome, everyone. My name is Brian Grimes and I am the company president at CBSI. And with me we have our sales and marketing associate, Megan Covert. Since 1955, CBSI has provided patient-friendly collection services for multiple industries. We work with over 100 dental practices in Iowa, and I've been supporting the Iowa Dental Association for over 20 years. As a "collection agency that cares," we focus on connecting with consumers, resulting in better returns while fostering genuine customer relationships.

Due to everything that everybody on this call has been experiencing in the last 15 months, the ADA report shows 2020 revenues were down by 38%. And estimates for ADA show that they will be down 20% in 2021. Our goal today is help recover some of that revenue in-house and the best methods to work with a third-party collection agency. And later in this presentation, we will address when is the best time to write off an account -- and your overall goal should be to write off 1% or less of gross revenue.

Megan Covert:

Revenue cycle improvements. The more work that is done upfront to collect payment, the better. With increasingly more self-pay patients using your services, do as much as you can to collect upfront. Pre-Service pricing is very important. Helping your patients understand what their costs are going to be upfront will greatly increase your chances of getting paid. Friendly and consistent communication is key. Giving your patients a feeling that you are working with them and not against them, will foster better relationships and will help in getting payments.

Also, engaging early with payment options, educating your patients on different ways payments can be made, will lead to more payments. And, finally, develop an insurance discovery process. Are there any payers that should be responsible for this bill? An insurance discovery solution can convert one to five percent of your uncompensated care accounts.

Brian Grimes:

Having well-trained staff on the front lines is crucial for your upfront collections. It can be tough to ask for payment. Make sure to train your staff to address payment issues in a tactful manner. It's really no different than the way that we train our collectors on overdue accounts. You need to cater your approach to the specific personality of the patient. For example, if someone is very emotional, you need to remain calm and composed. Acknowledge what the individual is saying, show empathy. But at the same time, ask for payment. If somebody is argumentative or does not believe that they owe payment, make sure to have all your ducks in a row. Produce documents for every denial or copay and have this ready ahead of time. If the staff member is still not able to ask for payment after extensive training, you may need to find a better fit for the position. Intake forms and patient contact info are key to the success of your collection agency.

Make sure you're obtaining as much information as possible on your intake forms, including date of birth, Social Security number and middle name, or at least the middle initial -- if you don't have a Social Security number and a date of birth as is required for credit reporting -- and employment, including employer phone number and address. And sometimes you can get this off the intake forms and insurance cards that you are getting from patients. Phone numbers are also very important -- include both landline and mobile numbers.

And email addresses. Although not currently widely used in collections, there is new legislation in the works, providing a safe harbor for a collection agency to use email in 2022. In the case of a child, be sure to collect information on the spouse as well. In Iowa, both parents are responsible for medical-related bills, regardless of what the divorce decree says. And among all the normal disclosures, make sure your intake forms grant permission to contact patients via autodialer phone calls, automated messages, email and texts.

Megan Covert:

Tips for a successful collection effort. Select the best personnel. If someone is uncomfortable asking for money, maybe you should make a change. The best customer service people know how to manage the call. It is important to be empathetic. However, allowing a call to go beyond several minutes is usually counterproductive. Actively listen, and keep the conversation focused on making the payment. Offering multiple payment options gives the patient the convenience of paying in the manner most comfortable for them. Offer credit card, check, online web portal, in person or ACH.

Initially during the call, try to achieve payment in full. However, being flexible in offering payment plans that can fit within their budget is critical to satisfying the debt. Automatic payments are an excellent method to ensure the debt is paid. Offer weekly, biweekly or monthly payment plans. Offer to schedule automatic payments to match their paycheck dates, usually bi-weekly or the first and 15th of the month. Try to get a commitment to make a payment today. Being flexible is also important. Offer to skip payments or move payments if someone loses their job or seems to be in a financial crisis.

Brian Grimes:

When do you use an agency? We all know that upfront collections are best. However, there will be times when you need to send somebody to collections. Megan and I get asked every day, "Now when is the right time to send an account to collections?" And our current best practices that we recommend is, once insurance has been applied -- typically 30 days after service -- send out your first statement. If no payment is received, send a past-due text, phone call, or email. And at the 60-day, mark send out a past-due statement. It's best if your past-due statement has a different look and feel from your first statement. Once again, if payment is not received, send out a past-due text, phone call or email. And at 90 days, send a final notice, explaining the account is going to be turned over to collections if not paid within X amount of days.

I recommend 10, as it creates a sense of urgency to the letter. And if no payment is received, collection agencies should come into play at 120 days past due. Now a lot of agencies push to send your account at the 30- or 60-day mark, but I just think this is too soon. Patient relationships are a concern. And obviously so are the commissions. However, if somebody is not willing to pay after three statements and 120 days, the stats show that you'll end up with more in your pocket by sending the account to collections than to just continue to send statements. Of course, there will be situations where you're waiting on insurance. However, if you're going past six months, it's really going to cost you, as bad debt is very time sensitive. Once an account goes to CBSI, we then verify addresses with the USPS. We scrub for bankruptcies and deceased accounts.

We then score each account based off its collectability. And then accounts are grouped with any other existing accounts in our database. And this currently happens approximately 90% of the time. And then we send out a validation notice. The law requires that patients be given 30 days to dispute a debt. Each letter has a linked or online payment negotiator to set up payment plans. And then the collection calls start. Credit reporting begins at roughly day 60, and legal action can be taken after all our regular collection efforts are exhausted. We only pursue legal when we believe that patient has the ability to pay, but is choosing not to. Potentially, the legal process could start sooner than this timeline, if we already have a relationship with that individual and already started the legal process.

You see in this chart, that collectability drops considerably over time. The longer you wait, the less chance that you have collecting the debt. After six months, the return rate drops dramatically. And after two years, you'll have very little chance of collecting any money.

Megan Covert:

Another way to look at this is, the longer your debt is owed, your dollar shrinks. Your dollar is worth considerably less, the longer the money is owed. This is why it's so important to have a consistent process in place to ask for the money. Using a professional collection agency is a key component in this process. The sooner you start the collection process, the more likely you'll collect.

Brian Grimes:

Different types of collection agencies. There are several national agencies. They typically market to a lot of dental practices where you pay for a prepaid letter service, charging by the letter. And you typically buy 100 accounts or more for maybe $1,200 or $1,400, to send out a series of three letters. And if it's not collected with the three letters, the accounts are then put into a contingency collection rate at a really high rate -- typically 50%. They do push to send accounts very early in the process, and maybe, when all it would take is to send out another statement to get paid. These agencies typically do not credit report at all. They almost never pursue legal.

The collection agency in these scenarios gets paid regardless of the results. And it typically results in very low return rates. I do have a real-world example of a dental practice that we currently work with that was utilizing one of these services. The letter service, when adding up the cost of the upfront cost of every letter -- and keeping in mind, you can't collect everything -- and the high 50% contingency rate, effectively the dental practice is being charged a 34% commission, right? They had an overall return rate of only 16%.

We actually worked those accounts on what we call a "second placement," as they had already been with that agency. And our current return rate on those accounts is at a 46%. And on their first-placement return, it has tripled with CBSI and we're charging essentially the same commission rate. Letter services may be worth it, if your average balance was like, say over $1,000. But typically dental clients' average balance is maybe $150 to $200. At CBSI we work on a contingency basis, where we only get paid on what we collect.

Megan Covert:

So here's what to look for when choosing a collection agency. An agency that works your local market will generally return more than a national agency. A local agency will usually have more patient or patient contact information, because they are working at the local market extensively. You will want to ask the agency about their license. Many states require licensing, and this is important because it protects the patient and you, the client or provider.

Also check, can the agency pursue legal? Not all agencies offer legal services, which can include pursuing a judgment. At CBSI we pursue legal via right of assignment in CBSI's name, not yours. So we only pursue legal in situations when the patient has the ability to pay, but is just choosing not to. And we do have the ability to accurately determine if the patient has the ability to pay. Membership in the Association of Credit and Collection Professionals, ACA International, indicates that the agency adheres to industry standards for ethical and professional conduct.

Also check the agency's Better Business Bureau rating and Google reviews, although sometimes individuals will complain to get out of paying a legitimate debt. Make sure your agency is responding to any complaints and does not have an unusually low rating. Also, having access to a secure online website can save you time and give you information about your accounts 24/7.

Brian Grimes:

A little bit about CBSI is, we are a consumer-friendly debt collection agency and we've been in business for over 60 years. Now, a lot of agencies are moving much more towards a consumer-friendly approach, but sometimes it's hard to teach an old dog new tricks on the collector side of things. Luckily, we've always had this mentality, and we just do not get complaints about our team. Our collectors are flexible and take pride in helping a patient get out of debt. We also have a very large Iowa database. CBSI has over 1,300 clients and almost two million accounts in our database. If you don't have a good address or phone number for a patient, we probably do. On average, 90% of the time you send us an account, we already have that name in our database, because they owe one of our other clients money, as well.

The net result is more accurate data, established relationships, and a higher recovery rate. We work in multiple industries. We may get a new account with more current information, even down the road. Skip tracing. We can find patients that have moved without leaving any type of forwarding address with our database, as well as a lot of other pay for one. We do credit report. CBSI is a credit bureau. And after a grace period of approximately 60 days, we'll leverage credit reporting to collect on your debt. And with your permission via right of assignment, we can pursue legal in CBSI's name to garnish wages and collect the debt. We find this an effective way to recover on accounts that can pay, but choose not to.

In industry experience, we currently work with over 100 dental practices. And we find that patients that don't intend to pay when they come in, kind of bounce around from one dental practice to another, which once again allows us to combine efforts -- to combine all accounts potentially into one small claims lawsuit. We are complaint-free and we treat all patients with the utmost respect and do not harass with multiple calls per day. We have an A+ rating with the BBB and we work strictly on a contingency basis and only get paid on accounts that we collect.

Brian Grimes:

And with that, I'd love to open it up to any questions that might be out there.

Tom Barrett:

Thank you, Brian. We do have a question here that says, "Why should I pay you to collect my money?"

Brian Grimes:

Sure, Tom, I can grab that. You know, I look at it differently than that. We do take a percentage, yes, on what we collect. But the end result is we're going to collect way more than you would have. And especially on those accounts that you've given up all your efforts on. So in the end, I look at it as though it's going to cost you money by not sending somebody to collection versus to continue to send statements out.

Tom Barrett:

Brian or Megan, we have another question here. How can you collect overdue bills when I can't?

Megan Covert:

Yeah, I can answer that one. So that credit reporting really helps that piece out. I mean, you know, this stays on their credit report from seven years of date of service, and if they go to get a loan, you know: House, car or anything like that, that's going to show up. And they're going to have to get that paid to get that loan. So, and also like we mentioned the legal as well. If it comes to that point, we can definitely pursue legal and get that garnishment as well.

Tom Barrett:

How much will your services cost me typically?

Brian Grimes:

Tom, what we do is we look at somebody's average balance and their volume. Average balance is really our biggest concern. Our goal is to come up with a rate that should lead to the highest rate of return on your accounts. So it can vary depending on what kind of volume and that average balance. But the ultimate goal is to get the highest rate of return in dollars back in someone's pocket.

Tom Barrett:

Brian and Megan, I have another question that came in. How will my patients be treated?

Megan Covert:

Yeah, I can answer that. So at CBSI, I mean we really believe that being "Iowa nice" is the right way to treat people. So we're very understanding, you know. We really like to work with that person. If they can't pay in full right away we understand and we offer payment plans and things like that. We also have an online web portal that they can go to and do a little payment negotiator on that as well. But we really believe that being nice to people, you know, is the best way to get a payment, and being rude and nasty doesn't help things. So, and not everybody expects to go into debt, so we really try to help people out.

Tom Barrett:

Here's another question. How will I know the status of my accounts?

Brian Grimes:

Sure, Tom. I can grab that. We have a web portal that our clients can log in 24/7, see the status, run reports, and upload accounts, even send messages back and forth. It's all HIPAA compliant and secure. It's actually double the encryption requirements for HIPAA and has the highest rating in our industry for security.

Tom Barrett:

Thank you. What if my mail is being returned and we don't have another address?

Brian Grimes:

We can utilize skip tracing, Tom. And a lot of times we have that already in our database, but we do have multiple different databases that we're able to locate folks. All the way down to potentially even looking online, trying to find individuals through social media and whatnot. A good skip tracer is really like a detective. And our collectors are very good at it, and they are rewarded when they're able to find somebody.

Tom Barrett:

Well, Brian and Megan, that looks like all the questions we have right now. Thank you so much. Is there anything you'd like to add?

Brian Grimes:

No, Tom. Thank you. I appreciate everybody on the call, and thank you guys very much for your time.

Demand for Telemedicine Continues

Fri, 21 May 2021 20:14:00 GMT

Demand for Telemedicine Continues

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More Patients Choosing Telehealth
Over Office Visits

Iowa healthcare providers report that the demand for telemedicine remains higher than ever.

Last year, fear of COVID-19 was the impetus behind the initial surge in telehealth across the state. But even though most clinics and other healthcare services are now open and receiving patients, telemedicine is still preferred in many cases.

Pandemic-Fueled Technology

In 2020, the AMA reported that 60% to 90 of physicians nationally were relying on telemedicine during the pandemic. In Iowa, UnityPoint Health saw telehealth visits increase from 6,700 in the months before COVID to more than 174,000 during the pandemic. And Mercy Medical Center in Cedar Rapids reported 49,000 telehealth visits between March and December 2020, compared to less than 1,000 for all of 2019.

This demand fueled the development of much more sophisticated telehealth platforms. Providers can now diagnose and treat patients via high-resolution, secure video. The new technology also allows:

Sharing of medical images and health data,
Real-time online chats,
E-prescribing services, and
Medical device integration.

In addition to connecting providers to patients, high-tech innovations are being used to connect providers to other providers. And to connect a single patient to more than one provider, such as when seeking a second opinion.

A Boon to Rural and Underserved Areas

Telemedicine advocates have long promoted it as a potential solution for improved access to healthcare services, especially in rural areas with limited resources. (See sidebar, “Rural Iowa Healthcare.”)

Rural Iowa
Healthcare

Forty percent of Iowans reside in rural communities. As of January 2021, they have access to the following healthcare facilities:

82 critical access hospitals

199 rural health clinics

47 federally qualified health center sites located outside of urbanized areas

14 short-term hospitals located outside of urbanized areas.

Source: Rural Health Information Hub

But reliable broadband internet access is a prerequisite to providing telehealth to rural populations. And although Iowa’s broadband coverage is relatively even throughout the state, its download speed is the second slowest in the country. (Only Alaska is slower.)

Even so, medical specialists throughout the state have noticed a surge in telemedicine preference among their more rural patients. Rather than drive long distances to see a specialist, patients are consulting with their doctors from the comfort of their own homes, or even their cars.

Primary care and post-operative follow-up visits also lend themselves well to telemedicine, as long as no medical procedure is required.

Benefits to Providers

Because of the convenience telemedicine offers to patients, providers are noticing a decrease in no-show and cancellation rates, which is helping them stay on schedule. Virtual visits take less time, allowing providers to increase their efficiency and treat more patients.

Telehealth also allows physicians to reach out to their patients regularly to ensure proper management of their condition. And whenever providers can easily meet with their patients, they report increased job satisfaction. What's more, telemedicine has been shown to reduce overall healthcare costs by about 20 percent .

Getting Paid

Oftentimes patients pay for their virtual visits directly. However, most states (including Iowa) require health insurance companies to cover telemedical services in the same manner that they cover services delivered in person. Likewise, the Centers for Medicare & Medicaid Services (CMS) continues to pay for virtual visits at the same rate as office visits while the COVID pandemic continues.

Several real-time telehealth platforms include a billing component, allowing healthcare providers to collect payments and file claims. Such platforms can be integrated with the provider’s electronic health record (EHR). In all cases, the documentation for virtual visits must meet the same criteria as in-person visits, in order to qualify for payment.

--Article Continues Below--

Potential Drawbacks and Barriers

But telehealth cannot recreate the hands-on component of a standard office visit. Nor can patients undergo procedures or imaging tests remotely. As a result, diagnosis can be more difficult. And, of course, patients who require urgent medical attention must always be seen in person.

Additionally, some providers are concerned that poor broadband connections and other technical problems could have serious repercussions.

For instance, a disconnected virtual consultation could result in a patient following the wrong treatment regimen.

Lack of familiarity with technology is another potential barrier. Elderly patients or those who are not tech-savvy may need to be walked through a virtual meeting. Most physicians have neither the time nor the staff to deal with IT issues before initiating a virtual visit.

Healthcare’s Future?

Despite limitations, telehealth is often the best alternative for patients who are unable or unwilling to schedule an in-person visit. It allows providers to consult with and treat patients who reside miles away. It can offer improved access to better care.

It could very well be the future of healthcare.

Sources:
Featured Image: Adobe, License Granted

Animated Image: Giphy.com

The Gazette

CDC
American Medical Association
Cureatr
Becker's Hospital Review s://www.beckershospitalreview.com/healthcare-information-technology/overcoming-4-challenges-in-implementing-telemedicine-healthcares-next-frontier.html

CBSI Best Practices for Mental Health Professionals

Mon, 12 Apr 2021 13:20:00 GMT

Mental Health Professionals Best Practices for Revenue Cycle Improvements

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CBSI Revenue Cycle Webinar

(3-11-21)

This 30-minute webinar explores the best ways mental health professionals can improve their revenue cycles without compromising the confidentiality, sensitivity and compassion so critical to the mental health field. Discussion topics include debt recovery challenges specific to mental health practitioners, credit reporting restrictions, and practical tips for effective accounts receivable.

Tom Barrett:

Thank you for joining our webinar. That's "Mental Health Professionals -- Best Practices to Improve Your Revenue Cycles." With me today are Brian Grimes and Megan Covert. Brian?

Brian Grimes:

Thanks, Tom. Good morning and welcome everyone. My name is Brian Grimes. I am the company president at CBSI and with me, I have our sales and marketing associate, Megan Covert. Since 1955, CBSI has provided patient-friendly collection services for several industries, including mental healthcare professionals. As a collection agency that cares, we focus on connecting with patients, resulting in better returns while fostering genuine patient relationships. As we all know, the amount of self-pay medical debt is rising dramatically. On average, patient pay now represents 30% of provider revenue. High-deductible health plans are on the rise and 68% of patients under 65 high-deductible health plans. At CBSI we're seeing a dramatic rise in people registered as self-pay. In other words, you know, people without health insurance. And overall the number of uninsured patients has increased more than 12%. That's why it's extremely important for you to maximize your amount of self-pay collected both on the front end and on the back end.

Megan Covert:

Revenue Cycle Improvements. The more work that is done upfront to collect payment, the better. With increasingly more self-pay patients using your services, you need to do as much as you can to collect the payment upfront. Pre-service pricing is the most important priority. Helping your patients understand what their costs are going to be upfront greatly increases your chances of getting paid. Friendly and consistent communication is key. Giving your patients the feeling that you are willing to work with them -- not against them -- will foster better relationships and will help in getting payments. Engage early with payment options.

Educating your patients on different ways payments can be made will lead to more payments. And finally develop an insurance discovery process. Are there any payers that should be responsible for this bill? (Workman's comp, auto insurance, Medicaid presumptive, etc.?) An insurance discovery solution can convert 1% to 5% of your uncompensated care accounts.

Brian Grimes:

A well-trained staff on the front lines is crucial for your upfront collections. It can be tough to ask for payment. You need to make sure that your staff is able to address payment issues in a tactful manner. It's really no different than the way that we train our collectors on overdue accounts. You need to cater your approach to the specific personality of the patient. For example, if someone is very emotional, you need to remain calm and composed.

Acknowledge what the individual is saying, show empathy, but at the same time, ask for payment. If somebody is argumentative or doesn't believe that they owe payment, make sure to have all your ducks in a row. Produce documents for every denial and copay and make sure to have that ready ahead of time. If the staff member is not able to ask for payment after extensive training, you may need to find a better fit for the position.

And intake forms and patient contact info are key to the success of your collection agency. Make sure you're obtaining as much information as possible on your intake forms, including date of birth, social security, number, middle initial, employment (including employer phone number and address). And sometimes you guys can find this right off your insurance cards that people have. And phone numbers are also very important -- both landline and mobile numbers -- and email addresses as well. It's not currently widely used in collections, but there is some new legislation in the works providing a safe harbor for agencies to use email.

And due to high legal and privacy concerns, we do not currently utilize credit reporting in the mental health field. In the case of a child, do make sure you get all the information for the spouse as well, as both parties are responsible for medical debts, regardless of what the divorce decree says. And among all the normal disclosures, make sure your intake forms grant permission to contact patients via autodial, automated messages, email and text.

Megan Covert:

So having multiple payment options for your patients is very important. We all like to have options, and we want the payment process to be convenient. Your more traditional patients will still want the ability to pay by check and mail their payment in, so they need to have this option. Online bill pay is becoming increasingly popular, especially with the millennial population. They want to be able to access their account from their computer or their phone and make their payment. CBSI receives 20% of its total payment revenue online.

Acquiring credit card information and keeping it on file for payments is another way to make sure payments can be made. Letting your patients set up a reasonable payment plan is very important. Having to pay a bill in full can be very overwhelming for some patients, which is why they just don't pay at all. But if they know they can set up a plan that will work within their budget, they'll be more likely to pay. Setting up automatic payments is also a good option.

Brian Grimes:

Upfront collections are truly best. However, we all know there'll be times where you have to send somebody to collections. You know, Megan and I get asked this every day, "When is the right time to send an account to collections?" And typically our current best practices include the following: Once insurance has been applied, typically 30 days after the service, you send out your first statement. And if no payment is received, send out a past-due text, phone call, or email. And at the 60-day mark, send out a past-due statement as well. And have a different look and feel to that second statement, if you can. You want it to, I guess, escalate things. And once again, if payment is not received, send a past-due text, phone call or email. And at 90 days, send out a final notice. You can explain they're going to be turned over to collections if not paid within X amount of days.

And I typically recommend 10 (days), as this creates a sense of urgency. And if no payment is received, the collection agency should go into play around 100 or 120 days past due. Now a lot of agencies do push to send the account sooner, like the 30- or the 60-day mark. Although I really think it is too soon. Your patient relationships are a concern, obviously. So are commissions, at that point, from the collection agency too. So if somebody is not willing to pay after three statements and 120 days, the stats do show that you end up with more in your pocket by sending that account to collections, than just to continue statements. Of course, there are situations where you may be waiting on insurance, or if you're going past six months, it's going to cost you, as that is very time-sensitive. So once an account goes to collections with CBSI, we then verify addresses with the USPS.

We scrub for bankruptcies and deceased accounts. We score each account based off the collectability. And the accounts are then grouped with any other existing accounts we have in our database. And currently that happens roughly 90% of the time. Then send out a validation notice. There's a law that requires patients be given 30 days to dispute a debt. And each letter has a link or online payment negotiator to set up payment plans.

And then next, the collection calls start. And legal action can be used after regular efforts are completely exhausted. And we only pursue legal if we believe the patient has the ability to pay; however, he's choosing not to. And this chart shows that collectability drops over time. The longer you wait, the less chance you have of collecting the debt. And after one year, you'll have less than half of what is owed. And after two years, you have very little chance of collecting any money at all. So this chart represents all debt collections, not necessarily just medical.

Megan Covert:

Another way to look at this is, the longer your debt is owed, your dollar shrinks. Your dollar is worth considerably less the longer the money is owed. This is why it's so important to have a consistent process in place to ask for the money. Using a professional collection agency is a key component in this process. The sooner you start the collection process, the more likely you'll collect.

Tom Barrett:

So with me today is Amy Vroegh. Amy has been with CBSI for the last 14 years. She is their collections manager, and she's going to walk us through a typical collection call. She'll follow it up with tips for a successful collection call, and then what we are experiencing today with collections during the pandemic. Amy, how are you doing?

Amy Vroegh:

Good. How are you?

Tom Barrett:

Good. Will you go through a collection call with me, just for our audience, so they can understand what a typical collection call would sound like?

Amy Vroegh:

Sure.

Tom Barrett:

Okay. So I'll be the debtor. You'd be the collector.

Amy Vroegh:

Hi, is this Tom Barrett?

Tom Barrett:

Yes, this is him.

Amy Vroegh:

Good morning, Tom. This is Amy calling from the Credit Bureau Services of Iowa, and we are a debt collection agency. Can you verify the last four of your social or date of birth so I can verify I have the correct Tom?

Tom Barrett:

Yes. It’s 4525.

Amy Vroegh:

All right, Tom. So I do need to tell you since it's the first time we've spoken, we are the Credit Bureau Services of Iowa. This is an attempt to collect a debt and any information obtained will be used for that purpose. I'm giving you a call today, Tom, about an account that was placed in our office for collections from ABC Hospital. It looks like it has a balance of $1,200 from a date of service of 2/3 of 2020. I was just calling to see if you could possibly take care of that today or set up some sort of payment arrangements with us.

Tom Barrett:

Well, Amy, I don't know of anything that I owe.

Amy Vroegh:

Do you remember possibly being at ABC Hospital back in February of 2020?

Tom Barrett:

Yeah. It was an emergency room visit. And I thought my insurance covered it.

Amy Vroegh:

Okay. Well, I will tell you, Tom, most of the time when it's during the first of the year, you probably haven't met your deductible or co-insurance yet. So that's possibly what this balance could be for. A lot of times you'll get an EOB from your insurance company, letting you know what your balance could possibly be. Do you remember getting something like that?

Tom Barrett:

No, I don't. What's an EOB?

Amy Vroegh:

It's called an explanation of benefits. Your insurance company provides it to you to let you know what portion of the bill's been paid by them and what portion is your responsibility.

Tom Barrett:

Well, I don't pay too much attention to those things.

Amy Vroegh:

Yeah. It's kind of like other mail. You don't look at it as closely.

Tom Barrett:

Okay. So how can I satisfy this debt?

Amy Vroegh:

Well, if you could take care of a day, that'd be great. If you're unable to do that, we can definitely set up payment arrangements. Are you working at this time, Tom?

Tom Barrett:

Yes, Amy, I'm still working at the hospital. But it's been kind of rough. They've had some layoffs and I'm just not sure about my job right now.

Amy Vroegh:

I understand with the pandemic right now, everything's a little uneasy. So I understand. We're more than willing to work with you, Tom. Like I said, we could set up payment arrangements. Would you possibly be able to pay like $600 of it today and then set up payment arrangements on the balance?

Tom Barrett:

$600 is a little bit much. And then how long on the balance?

Amy Vroegh:

With a balance that size, if we were setting up payments on $600, if you could do at least $100 a month, I would be more than willing to work with you on that.

Tom Barrett:

I can't do $600 now. Um, I could do $400.

Amy Vroegh:

Okay. I would be willing to work with that. And then we could set up on the balance bi-weekly, weekly, monthly payments. Whatever works more convenient for you.

Tom Barrett:

You sound pretty easy to work with. I get paid on the first and the 15th of every month, and I could handle, I think, $100 the day after I get paid.

Amy Vroegh:

Okay. So do $100 biweekly then? That'd be $200 a month. And that would get you taken care of with your balance of $800 in about four months. Would that work for you, Tom?

Tom Barrett:

Yeah, but I can't do $400 plus $200 this month. So could I start the payments on the first of next month and pay the $400 now?

Amy Vroegh:

Sure. I would be happy to do that with you.

Tom Barrett:

So, okay. How can I pay you the $400?

Amy Vroegh:

We can do debit card, credit card, check by phone. We have an online web portal that you can go to, Tom. Or you can mail it to us or, if you're here in town, you can drop off your payment.

Tom Barrett:

Hmm that's sounds pretty easy. Um, okay. Let me pay with a check. You can take an ACH over the phone?

Amy Vroegh:

Yes, sir.

Tom Barrett:

And I'm worried about my job. What happens if I lose my job?

Amy Vroegh:

Just keep in contact with us, Tom. If something comes up and you're unable to make the payments, we are more than happy to work with you. We can skip payments, we can lower the payment. Whatever makes you feel more comfortable, we can work with you to try to get it taken care of.

Tom Barrett:

Okay. Okay, good. So, Amy, you sound really nice to work with. Here's what I see happening during a collection call. And this applies, I think, to first party, as well as third party. I think it's really important that you asked me, "How can we help you?" Your people are trained to do that, aren't they?

Amy Vroegh:

Yes. You know, we all truly feel that we are here to help people. You know, nobody expects to be in debt, especially for medical bills. We don't expect to have to go to the hospital. So in these instances, we are here to help them resolve the debt and help our clients as well.

Tom Barrett:

So I would imagine that you might get some people that are pretty upset that you'd be calling during a pandemic.

Amy Vroegh:

We do once in a while, but not very often. You have to remember that they're not upset with you. They're upset with the situation. We try to "talk them off the ledge," so to say, and work with them to resolve the issue and get the debt taken care of.

Tom Barrett:

So if I had started to talk about my sick mother or concerns that I have for my children, and they're not in school now, how do you handle that?

Amy Vroegh:

We do our best to listen. We want them to know we care and we're here to help. But we also try to get back on task to get the account taken care of.

Tom Barrett:

So, how has it been going since people have been getting their stimulus checks?

Amy Vroegh:

Rather well. More people are calling or answering the phone when we call. You know, they want to talk. They're stuck at home and they have time to look at things and work on things of their own. So they're more likely to answer the phone and willing to set up payment arrangements or work to take care of whatever they've got here.

Tom Barrett:

And as I understand it, most of your collectors have been in a similar situation where they're a debtor and they owe a bill.

Amy Vroegh:

Yes, yes. We've all been there. So we understand and, you know, you treat each other just like you would want to be treated if you were on the other end of the phone. So we do our best to work with them and make them understand that we're here to help.

Tom Barrett:

So do you ever get any compliments?

Amy Vroegh:

We do on occasion. Yes.

Tom Barrett:

So here's some of the things I think that we've seen, and this is true especially for first-party collections. The most important piece is that you select personnel who are willing and really do want to help people settle their medical bills. Whatever it is, most people by and large do not want to be in debt. And if they can see a way out of it, they would really like to pay it off. Amy, do you agree?

Amy Vroegh:

Yes, very much so.

Tom Barrett:

So the people, the personnel, that you select also have to be able to manage the call. So the right people doing this is really important. And they have to have the time to manage a ton of phone calls. And so that it doesn't go on and on and on.

Amy Vroegh:

Right.

Tom Barrett:

Amy, do you have a time limit on your calls?

Amy Vroegh:

Well, we try to let the collector make that decision, but we also want them to know that, you know, you can't spend 20 minutes on the phone with a consumer discussing their family issues. But we also want to listen. So, you know, we do our best to make it work.

Tom Barrett:

Yeah. You bring it back to the conversation, back to the subject and you keep on asking for payment.

Amy Vroegh:

Yes. Because we're here to get the client their money, as well.

Tom Barrett:

And as I understand it, the online payment has been a tremendous support mechanism.

Amy Vroegh:

It has, and we have a lot of people going online to set up payments.

Tom Barrett:

So they can check their balance. They can see exactly when it's going to be paid off. They know where they stand at all times. And I noticed that you asked for payment in full, but you pretty quickly split it down and gave me the offer that I could make payments.

Amy Vroegh:

Right. Because not everybody has extra money sitting around. But if they do, that's the opportunity to say, "Hey, let's get this taken care of, so it's not here in our office." But if they don't, we're willing to work with them to set up those payment arrangements.

Tom Barrett:

And you really seem to want some sort of payment today. You want to come off the phone with some commitment.

Amy Vroegh:

Yes. We do.

Tom Barrett:

Okay. So being flexible is critical.

Amy Vroegh:

It is. Very much so.

Tom Barrett:

And on a balance that I had of $1,200, how low would you have gone?

Amy Vroegh:

With the pandemic and the situations going on... Most of the time I would tell you that we would like to have at least $100 to $150 a month to get this taken care of in a decent amount of time. But with things going on right now, I would tell you that we would go down to $50 a month on that.

Tom Barrett:

Okay. So flexible is important and supportive is critical.

Amy Vroegh:

Yes.

Tom Barrett:

Anything you'd like to add?

Amy Vroegh:

We also are reaching out or letting our consumers know of certain resources that they can get to. You know, 211, the United Way. Also, putting them in touch with state and federal benefit places that they can get in contact with. And letting them know that they could possibly apply for Medicare or Medicaid. Just things to help them out. So they understand that there is help out there if needed.

Tom Barrett:

Sweet. So what have you been experiencing since the pandemic first started?

Amy Vroegh:

Just more people calling, more people answering and wanting to take care of their debts. It's a concern and now they have time to do so.

Tom Barrett:

So you're experiencing a high connection rate as well as a pretty high collection rate.

Amy Vroegh:

Yes. Yes, we are right now.

Tom Barrett:

And people seem to have time on their hands.

Amy Vroegh:

They do.

Tom Barrett:

And then, Amy, you also said that, for people who really can't pay, you do have resources available for them. And as I understand it, in Iowa, there's a 211 that leads into the United Way and they can provide childcare resources, Medicare/Medicaid resources. Presumptive Medicaid is a pretty interesting concept. It's been expanded. So it's no longer limited to pregnant women and children. Most of the hospitals are aware of this, but a lot of the private practices are not. And the goal of the presumptive Medicaid eligibility process is, a practice can offer immediate healthcare coverage if they qualify for Medicaid before a full Medicaid determination has been made. And you also will refer people to local food banks and you have a list of mental health resources.

Amy Vroegh:

Yes, we do.

Tom Barrett:

Yeah. You sound like you really enjoy your job.

Amy Vroegh:

I do. I've been here 14 years and I truly love what I do. I am here to help and get people out of debt. Nobody wants to be in debt and nobody wants to have to deal with a collection agency. But we want them to feel comfortable if they have to deal us.

Tom Barrett:

I also understand most of your collectors have been there for a long time.

Amy Vroegh:

Yes. Yes, they have.

Tom Barrett:

Well thanks very much, Amy. Anything you'd like to add?

Amy Vroegh:

Nope.

Tom Barrett :

Okay. Back to you, Megan.

Megan Covert:

Thanks, Tom. Thanks, Amy. So if you're considering a collection agency, here are some things you'd want to look for. An agency that works your local market will generally return more than a national agency. So a local agency will usually have more patient contact information because they are working with the local market extensively.

You'll want to ask the agency about their license. Many states require licensing. This is important because it protects the patient and you as the client or provider. Also check, can the agency pursue legal? Not all agencies offer legal services, which can include pursuing a judgment. At CBSI we pursue legal via right of assignment in CBSI's name, not yours. We only pursue legal in situations when the patient has the ability to pay, but is just choosing not to.

And we do have the ability to accurately determine if the patient has the ability to pay. Membership in the Association of Credit and Collection Professionals (also the ACA international) indicates that the agency adheres to industry standards for ethical and professional conduct. Check the agency's Better Business Bureau rating. Although sometimes individuals will complain to the Better Business Bureau to try to get out of paying a legitimate debt, make sure your agency is responding to any complaints and does not have an unusually low rating.

Having access to a secure online website can save you time and give you the information about your accounts 24/7. So a low contingency rate can be misleading. Most agencies work on a contingency basis and only get paid when you get paid. Some agencies will offer an exceptionally low rate to get your business. However, a low rate will not maximize your recovery. Net dollars returned, which is the amount of recovered dollars less the agency's pay, is a better measure of an agency's performance.

Brian Grimes:

Thanks, Megan. And just a little bit more about CBSI in general is, we are a patient-friendly debt collection agency. We have been in business for over 60 years. And as you guys heard with Amy there, we're very flexible. And we take pride in helping patients get out of debt. And a lot of agencies are moving much more towards a patient-friendly collection approach, but you know, sometimes it's hard to teach an old dog new tricks, especially on the collector side. So we are very familiar with mental health type collections and our clients can sleep at night, knowing that we are very serious about your patient’s experience and privacy. We have a really large local database. It's one of the main things about CBSI, almost 1,300 clients, mostly Iowa, two million collection accounts in our database. And if you don't have a good phone number or address for a patient, we probably do.

I mentioned earlier, I think 90% of the time when you send us an account, we already have that name in our database. So they owe one of our clients -- other clients -- money as well. So the net result is more accurate data, already-established relationships, and a higher recovery rate. And we work in multiple industries. We may get a new account even down the road, after we've gotten yours, with more current information, and then we can revisit all accounts at the same time. And skip tracing. We can find patients that have moved with our own database. Also several other pay-for databases to find addresses. And we do pursue legal. Roughly I'd say 95% of our mental health clients do allow us to pursue legal via right of assignment. We're going to pursue that in CBSI's name, and then typically garnish wages to find a way to collect on that.

It is effective on those accounts that can pay, but kind of choose not to. We also keep everything private by only pursuing a single party on those lawsuits, and we redact all medical information. And industry experience. We do work with multiple mental health professionals, including some pretty large ones here in the state of Iowa. And we are complaint-free, and we have an A-plus rating with the BBB. And we work strictly on a contingency basis and only get paid on accounts that we collect. So with that, I want to thank everybody and open it up to questions. If anybody has anything out there that they'd like to ask.

Guest:

I guess my question would be, what would be the lowest amount owed that you would be willing to take? I mean, that you would take on a client that owes what low amounts, like $30, $60, $80, or does it have to be in the hundreds?

Brian Grimes:

A lot of agencies do have a minimum dollar amount placement. Usually it's $50 or $100, somewhere around in there. Ours is we say typically $20, because a lot of times we already have that name in there, just adding another account to the mix, so to speak. Or if you have several encounters, for example, small deductibles, that add up to be $20 or more, we would be glad to take a look at those accounts. We also typically draw the line at five years of age on accounts. Now, obviously not as collectible, like we mentioned earlier, but we can have pretty good luck on some older accounts. You'd be surprised just being able to find people is more or less than anything. So five years is roughly where we draw the line there.

Guest:

Thank you.

Brian Grimes:

We do seem like the go-to for mental health facilities, just because of our approach. And it's not just that way for mental health folks, it's for medical and everybody else out there. And that's what they've always kind of wanted is to, you know, have that patient friendly. And I think it works a lot better here in Iowa. We'll get, you know, more luck with kindness.

Tom Barrett:

Brian, you can also gauge a little bit by your experience on the collectability of an account too, can't you?

Brian Grimes:

That does help a lot. You know, not only that database, if we have that account in there we can tell, "Oh, well we've already got a hundred accounts on this person. They've never paid a dime." Are we going to beat that to death? Probably not. But you have somebody who's working full-time and they're not paying, you know, we have more leverage there for sure.

Tom Barrett:

Thank you, everybody, for joining our webinar, "Mental Health Professionals -- Best Practices to Improve Your Revenue Cycles."

Bankruptcies Lowest in 35 Years, Despite COVID-19 Recession

Thu, 18 Mar 2021 12:09:00 GMT

Bankruptcies Lowest in 35 Years, Despite COVID-19 Recession

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Unemployment Was Way Up,
But Bankruptcy Filings Are Way Down

An economic downturn and increased unemployment typically result in more bankruptcies. But with last year’s COVID-related recession, the reverse occurred.

Given 2020’s economic climate, U.S. bankruptcy filings were expected to soar. They didn’t. Instead, the total number of bankruptcies filed fell by 28 percent – the lowest in 35 years .

Nothing Normal About It

The data defies normal economic patterns, according to researchers from both Harvard Business School and Columbia Law School . Historically, consumer bankruptcy filings mimic unemployment claims. As job losses increase, bankruptcy filings climb as well. This correlation was particularly strong during the economic recession of 2007-2009.

But even though 2020 witnessed the highest jobless rate since the Great Depression, consumer bankruptcies declined dramatically – and immediately – after a national emergency was declared. What’s more, the states with the largest increases in unemployment have seen the sharpest decreases in bankruptcy filings.

The statistics have baffled experts and left them searching for answers.

Record Number of
Chapter 11s

Chapter 11 business bankruptcies (used primarily by large corporations) showed the only increase over 2019. In fact, the largest corporations -- those with more than $50 million in assets -- filed in record numbers in 2020.

However, when small businesses are included, the total number of business bankruptcies was down.

Types of Bankruptcy

People are often surprised to learn that there are actually six different types of bankruptcy protection under the U.S. Bankruptcy Code:

Chapter 7 Liquidation for individuals and businesses

Chapter 9 Reorganization for municipalities

Chapter 11 Reorganization for corporations, LLC’s or partnerships

Chapter 12 Reorganization for fishermen and family farmers

Chapter 13 Reorganization for individuals (including sole proprietors)

Chapter 15 Cross-border Insolvency for foreign companies with U.S. debts.

Of these, Chapters 7, 11 and 13 are by far the most common.

In a Chapter 7 liquidation, debts are essentially wiped clean, with no obligation to repay. In 2020, more than 367,000 – almost 70 percent of all bankruptcy filings – were Chapter 7. As large as that number is, it still represents a 30 percent reduction compared to 2019.

Chapter 11 reorganization allows businesses to remain operational while restructuring their finances in order to pay their debts. Last year, more than 7,800 businesses (and a few individuals) filed for Chapter 11. This was the only bankruptcy type which showed a significant increase over 2019 – up by 29 percent. (See sidebar, “Record Number of Chapter 11s.”)

Chapter 13 is a three-to-five-year repayment plan that allows individuals to reorganize their finances in order to retain certain assets, such as a home. In 2020, almost 153,000 consumers and sole proprietors filed Chapter 13, compared to about 283,000 in 2019 – down 43 percent.

Unraveling the Mystery

Several possible explanations have been offered as to why the 2020 bankruptcy rate did not parallel last year’s high unemployment:

Limited Access to Services

Social distancing restrictions and shutdowns may have limited consumers’ access to bankruptcy attorneys and (in some states) bankruptcy courts. As the pandemic worsened, many courts shifted to online proceedings in the interest of public safety. Despite no official stay-at-home orders, most Iowa lawyers also chose to work remotely.

Too Broke for Bankruptcy

Some bankruptcy-eligible consumers may have lacked the financial resources needed to pay for a bankruptcy. The average Chapter 7 filing costs about $1,500 in attorney fees and court costs. This explanation is supported by the fact that consumer Chapter 7 filings did increase somewhat shortly after stimulus checks were distributed in mid-April.

Financial Aid

Government assistance through the $1.2 trillion CARES Act and the Paycheck Protection Program may have provided all the cash some consumers and small businesses needed to stave off bankruptcy during shutdowns. (Surprisingly, however, as these government programs expired toward the end of the summer, there was no upsurge in bankruptcy filings.)

--Article Continues Below--

Suspension of Collection Activities

State and local governments, federal agencies, and private businesses temporarily halted evictions, foreclosures, garnishments and other legal collection activities. The threat of foreclosure or eviction is a common trigger for Chapter 13 filings; last year consumer Chapter 13’s (that is, not including sole proprietorships) were about 60 percent below 2019 levels. Suspension of these collection activities, as well as general sympathy on behalf of the creditor, will likely play a key role in averting consumer bankruptcies for the time being.

Wake Me When It’s Over

Economic uncertainty could be forestalling bankruptcies. Consumers may be waiting for the pandemic to end (when they’ll have a clearer economic picture) before they decide on whether or not to file for bankruptcy.

Sources:

Featured Image: Adobe, License Granted

Harvard Business Schoo l

Columbia Law School

Epiq AACER (Automated Access to Court Electronic Records)

Law.com

U.S. Bankruptcy Court, Northern District of Iowa

U.S. Bankruptcy Court, Southern District of Iowa

Love and Debt: What You Should Know

Thu, 11 Feb 2021 12:48:00 GMT

Love and Debt: What You Should Know

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Certain Debts Can Be a
Romantic Roadblock

Jose was so in love with Ingrid that he gladly assumed payment of her debts. In fact, he considered it “a privilege” to be able to assist her in such a way.

Most people don’t feel that way. In fact, according to a 2020 Wallethub survey , 51% of all respondents -- and 60% of female respondents -- would not marry someone who has bad credit. (Forty-four percent of women would not even date someone with bad credit.)

Relationship Deal Breaker

Credit card debt was the biggest turnoff, with more respondents citing that as a red flag. Irresponsible spending was found to be worse than bad breath as a relationship killer. Around 46% of the Wallethub respondents indicated they’d break up with a significant other who had reckless spending habits.

On the other hand, they were much more forgiving with regard to personal loans and medical bills. These debts apparently were not associated with character flaws or making poor financial choices.

—Article Continues Below—

Talking About Debt

Debt is not usually a first-date topic. But it is something that should be discussed before a relationship becomes serious. Couples considering marriage should bear in mind that the debt of one partner can become the debt of the other.

Buying Love?

Here are the five most extravagant Valentine's Day gifts ever received:

Number Five : Chopard de Rigo Vision Sunglasses - $417,000. Decorated with 60 grams of 24K gold and 51 river diamonds.

Number Four : Montblanc/Van Cleef & Arpels Limited Edition Mystery Masterpiece Pen - $736,000. Decorated with 840 diamonds as well as more than 20 carats of emeralds, diamonds or sapphires.

Number Three : Bugatti Chiron Luxury Car - $4 million. With a 16-cylinder engine and quad turbo-chargers, this speedster goes from zero to 60 mph in 2.4 seconds.

Number Two : Bulgari Necklace - $8 million. Custom designed by David Beckham for his wife Victoria and dripping with diamonds and rubies.

Number One : Gulfstream Jet - $20 million. In 2005, actor Tom Cruise surprised his fiancé Katie Holmes with this little token of his affection. (Alas, they divorced seven years later.)

Source: Catawiki

Both parties should explain their debts, how they accumulated them, and how they’re handling them. This conversation can be uncomfortable, but it’s necessary if you want your relationship to move to the next level. If one person has made irresponsible choices in the past, he or she should indicate how they’ve changed, so as not to drag down their future as a couple.

Communicating about your finances allows partners to stand in each other’s shoes and view the situation from his or her perspective. In the end, it usually brings couples together and makes the relationship stronger.

Correcting Financial Mistakes

Romantic partners can help each other get their finances under control through budgeting. A budget provides clarity and engenders a sense of responsibility. You can start by looking at your monthly bank statements to see where cash flow can be improved and which expenses can be reduced or eliminated.

Then, using a simple 50/30/20 budget, divide your income to pay for needs (50%), wants (30%), and savings/debt repayment (20%). Start by paying off the smallest debts first; this provides a sense of accomplishment. Also, you may wish to alternate between debt repayment and savings in order to accomplish your most pressing goals.

Most people take about three months to get into their budget’s rhythm. But don’t’ be discouraged. It will definitely keep you on track as you work toward paying your debt. Not to mention the peace of mind you’ll have by knowing exactly where your money is going.

What’s more, creating and adhering to a budget shows your partner that you’re taking all the right steps to make yourself less of a financial risk.

Intangible Gifts from the Heart

Is your significant other is struggling to pay medical debts or pay down a car loan? Offering to help could be the best gift Valentine’s Day gift they’ll receive.

Of course, much depends on the status of your relationship. Proposing to pay off a credit card for someone you’ve only known a few months is never a good idea. In fact, paying credit card debt is best left to couples who are committed for the long haul.

But unforeseen medical debt is a whole other situation. If your partner is stressed out about his or her inability to cover medical expenses, a little financial assistance could be a very romantic gesture.

Even if you can’t afford to pay off the entire balance, reducing the principal amount could go a long way toward warming your beloved’s heart.

Sources:

Featured Image: Adobe, License Granted

Should Your Practice Be Accepting Medicaid?

Wed, 13 Jan 2021 15:21:00 GMT

Should Your Practice Be Accepting Medicaid?

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Pandemic Continues to Fuel

Medicaid Enrollments

As the COVID pandemic continues, Medicaid enrollments across the country have increased significantly. In Iowa, enrollments are up 44% as of the end of October. More than 65% of Iowa physicians are currently accepting Medicaid.

Should your medical practice be one of them?

More Americans Becoming Eligible

With last spring’s high unemployment rate, more Americans became eligible for Medicaid than ever before. All the primary health insurance companies who serve Medicaid patients confirmed dramatic enrollment increases. These insurance carriers expect this trend to continue for several reasons:

The rise in Medicaid enrollments typically lags behind other governmental benefits — such as unemployment insurance and food stamps — as people are more focused on the immediate needs of food and rent.

Workers don’t always lose employer-based medical insurance immediately upon lo sing a job.

The pandemic has influenced people to defer non-urgent medical visits. These visits often provide an incentive for Medicaid-eligible patients to enroll in coverage, especially since healthcare providers typically help their patients apply.

Consequently, providers can anticipate that Medicaid enrollment will continue to grow in the coming months.

There’s no question that Medicaid is an essential aid program. Millions of Americans would be unable to receive healthcare services without it. And because each program is managed at the state level, individualized needs can be met.

Medicaid-to-Medicare
Fee Index

The Medicaid-to-Medicare fee index measures physician fees relative to Medicare fees and varies by state. Doctors in states with higher ratios are more likely to accept new Medicaid patients.

According to data collected by the Kaiser Family Foundation , the overall national Medicaid-to-Medicare index is 72%, while Iowa scores higher at 82%.

Getting Paid

Iowa healthcare providers can be reimbursed for Medicaid services on a fee-for-service (FFS) basis, through managed care plans, or both.

Fee for Service

With FFS, providers are paid directly by the state for each covered service received by a Medicaid patient. FFS rates are designed to pay only for the care that a patient has specifically received. In Iowa, that figure is approximately 80% of the provider’s standard fee.

Managed Care

Iowa transitioned the vast majority of its Medicaid patients to a managed care plan (IA Health Link) in 2016. Through this plan providers are paid a monthly per-member case management fee in addition to the standard Medicaid fee-for-service (FFS) reimbursement.

But unlike FFS, the managed care fee provides upfront fixed payments for expected use of covered services, administrative costs, and profit.

So regardless of which services a patient receives, Medicaid pays out the same amount. That amount is then apportioned according to the actual services received.

The state of Iowa is currently serviced by two Managed Care Organizations (MCOs): Amerigroup Iowa and Iowa Total Care. Healthcare providers may contract with one or both of these MCOs in order to treat their Medicaid patients.

Advantages of Accepting Medicaid

You become part of the solution . Medicaid beneficiaries have far better access to care than the uninsured population. As a result, they are less likely to postpone or go without needed care due to cost. More than 43% of Medicaid’s beneficiaries are children. The program allows them to receive annual checkups, necessary vaccines, and appropriate medications whenever necessary. Disadvantaged families who require special care can also have their needs met.

--Article Continues Below--

Medicaid provides a large potential patient base. Within every community are households that qualify for the program. For example, in 2019, over 75 million people — more than 22% of the U.S. population — were enrolled in Medicaid. And because every state publicizes a list of participating providers, there’s no need to advertise. This built-in customer base can be particularly helpful when establishing a new practice.

Payment is guaranteed. Medicaid offers healthcare providers a guaranteed stream of income. This income stream is sometimes even more reliable than private insurance

Why Don’t More Providers Accept Medicaid?

In light of these advantages, you may be wondering why all healthcare providers do not accept Medicaid. Two primary reasons:

Medicaid reimbursements are often lower than those of private insurers, and there’s no guaranteed timing on payment. Providers also cannot charge a fee for missed appointments.
The level of documentation required for Medicaid reimbursement is greater than that required by private insurers, resulting in additional administrative overhead. Pre-authorization can delay delivery of treatment, and more appointments may be required.

You Decide

Only you can decide if your practice is a good fit for the Medicaid program. But with enrollments at an all-time high, and expected to increase even more in 2021, now may be a good time to consider it.

Sources:

Featured Image: Adobe, License Granted

Center on Budget and Policy Priorities

Kaiser Family Foundation

Health Research Funding

Checkpoint EHR

Bad Debt and Other Write-Offs

Wed, 09 Dec 2020 14:05:00 GMT

Bad Debt and Other Write-Offs

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Bad Debt: A Chronic Condition
for Hospitals

Even before the pandemic, a large number of hospitals and healthcare systems were wallowing in chronic bad debt. Now, many of these facilities are expected to recover less than one-fifth of what is owed to them.

How Bad Is It?

A 2018 survey by Sage Growth Partners indicated that more than one-third of all hospitals and health systems faced more than $10 million in bad debt at that time. For 6% of those facilities, bad debt exceeded $50 million.

Also prior to the pandemic, the American Hospital Association had estimated unpaid medical bills to total about 6% of annual hospital expenses.

Since the pandemic began, almost half of all hospitals have seen a 48% increase in bad debt and uncompensated care, according to a survey conducted by consulting firm Kaufman Hall in August 2020.

Hospitals With Largest Amount of Bad Debt

in 2019

Orlando Regional Medical Center (Orlando FL): $253,196,054
Memorial Hermann Southwest Hospital (Houston TX): $197,766,466
Prisma Health Richmond Hospital (Columbia SC): $183,453,703
WakeMed Raleigh Campus (Raleigh NC): $179,272,214
Christus Good Shepherd Medical Center (Marshall T): $165,085,900

Source: Definitive Healthcare's Hospitals and IDNs Database, 2020

Causes of Bad Debt

Of the executives who responded to the Sage survey, 59% cited insurance reform (and its associated increase in deductibles and copays) as the primary reason for bad debt. (Only 17% of the hospital executives blamed patient delinquency.

No doubt, the prevalence of high-deductible health plans (HDHPs) is a huge part of the problem. As is the dramatic increase in the number of uninsured patients.

According to recent surveys, 37% of Americans cannot afford to pay a medical bill of more than $100. At the same time, a 2018 study showed that patient balances after insurance (PBAI) grew by more than 52% over a five-year period. So while many patients have less, they are expected to pay more.

Generally, uncompensated hospital care falls into two categories: Charity care and bad debt. Charity healthcare is provided at little or no cost to eligible low-income patients. It’s care for which hospitals never expected to be reimbursed.

On the other hand, hospitals incur bad debt when they are not paid by patients who do not apply for charity care, but who are unable or unwilling to pay their medical bills. (See box, “Bad Debt Redefined. ”) These patients are expected to pay but do not.

Bad Debt Redefined

It used to be that hospitals could report bad debt as the difference between the amount billed to patients and the amount actually paid, regardless of whether the hospital ever expected to receive the full amount.

But that changed when the Financial Accounting Standards Board (FASB) redefined bad debt for hospitals in December 2019. Now, hospitals may only report bad debt in instances when an adverse even (e.g., bankruptcy or unemployment) prevents a patient from paying the medical bill.

When it comes to recovering bad debt, 36% of hospital executives surveyed employ a third-party collection service to recover bad debt. About 25% of hospitals collect debts in-house, while 18% utilize a combination of the two. This leaves more than 20% that do not have a debt recovery process.

Types of Write-Offs

Many facto rs determine how (and if) a hospital or other healthcare center can write off a patient’s bill. Types of hospital write-offs include:

Charity care write-offs , as described above, may be one component of a community care effort, as part of a faith-based healthcare system, or a financial assistance program.

Contractual write-offs are the portion of a patient’s bill for which a hospital does not charge because of billing agreements with the insurance carrier (or Medicare).

Small-balance write-offs are amounts left on a patient’s account that are too small to make the billing process cost-effective. Some healthcare providers have a policy of writing off these small debt balances.

Prompt payment discounts are write-offs for patients who pay in full at time of service. The difference between the standard fee and the discounted fee is written off.

Self-pay discounts represent write-offs for uninsured patients who receive a discount off the standard price of healthcare services. Again, the difference between the standard fee and the discounted fee is written off.

Bad debt write-offs are for those bills that are deemed uncollectible. For tax purposes, the IRS requires that both internal and external collection efforts be exhausted before the debt may be written off. Bad debt allowances should be clearly separated from other write-offs on tax returns to ensure proper tax return reporting. Listing bad debt together with other allowances may cause the IRS to disallow the entire deduction.

Non-Profits and Schedule H

While non-profit hospitals and healthcare centers are exempt from paying taxes, they still must report their bad debt and other write-offs to the IRS on an annual basis.

Schedule H (Form 990) is the schedule that non-profits must file each year to justify their tax-exempt status. It provides information on the activities and policies of the hospital and all of its associated facilities that were operated during the tax year.

While much of this form applies to the community benefit of charity care and other financial assistance, an entire section is also devoted to the reporting of “Bad Debt, Medicare & Collection Practices.”

Sources:

Featured Image: Adobe, License Granted

Definitive Healthcare

Advisory Board

American Hospital Association

Manage My Practice

LBMC

Debt Collection Best Practices for Property Managers

Sat, 28 Nov 2020 15:00:00 GMT

Debt Collection Best Practices for Property Managers

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CBSI Revenue Cycle Webinar

Imagine a collection agency recovering your accounts receivable and maintaining a happy clients, all while delivering great customer service and ensuring regulatory compliance.

In this webinar you'll learn how they do it. Plus you'll be able to do it also.

Additionally, you'll receive an update on best account receivable practices

during the coronavirus pandemic.

Thomas Barrett:

Welcome, everyone, to our webinar today. Best practices for collecting money owed for property managers. With us today is Brian Grimes, president of CBSI Credit Bureau Services of Iowa, and Megan Covert, sales assistant.

A few housekeeping notes. If you have a question, feel free to ask them during the presentation, just type them into the chat window or the Q and A at the bottom of the screen. And we will also leave time at the end of this presentation for any questions. We will also record this webinar and we'll make this recording available to all participants early next week.

Brian, Megan, thank you for joining us.

Brian Grimes:

As a collection agency that cares. We focus on connecting with consumers resulting in better returns while fostering genuine customer relationships. In today's environment, for property managers, it's really truly a nightmare. Everything is working against you.

Here are some of the most common problems facing property managers, when trying to collect money owed.

Government Regulations - you will face a wide variety of restrictions and legal challenges in collecting unpaid rent and damages. Collecting rent and evictions is more difficult today, under the pandemic restrictions to evict a tenant. They know they cannot be evicted and it makes it more difficult to collect rent.

Damages - collecting damages above any deposit amount can be difficult.

And lastly, no forwarding address. How do you find a tenant after they've moved without leaving a forwarding address? We'll talk more about skip tracing later on in the presentation.

Megan Covert:

Background checks and credit checks are critical to screening for good tenants. Add a co-signer to the lease agreement. Many times the co-signer is the parent of the tenant. So if a co-signer becomes aware of an overdue rent payment, they can bring the tenant's account current rather than take a hit on their own credit.

Tenant contact info and co-signer info, if applicable, is key to success when collecting overdue payments. Among all the normal disclosures, make sure your lease agreement gives permission to contact via autodial, automated messages, email, texts, and third-party vendors.

If your lease agreement includes interest charges for past due balances, it must be clearly stated in the lease agreement. So it must show the percentage as well. In Iowa, the maximum amount allowed is 18% interest.

Make sure you are getting as much info as possible on your leasing agreement. This is includes name, address, phone numbers, date of birth, social security numbers, middle initial. In recent years, the credit reporting agencies have really tightened their requirements on credit reporting.

So if you don't have a social security number or a date of birth, a middle initial is required to report on their credit. Employment, including the employer's phone number and address.

Phone numbers are key, including landline and mobile numbers and an email address as well. Although it's not used widespread in collections today, new legislation is in the works for providing as a safe harbor for collection agencies to email consumers.

Make sure this information is updated periodically.

Brian Grimes:

Having multiple payment plan options for your tenants can be very important. We all like to have options, and we want the payment process to be convenient. Your more traditional tenants still want the ability to pay by check and use a dropbox. But online bill pay is becoming increasingly more popular, especially with the millennials. They want to be able to access their account from their computer or phone and make their payment. CBSI receives more than 20% of our total payments online and online payments are ever increasing.

Getting credit card information and keeping it on file. Also another way to make sure payments will be made. If a tenant is behind on rent, letting your tenant set up a reasonable payment plan to catch up, can be very important. Having to bill pay a bill in full, it can be very overwhelming, so they just don't pay at all.

If they know that they can set up a plan that will work within their budget, they'll be more likely to pay. When using a payment plan, setting up an automated payment is also a good idea.

Automatic payments can be a credit card, debit card, ACH or through their checking account. Collection from a tenant when their rent is due as best. We all know that, but they will be times that we need to collect after the due date.

Current best practices in an eviction situation, when you do not have a forwarding address, we recommend turning the account over to collections agency as soon as they move out. However, if you have a forwarding address after the move out or eviction, send the first notice.

At 30 days, send a second statement. If the client does not pay, send a past due text, phone, call or email.

At the 60-day, mark send a final notice explaining that you're going to turn the account over to collections (for example X amount of days). If the client does not pay send a past due text, phone call or email.

A third-party agency would come into play at 90 days or less in a perfect world.

This chart shows the collectability of an account. The older it gets, the longer you wait sent over at account to collections, the collectability drops dramatically. Typically our returns are quite a bit even lower than this for the rental type of properties, just simply because of all the pieces in play.

Megan Covert:

So another way to look at this is as the length of time a debt is owed, your dollar shrinks. So your dollar is worth considerably less the longer the money is owed. This is why it's so important to have a consistent process in place to ask for the money. Using a professional collection agency is a key component in this process.

Our experience has been that the collection rate on overdue tenant accounts is significantly lower than this. So the sooner you start the collection process, the more likely you'll collect.

Often the tenant moves out because of a change in their employment status. So keeping in touch with the tenant until they find new employment can also increase the likelihood that you'll collect your money. So here, there are several things that you should look for when considering a collection agency, make sure you do your homework on this.

The location or market work is very important. You want to make sure the agency you use works in your market. Having a local database of consumer contact information is also extremely important for your collections. National agencies just aren't able to return as much money to you because they don't have the local contact information.

Using an agency that actively works your market gives them the ability to combine efforts because they are working with that same consumer who has debts with other local clients. It gives the agency the ability to use all the data collected and also understand the collectability of an account because they already have a relationship with that individual. The agency can also combine the accounts for that individual, which will equal a larger amount owed in total and assures the account will be worked and revisited several times to collect payment.

You will also want to ask the agency about their license. Many states do require a collection license or bond. So make sure the agency you decide to use has the correct credentials for your state or partners with an agency that does.

Does the agency pursue legal? Legal is an option that works well in some states, but not all. For CBSI it is a last resort after all regular collection efforts have been exhausted. We pursue, via right of an assignment, in CBSI''s name, so not yours. We only pursue legal on accounts that we have been unsuccessful in collecting with our regular efforts and we have verified that the individual has good full-time employment and has the ability to pay, but is just choosing not to.

Once legal has been pursued, we can garnish wages to collect the debt. The garnishment process is rather friendly as it does not drain their paycheck and only lasts 120 days, if the debt is not paid in full before then.

So be aware of that, send accounts to legal right away within 30 to 60 days of receiving the account. This is a tactic that less reputable agencies will use to charge you a higher rate. They will also sometimes send a letter to your client threatening legal, but then they never follow through with that, which is illegal.

ACA membership is also something to ask about the association of credit and collection professionals establishes ethical standards for collection agencies. Compliance and regulation are first and foremost. Members of ACA have access to the latest changes in information in the industry to stay compliant. An agency that is active in their local state, ACA Chapter is a good sign of a reputable agency. So compliance is extremely important. Your agency must be compliant with the FDCPA, Fair Debt Collection Practices Act and all state and federal regulations.

So ask if they have a compliance system in place and how they handle disputes.

Longevity of the agency is also very important. There are some fly-by-night agencies that come and go in our industry. Make sure your agency of choice has experience and there are good financial standing.

The BBB Better Business Bureau rating -- research that agency's BBB rating because, yes, individuals will complain to the BBB just to try to get out of legitimate debts. But make sure your agency is responding to those complaints and does not have an unusually low rating.

Using an agency who utilizes a secure, compliant online portal is also something to look for. It is helpful for you and your staff, as you can check on your accounts, run reports and communicate securely. It is also a great tool for your clients so they can make online payments to pay in full or negotiate a payment plan.

The collections approach -- make sure the agency you choose has a consumer friendly approach. Working with your clients in a caring, empathetic manner will get you more results than harsh demands. Being friendly, understanding and compassionate will also lead to higher returns in the long run and less complaints.

One of the most important things to remember about choosing a collection agency is to just not go for the low rate. Most agencies work on a contingency basis, but a lower contingency rate is not always best for your business. Agencies who offer unusually low rates do not put in the work needed into collecting the accounts. They may make one or two phone calls and then just give up.

So you want to focus on how much net dollars returned an agency can get you. Even with a higher contingency rate the agencies that put in the work to collect on your accounts will return more money back to you in the end, which is better for you in the long run.

To get an accurate number on how well your agency is doing, you can take the dollar amount, they have returned divided by the total dollar amount you've placed with them to get an accurate return percentage. This factors in the contingency rate, while focusing on true dollars, they were able to return to you. So lower contingency rate does not always equal savings or money back in your pocket.

Brian Grimes:

A little bit about CBSI. We are a consumer friendly debt collection agency and have been in business for over 60 years. A lot of agencies are moving more towards a consumer friendly collection approach, but luckily we've always had this mentality and sometimes it's hard to teach an old dog new tricks on the collector side.

Our collectors are flexible and take pride in helping a consumer get out of debt. We operate in a complaint-free environment, and we have a large local database. it is probably one of the key things for the rental property and via rent. CBSI has over 1300 counts and almost 2 million collection accounts in our database. So if you don't have a good address or phone number for consumer, we probably do. On average 90% of the time you send us an account, we already have that name in our database because they owe another one of our client's money as well.

The net result is more accurate data, already established relationships and a higher recovery rate. We work in multiple industries and may get a new account with more current information afterwards.

Skip Tracing - we can find tenants that have moved without leaving any forwarding address.

We do credit reports - CBSI is a credit bureau and, after a grace period of approximately 60 days, we leverage credit reporting to collect debts.

We do pursue legal with your permission via right of assignment. We can pursue legal and CBS I's name to garnish wages and collected debt. We find this as an effective way to recover on accounts they can pay, however, choose not to. We can also pursue any existing judgments that you have going back even 20 years.

Industry Experience - We currently work with several property management companies and we are complaint-free BBB. - We have an a plus rating with the Better Business Bureau and we work strictly on a contingency paces and only get paid on accounts that we collect. At this point. I just want to open it up to any type of questions that we have out there.

Thomas Barrett:

Brian, one of the questions that I have, what are the next steps, once an account is placed with CBSI for collections?

Megan Covert:

So once you place an account with us, we do send out a notice one. So that gives the 30 days to respond to us or pay in full. So after that 30 days goes by, we've heard nothing from them, we do send them to a collector and then they would make a phone call and send another letter, I believe. So that gives them 60 days then to either contact us or pay their debt in full.

So after that 60 days, then we do credit report and then we would continue phone calls and letters. You know, at that point, if they're still not responding to us, then we would ask you if, if they have enough, a small claims, we usually do a little over 500.

So if they have, you know, an existing account with other clients, we combine them together. And then we would try to pursue legal at that point. It takes maybe around six months to do that.

Thomas Barrett:

I have a question here from Caleb, "How do you work with property management companies to make sure accounts are placed timely, to avoid losing the likelihood of collection?" There's a second part to that question. So Brian or Megan, either one.

Brian Grimes:

I can handle that, Tom. Thanks, Caleb. You know, that's a great question. And typically what we ask is that folks send those over to us once the eviction process is all done with, and you have a total dollar amount owed. And you guys right now are currently faced with a situation where it's not so easy for you to evict people, and then you're continuing to not get rent.

Like I talked about before, the age of the account is very important. So I'm willing to open this up to anybody on this call to where, if you have somebody who's continuing not to pay rent, that you could place that account with us before you go through the eviction process and then what has to happen. We have to place every time that you place that account, you have a new debt owed, you have a new debt owed, you have to place a new account with us?

And then we have to go through our 30-day validation period and everything. But if you have a situation where you don't have a forwarding address, they've been evicted or they're out of apartment or rental property, there's probably no point to continue to try and send out statements, to try and make phone calls, because you may not have any of that contact information.

It makes sense to just send it over sooner than later. So maybe it's, you know, 30 days after that, after you've come up with the total amount owed or even right away.

Thomas Barrett:

Brian, I have another question from Caleb. Caleb, if you like, I can unmute you and you can talk. Caleb asks, "Do you have any special methods for collecting from international residents? They've had several instances with international residences, abandoning units and leaving the country, leaving him with little or no recourse."

Brian Grimes:

Caleb, that is a very tough one. We run into that, especially in the college areas -- Iowa City, Ames -- and I don't have really many options for you. The credit reporting is going to be tough. We'll try and credit report on those accounts, but to be able to go overseas and collect on these, we really don't have the ability to do so.

If it does get out on the credit report, hopefully if that person's back in the country, that would help pay it off down the road. But I totally understand where you're coming from. And those are some of the hardest to collect on.

Thomas Barrett:

Caleb, if you have any more questions, let us know. I have a question here, "I typically use an attorney as a first resort to collect a debt. What do you recommend?"

Brian Grimes:

Okay, well, the attorneys, we actually work accounts right now for a lot of different attorneys and we market to them. Sometimes the letter from the attorney doesn't hold as much weight as one would think. Sometimes you're just throwing good money at bad money. So the attorney is going to cost you typically, no matter what, to send out the demand letters to work that account and potentially to pursue legal.

So they also don't have as many leverages as we have. The credit reporting is a huge leverage that we have. We've got the team of collectors making phone calls. We've got the database and then we can, and will, pursue legal without any costs to you, if it looks like an account that does look collectible.

Maybe they have a bunch of other liens and judgments out there, tax liens, whatnot. It does not make sense usually, unless they have a job and then they have not a lot of different liens and judgments out there to pursue legal at that point in time.

Thomas Barrett:

Caleb, if your question hasn't been answered, let us know. I have a question here from Brenda, "How are accounts submitted to CBSI? Do you integrate with any accounting software or do we have to manually submit accounts?"

Brian Grimes:

That's a great question. So I don't actually integrate to any of the software as far as property management companies goes. And I know there are companies that do, and you're looking at an out-of-state type agency that typically doesn't have the ability to work the accounts thoroughly. They may not, more than likely aren't going to have any type of database that we do.

And you're better off, frankly, working with a more local agency when the biggest piece is the legal. A lot of these agencies are not going to pursue legal at all. You know, they may send out a threatening letter for that, but it's really hard to set up a full network of attorneys across the country to be able to pursue legal.

Now, having said that, we can work off of any type of spreadsheet that you have, whether that be like an Excel spreadsheet, comma-separated values. We can work with that. And if it's a decent size account for us, we could see about programming to make sure that we can get all that data in there regardless of the format. So we have a web portal that you go online. You can place the accounts online. You can either enter them onesy, twosy. We have a data entry team that can help edit data, enter those accounts, if you have all the information on paper.

And then lastly, like I said, the upload piece is really pretty slick. As long as you can get and run a report on your end and send that over, we can get it into our system.

Thomas Barrett:

Okay, we're coming up to the top of the hour. If anyone has any questions that they didn't feel comfortable asking, or if you have anything else you'd like to discuss with Brian or Megan, their phone number is (800) 383-0234, or you can email them at info@creditiowa.com.

Thank you very much for your participation. We will get you a recording of this webinar next week. Thank you and have a great day.

Brian Grimes:

Thank you, everybody.

Should Healthcare Providers Request Upfront Payment?

Wed, 11 Nov 2020 13:37:00 GMT

Should Healthcare Providers Request Upfront Payment?

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Requesting Upfront Payment
Ca n Be a Delicate Matter

As 68-year-old Susan Bradshaw lay on a hospital gurney and waited to be wheeled into surgery for an emergency appendectomy, she was approached by the surgeon's office manager.

The woman demanded that Bradshaw pay $1,400 before the surgery could proceed.

"You have got to be kidding," Bradshaw said. "I don't have a credit card on me."

The woman crossed her arms and told Bradshaw she'd have to "figure it out."

This rather shocking scenario illustrates how NOT to request upfront payment for medical services. But there are plenty of other situations where requesting payment in advance of services is not only acceptable, it can benefit patients as well as providers.

Point-of-Service Collections

Rick Gundling is Sr. Vice President at the Healthcare Financial Management Association (HFMA). According to him, about three-quarters of all healthcare and hospital systems ask for some payment at the point of service.

Upfront Payment Policy

Make sure your Patient Financial Responsibility Form includes a reference to your upfront payment policy. Explain how your facility or practice operates with regard to point-of-serve payment.

For example: "We will submit the claim to your health insurance carrier and provide you with a written estimate of your out-of-pocket expenses. Our financial counselors are available to assist you with payment plans."

Often, the amount collected upfront is simply the insurance copayment. But increasingly, healthcare providers are also requesting some or all of the patient’s out-of-pocket expense. Obviously, there's a big difference between seeking a $20 copay and expecting a patient to cover a $2,000 deductible.

Which is why requesting upfront payments requires both technology and training: technology to accurately estimate the patient’s financial responsibility, and training to effectively counsel patients and establish a workable payment plan. (According to a 2016 survey , 53% of patients reported using a payment plan to pay off medical bills.)

Start with Accurate Cost Estimates

A variety of software technologies are available to help healthcare providers estimate total costs for medical services, as well as the patient’s self-pay portion. Typical capabilities include:

Estimating fees for various treatments, including outpatient, ambulatory surgery center, and physician services.

Estimating patient expenses based on the provider’s contract with payers, historical inpatient and outpatient procedure charges, and patient insurance information.

Creating an expense estimation letter to share with patients.

Proper Training Makes the Difference

A personable approach by properly trained staff can make all the difference when it comes to requesting upfront payment for medical services. Staff members should be trained to offer financial counseling to patients who may face difficulty in covering their out-of-pocket expenses.

A large part of financial counselor of patients involves education: taking the time to explain basic medical and insurance terminology, and explaining the expense estimation letter. Then, the counselor and patient together can create a workable payment plan. Also, be sure to advise patients of any financial assistance programs for which they may be eligible.

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Train staff members to suggest multiple payment options, such as:

Prompt-payment discounts of 20% (considered standard)
Longer payment periods for high balances
Flat-rate basic services for self-pay patients

Empathy and compassion are the key to successful upfront financial counseling, particularly in light of the COVID-19 pandemic and subsequent economic fallout. Patients are experiencing very high levels of stress. The job of the financial counselor is to help alleviate that stress, not contribute to it.

Between a Rock and a Hard Place?

As a healthcare provider, you may sometimes feel that you are between the proverbial “rock and a hard place” when it comes to collecting the patient responsibility portion of your payment.

On the one hand, this portion represents a significant chunk of your overall revenue. It must be collected for your practice to remain financially afloat. On the other hand, you’re aware of the negative effect financial stress has on the health of your patients.

With the right technology and properly trained staff, an upfront payment policy can result in fewer bad debts. But in order to be effective without jeopardizing the valuable patient relationship, this policy must be based on compassion, applied tactfully, and include patient financial counseling.

Sources:

Featured Image: Adobe, License Granted

NPR.com

Nurse Practitioner Business Owners

PatientCo

HFMA

Debt After Death: Who Pays?

Thu, 08 Oct 2020 13:03:00 GMT

Debt After Death: Who Pays?

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Debts Don’t Die
With the Decea sed

While most of us choose not to think about it much of the time, death is a fact of life.

But what happens to a person’s debts when he dies? As a healthcare provider or other creditor, how can you make sure you get paid?

Upon death, a consumer’s debts become the responsibility of his estate. The estate’s executor is the person charged with using the deceased’s assets to pay off his current bills and all other debts.

This process could be as quick and easy as writing checks from a bank account, or as long and complex as selling a home or other property to get the necessary funds. Either way, it’s an important part of probating the estate.

The Solvent Estate

When the consumer’s estate is solvent , there are sufficient assets available to cover all debts after his death. In other words, the total value of everything he owned exceeds the total of everything he owed .

While most of the decedent’s estate must be probated, there are certain assets that are excluded from the process, such as:

Property that is jointly owned with someone else,

Retirement accounts with designated beneficiaries,

Life insurance with designated beneficiaries, and

Trusts

The executor would have no control over these assets.

The Insolvent Estate

If there are not enough assets in the decedent’s estate to pay off his debts, the estate is considered insolvent . (The total of everything owed exceeds the total value of everything owned .)

In that case, the executor must prioritize the deceased person’s debts in accordance with federal and state law. Every state has its own probate laws that direct how someone's final affairs are to be handled. This includes the priority of debt payment.

In Iowa, the priority for payment is as follows:

Court and administrative costs
Funeral and burial expenses
Federal taxes
Recent medical care expenses
State taxes
Medicaid reimbursement
Employee wages
Support payments
All other claims

You will notice that medical debt takes precedence over other claims. In Iowa, this debt must pertain to the “decedent’s last illness.” The executor is to pay these and other "priority" debts first. Other creditors would then be allocated a share of any money that's left over.

Filing a Claim Against an Estate

The estate executor is responsible for notifying creditors of the consumer’s death. Typically, they also notify the big three credit bureaus (Experian, TransUnion and Equifax), so the account can be flagged as “Deceased: Do not issue credit.”

After receiving notice, creditors usually have six months to file claims against the estate. Here’s how:

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Locate the correct probate court. The executor can file for probate in the county where the deceased person lived or in the county where the deceased owned property.

Gather documentation to confirm the debt AND to prove that the debt was still owed at the time of death.

Complete the claim form. Some courts require that claims be completed and filed in person; others allow this to be done online.

File the claim. Depending on the court, this may be done in person, online or by mail. Once filed, be sure to obtain a certified copy of the filing for your records.

OR LET US DO IT FOR YOU

If you’re already a CBSI client, we’ll gladly file the claim on your behalf. Not a client? Contact CBSI toda y to take advantage of this and the many other debt recovery services we can offer.

Sources:
Featured Image: Adobe, License Granted
Nerd Walle t
The Balance
Iowa Probate Code

Legal Zoom

Why Age of Accounts Matters

Wed, 05 Aug 2020 19:53:00 GMT

Why Age of Accounts Matters

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The Older the Debt,
the Less Likely You’ll Collect

The sooner you send past-due accounts to collections, the higher your return.

Alternatively, the longer you wait, the less likely the debt will be collected. In fact, some studies indicate that your chance of collecting within the first 60 days is 90%. Wait till over 90 days, and your chance drops to 50%. Over 180 days, and you have a 20% chance of collecting.

If you wait for more than a year, you’ll probably get nada.

What Makes Older Balances So Hard to Collect?

The Commercial Collection Agency Association (CCAA) of the Commercial Law League of America agrees that the probability of collecting on a delinquent account drops sharply with the length of delinquency.
No doubt about it: When it comes to debt collection, time is not your friend.

Why are these older balances so hard to collect? Many reasons, such as:

Patients have forgotten about the services rendered and question whether the debt is legitimate.

Patients assume insurance covered the entire cost of services (or believe it should have).

Patients file for bankruptcy.

Patients move and cannot be located.

Patients' financial records are misplaced.

The Power of the Gentle Reminder

You’re much more likely to collect a debt by pursuing payment within the first 30 days. After that, past-due accounts are best left to medical collection experts specifically trained in debt recovery on older accounts.

By keeping a close eye on the age of your accounts receivable, you can identify those patient accounts that should be pursued first. Then deal with the problem head-on, by being straightforward but not aggressive.

Gentle reminders can be quite effective during the first 30 days of delinquency. (After all, people do forget.) Quick and courteous debt collection practices are more likely to result in payment than waiting for a patient to send you a check.

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The Smaller, the Shorter

Generally speaking, the smaller your healthcare practice, the shorter your age of accounts should be. Large healthcare providers can sometimes handle keeping older debts on the books (at least, temporarily) because they have more revenues and assets to draw from. Smaller providers, however, rely more heavily on their accounts receivable to maintain their cash flow.

A recent study by the National Federation of Independent Business indicates that the small business receivables cycle has increased 30% over the last five years. It’s now about 48 days.

Do the Math

Calculating your average collection period will give you a clear idea of how long it typically takes for your business to receive payment for services. Here’s the standard formula:

Days in Period x Average Accounts Receivable / Net Credit Sales
= Average Days to Collection

Let’s define each of the basic elements:

Days in Period — The number of days you choose for your calculation can be 365 or 90, or whatever works best for you. However, the other data in the formula must span the same number of days.

Average Accounts Receivable — Calculate your total accounts receivable at the beginning of your Days in Period and the total accounts receivable at the end of your Days in Period. Add these two numbers and then divide the sum by two.

Net Credit Sales — This figure is the total amount of your facility’s gross sales minus the total of all returns during your Days in Period.

Here’s an example that uses 365 as the Days in Period:

ABC practice had $80,000 in A/R at the beginning of the year and $90,000 in A/R at the end of the year.

So its Average Accounts Receivable over the course of the year would be $85,000.

($80,000 +$90,000 divided by 2 = $85,000)

Over the same period,

its net credit sales was $600,000.

Plugging these figures into the formula, we get:

365 x $85,000 / $600,000 = 51.7

So it takes ABC practice an average of 51.7 days
to collect on an account.

According to The Commonwealth Fund , 79 million Americans are struggling with medical debt. When you partner with CBSI, you’re working to help alleviate that burden.

And by sending overdue accounts to us early in the process, you’re optimizing you’re window of opportunity for maximum recovery. AND you're freeing up your valuable time.

So you can get back to what you do best – providing exceptional health care.

Sources:
Featured Image: Pixabay
Credit Research Foundation
Patriot Software
The Balance
The Commonwealth Fund

What Is Skip Tracing?

Tue, 21 Jul 2020 13:11:00 GMT

What Is Skip Tracing?

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Professional Skip Tracers Can Locate

Just About Anyone

If you’ve e ver been unable to locate someone, you know how frustrating it can be.

This is why skip tracing is such a valuable tool. The healthcare collections industry uses skip tracing to locate patients who have overdue accounts, but whose contact information is inaccurate.

This often happens when the patient has moved but failed to provide a forwarding address. In fact, according to the U.S. Postal Service , almost 75 percent of all undeliverable mail is intended for residents who have relocated and left no forwarding address.

Hide and Seek

Returned mail, disconnected phone, wrong phone number, and change of employment are all clues that the patient’s contact information is no longer accurate.

It’s not unusual for skip tracers to search through massive amounts of both public and private information in order to locate someone. But access to such data must often be purchased.

Because the skip tracing process is both time- and labor-intensive, it requires not only access to information but also specialized expertise. It’s not a task for the inexperienced or untrained. Without proper training, you can easily (and inadvertently) violate privacy laws.

The starting point is often the patient’s credit report. A skilled skip tracer can quickly locate valuable information from the report, such as a new address or phone number, or recent credit activity.

If the credit report cannot be accessed – or if it’s not current -- the skip tracer will begin an internet search. All types of resources are accessed in an effort to collect the required information, such as:

The Skip Tracing Process

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Phone number databases
Social media (such as Facebook and Linkedin)

Uniform Commercial Code (UCC) filings
Bankruptcy records
Property records
Title searches
Judgment liens
Credit card applications
Loan applications

If your patient has moved and left no forwarding address, he may not even be aware of the debt.

Locating him early in the skip tracing process provides him with the opportunity to pay off the debt before it harms his credit score.

Tax filings
Motor vehicle records

Why Use a Collection Agency for Skip Tracing?

As a health care provider, is your practice proficient in skip tracing? Probably not. Which means your accounting staff can waste a lot of time spinning their wheels in an attempt to track down patients who owe you money.

It also means you’ll be paying your employees’ wages, health benefits, etc., while they try to skip trace. These can quickly add up. And then, as previously mentioned, you must purchase access to many informational databases. This can also be costly.

Healthcare collection agencies like CBSI work on a contingency basis. So they’re paid only when they collect on the debt. Even more important, professional collectors are trained in using the various resources to locate people faster and more effectively than your staff can do on their own.

How much time and energy are you willing to waste trying to locate a patient who owes you money? Is that how you want your staff spending their time? Would they even know where to start?

Leave It to the Pros

CBSI's collection professionals are skip tracing experts. Using proprietary technology an advanced skip tracing skills, they'll locate even the most elusive consumers.

And they'll do it without jeopardizing your valued patient relationships or risking non-compliance with state and federal regulations.

Did You Know...

More than 80% of the past-due accounts placed with CBSI are already in their database -- a database that contains over 1.8 million accounts!

Sources:

Featured Image: Pixabay
Experian

Nerd Wallet

DataTree

ACA International

Trending Technology Simplifies Debt Collection

Wed, 10 Jun 2020 16:49:00 GMT

Trending Technology Simplifies Debt Collection

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New Technology Has Improved Analytics,
Compliance and More

Is technology a good thing or a bad thing? It depends on who you ask. But when it comes to debt collection, it’s most definitely a good thing!

Thanks to technological advancements, debt collectors are able to contact more consumers and recover more funds than was ever thought possible a few decades ago. We now have better communications and consumer access systems, stronger analytics, robust compliance solutions, and improved security features.

All these tools streamline the debt collection process and make recovery simpler and easier.

Can We Talk?

New communication technology allows collection agents to contact increasing numbers of consumers in a fraction of the time, and in a consumer-friendly manner.

For instance, technologies such as voicemail drops send ringless messages so that consumers can respond on their own timetables. Contact strategies can also be automated in accordance with a consumer’s preferred mode of communication.
For ease of payment, collection agencies now offer multiple options, including online portals and mobile payment apps.

What’s in Your Data?

Improved data analytics allow us to learn more about our consumers and their payment behaviors.

For example, we can identify the best time to contact a particular consumer, resulting in more efficient and effective calls. We can also use this data to determine the time of month when he or she is most likely or able to make a payment.

In addition, analytics can be used to create customized incentives, in order to keep a high-risk account from becoming delinquent. And they can also be used predictively to identify and flag high-risk consumers based on their profile or credit history.

Navigating the Compliance Minefield

The regulatory environment for medical debt collectors (in particular) is both complex and ever-changing. As a result, it can quickly become a minefield for the inexperienced or untrained.

Because they have access to both sensitive financial data and patient records, they must increasingly rely on advanced technologies to ensure strict compliance with HIPAA, as well as the Fair Debt Collection Practices Act (FDCPA) and all other federal and state regulations.

Compliance management technology allows debt collectors to detect, investigate and address any potential compliance issues. The reports that are automatically generated help analyze compliance with all the various aspects of consumer financial regulations.

Robust Security Controls

In addition to improved data analytics and compliance technologies, robust security controls protect consumer data and deter cybercriminal activity. As cybercrime becomes increasingly sophisticated, recent technological developments have also advanced to ensure consumer data remains secure.

The next generation of cloud technology, IoT security and even artificial intelligence are now being used by collection agencies to offer their clients both legal protection and peace of mind. And redundant virtual computer servers provide daily backup of data.

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At CBSI

As “The Collection Agency That Cares,” we at CBSI know the importance of pairing empathetic and persuasive collection agents with the right technological tools, to make the collection process faster and more productive.

We use proprietary data analytics tools to examine consumers’ payment behaviors, so we can optimize our recovery strategies. The end result for you is a much improved cash flow.

We score each account according to its collectability, to ensure maximum results for our clients.

We “scrub” our data for bankruptcies, deceased individuals and litigious consumers.

Our contact systems are directly connected with USPS to ensure addresses and phone numbers are accurate and current.

Our custom-made compliance management system enables us to respond proactively to the constantly changing regulatory environment.

Our cutting-edge security tools incorporate the latest physical and firewall technology to keep sensitive consumer data stored safely.

Sources:

Featured Image: Adobe, License Granted

Wipro

PR Newswire

Medical Debt Collection with Compassion

Wed, 03 Jun 2020 13:14:00 GMT

Medical Debt Collection with Compassion

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Retaining Good Patient Relationships
During the COVID-19 Pande mic

Imagine a collection agency recovering your accounts receivable and maintaining a happy customer, all while delivering great customer service and ensuring regulatory compliance! In this 30-minute webinar, you'll learn how they do it. You'll also be updated on best practices for accounts receivable during the coronavirus pandemic.

Tom Barrett:

Good morning, everyone. Welcome to our webinar, Medical Debt Collection with Compassion: Retaining Good Patient Relationships During the COVID-19 Pandemic. My name is Tom Barrett and I've been working with CBSI for the past four years on marketing communications. They got started in 1955. They've provided collection services for governments, schools, attorneys, healthcare, utilities, consumer and commercial clients. Their collectors are more than just sympathetic, they're empathetic. And most of them know what it's like to have an unpaid debt going to collections, because they've been on that side of the fence. They treat your customers the way they want to be treated. CBSI's respectful, solution-focused interactions with consumers produce better results than harsh demands, and that's more important today during the pandemic than ever before. Their collectors are trained to ask questions, analyze the facts and help identify a solution that meets both your and your consumer's needs. With their friendly approach, their caring approach, everybody wins.

With me today is Amy Vroegh. Amy has been with CBSI since for the last 13 and a half years. She is their collections manager and she's going to walk us through today what we are experiencing with the pandemic and debt collections. Amy?

Amy Vroegh:

Good morning.

Tom Barrett:

Amy, tell us what you've been experiencing with debt collections over the last eight weeks or so, since the pandemic first started.

Amy Vroegh:

Our contact rate has been very high. People are answering the phones. They have more time on their hands. They're at home. And this pandemic has given us an opportunity to have a conversation. People want to talk right now. They have a lot on their minds. They're looking at their credit report. They're looking at refinancing their home, purchasing new vehicles, and just clearing up their old debt. So they have been answering the phone.

Tom Barrett:

And as I understand it, you're experiencing a pretty high collection rate. Not only are they answering the phones, but they want to pay.

Amy Vroegh:

Yes, people are wanting to clear up the items that are on their credit report, or even accounts that may not be on their credit report. But they're wanting to clear up the bad debt that they have.

Tom Barrett:

And you are having people call you even about old debts that are beyond the legal statute of limitations, if I understand it correctly.

Amy Vroegh:

Yes, very much so. People are reaching out to us because, like I said, they have time on their hands and maybe they found an old letter from us or, you know, they remember having a conversation. They are calling to see if they can resolve the issue.

Tom Barrett:

And as I understand it, the conversation has actually gotten started because of the pandemic.

Amy Vroegh:

Yes, people want to talk about it, they want to know your thoughts, opinions, ideas, you know, how things are going. And we want to listen to them. That's our goal.

Tom Barrett:

Would you go through a collection call with me? Just for our audience, go through what a typical collection call would sound like and how it would be handled.

Amy Vroegh:

Sure.

Tom Barrett:

So go ahead. I'll be the debtor. You'll be the collector.

Amy Vroegh:

All right. Hi, is Tom Barrett there?

Tom Barrett:

This is him.

Amy Vroegh:

Hi, Tom. This is Amy calling from the Credit Bureau Services of Iowa. Can you verify the last four of your social or date of birth for me please so I can make sure I'm speaking to the right Tom?

Tom Barrett:

Yeah, it's four five two five.

Amy Vroegh:

All right, Tom? Yep, I do show that's the same person. I do need to tell you, Tom, since this is the first time we've spoken, we are the Credit Bureau Services of Iowa. So this is an attempt to collect a debt and any information obtained will be used for that purpose. Tom, I'm calling you today about an account that was turned over to us from ABC Hospital. It looks like it has a balance of $685. Looks like a date service of 12/01/19. I was calling to see if you might be able to take care of that today, or possibly set up some payment arrangement with us.

Tom Barrett:

Amy, I wasn't aware of that.

Amy Vroegh:

Well, Tom, it's been in our office office since February 1st. We did send out a notice. I'm sure you received possibly an EOB from your insurance company and some letters from the client as well.

Tom Barrett:

What's an EOB, Amy?

Amy Vroegh:

Explanation of Benefits - your insurance company would send that out to you to let you know what they have paid, what your deductible may be, and any information regarding the visit.

Tom Barrett:

Oh, okay. Okay. Yeah, I think I remember seeing that. I don't pay too much attention to those things.

Amy Vroegh:

Yeah, a lot of us don't. It's just not important paperwork.

Tom Barrett:

You know, I don't want to have anything appear on my credit report and I remember the service. I thought the insurance paid it all off.

Amy Vroegh:

Yes, we can definitely look into that. Tom, do you remember being there though? Usually, you know, most claims they've submitted to your insurance and this is either your deductible or your copay.

Tom Barrett:

Yeah, I do remember it was an emergency room visit, so I didn't really expect it.

Amy Vroegh:

Yes, most medical debt is unexpected for all of us, so I understand completely.

Tom Barrett:

Amy, I don't have enough money to pay it all off right now.

Amy Vroegh:

Okay.

Tom Barrett:

With the pandemic, I'm really concerned that I'm not going to have a job.

Amy Vroegh:

Okay, so you are working right now, Tom?

Tom Barrett:

Yes, I have a job.

Amy Vroegh:

Okay, and still working at the hospital?

Tom Barrett:

Yes, but they reduced my hours and, you know, the hospitals are way down with the number of patients that we're seeing today. So I'm concerned about still having a job.

Amy Vroegh:

I understand. Well, we're more than willing to work with you, Tom. Would you be able to pay maybe half of it today and set up some payment arrangements with us? We do give a 60-day grace period. So this would not report out against you, if you have it paid within the first 60 days.

Tom Barrett:

Half of it is a little bit too much for me right now.

Amy Vroegh:

Okay, what do you think you can do, Tom?

Tom Barrett:

I just got my stimulus check, so I could pay $100.

Amy Vroegh:

Okay. All right. I would be willing to work with that. And what would you like to set up with the balance?

Tom Barrett:

How much would I have left?

Amy Vroegh:

That would be $585.

Tom Barrett:

If I paid it off over 60 days, how much would that be per month?

Amy Vroegh:

About $275.

Tom Barrett:

That's high for me.

Amy Vroegh:

Now we can split it up for you, Tom. We can do weekly or biweekly payments, if that does help.

Tom Barrett:

Well, I get paid every other week, so that would help. How much would that payment be?

Amy Vroegh:

That would be about $130. Would that be something you would be able to do? And we can do, Tom, we can do debit card or credit card over the phone.

Tom Barrett:

$130 is a little bit too much for me. Could I do $100?

Amy Vroegh:

Y es, we can start out with that. That's not a problem.

Tom Barrett:

Okay, but that's going to push me past the 60 days, isn't it?

Amy Vroegh:

And with the pandemic going on, Tom, we all understand, you know, it's very scary out there and we're willing to work with you. So we would be willing to extend the credit reporting for now for at least another 30 to 60 days. So hopefully you can have it all paid by then.

Tom Barrett:

Okay, that sounds good. So how can I pay you the $100 now?

Amy Vroegh:

We can do debit card or checking information over the phone. We do have an online website that you can also go to. You can mail in a payment or, if you're here in town, you can drop off a payment as well.

Tom Barrett:

Okay. Yeah, I'm here in town, so I'll drop off a payment.

Amy Vroegh:

Sounds great.

Tom Barrett:

Okay. So, Amy, was there anything unusual about that call?

Amy Vroegh:

No, not really. We're experiencing a lot of people that are struggling to make ends meet right now. If they're not working or if their hours have been cut, we're doing our best to work with them. Our consumers that we're dealing with now, we've explained to them, if it comes a time when you can't make your payment, give us a call. You know, we're willing to work with you. If we can double up a payment the following month or skip a payment for this month and add it in towards the end. We're more than willing to work with those consumers to try to make ends meet, so that they can get their debt cleared up here and also continue to live their life.

Tom Barrett:

So if I were to lose my job, let's say in the next month or so. I would make the $100 initial payment and then the other $300, or the other $200, would you be able to work with me or put a pause on this until I received unemployment benefits or found another job?

Amy Vroegh:

We sure could.

Tom Barrett:

Okay, okay, so you sound nice to work with. So here's kind of what we see happens during a collection call. And this applies to first-party as well as third-party: it's really important to ask. "How can we help you?" Amy, your people are trained to do that, aren't they?

Amy Vroegh:

Yes, our collectors are compassionate and caring, and they understand a medical debt is not something that anybody can predict coming along. You don't expect to go to the emergency room or something to happen. So it's not a debt that you have on the table to pay. We want them to understand that we care and we're here to help. All we want to do is resolve the debt for them and also for the client. So we do our best to work with them in any way we can.

Tom Barrett:

I would imagine that you would get some people that were pretty upset that you would be calling during a pandemic to collect a debt.

Amy Vroegh:

Yes.

Tom Barrett:

How often does that happen?

Amy Vroegh:

Not very often. For the most part, most consumers are willing to work with us and they understand that we're here to help. You do occasionally get someone that's irate, but we do our best to talk them off the ledge, so to say. You have to always remember, they're not angry at you, they're angry at the situation. And you don't know what's going on in their life, so you do your best to help them through that situation.

Tom Barrett:

So if I started to talk about my sick mother, or the concerns that I have for my children, and they're not in school, how do you handle something like that?

Amy Vroegh:

We do our best to empathize with them, but we also try to get back on track of what we're trying to do to get this debt taken care of.

Tom Barrett:

So friendly, consistent communication is critical.

Amy Vroegh:

Yes.

Tom Barrett:

I also noticed you came on a little bit aggressively to ask for a payment.

Amy Vroegh:

Well, you know there are people that are getting their stimulus checks. There are people that maybe do have a little bit of emergency funds in their savings account. And so, you know, your first bet is to try to get them to pay it in full, if they can.

Tom Barrett:

Yes, here's some of the things that I think we've seen, especially for first-party collections. The most important piece is that you select personnel who are willing and really do want to help people settle their medical bills or their consumer debt, whatever it is. Most people by and large do not want to be in debt. And if they can see a way out of it, they really would like to pay off the debt.

Amy Vroegh:

For sure.

Tom Barrett:

People have to be able to manage the call, so the right personnel are important. And they have to be able to manage a ton of phone calls, so that it doesn't go on and on. Amy, you have a time limit that you put on a call, don't you?

Amy Vroegh:

Yeah, we try to keep our call within a few minutes. You know, I want them to know we're listening and we want to talk, whether it be small talk about anything. But we also want to get to the job at hand and get that phone call made and get that person taken care of.

Tom Barrett:

Yes, keep bringing it back to the subject. And you offered me multiple payment options. How important is that?

Amy Vroegh:

I think it's helpful to any consumer. You know, some people want to pay their bills online, some people want to hand-write a check and mail it in. Other people want to deliver cash. So the more options available, the better off for them.

Tom Barrett:

And as I understand it, the online payment has been a tremendous support mechanism.

Amy Vroegh:

Yes, very much so. A lot of people have gone on and set up payment arrangements and it's very easy to use.

Tom Barrett:

They can check their balance and they can see exactly when it's been paid off. So they know where they stand at all times. And I also noticed that you asked for payment in full, but you very, very quickly split that payment down in half. You really did seem to want a payment or something to happen today.

Amy Vroegh:

Yes, yes, that's one of our main goals. To try to get you to start your payments today, if at all possible.

Tom Barrett:

And on that particular bill of $685, how low would you go, do you think?

Amy Vroegh:

On a balance that size, we would like to see at least $50 a month, if possible, depending on your circumstances. But we are willing to go down to $25 ,if things are tight and you're laid off or things like that. But we do do our best to try to stay, you know, and we will split your payments weekly, biweekly. So any way to help in order to get that payment amount.

Tom Barrett:

Okay, thanks. So being flexible is critical.

Amy Vroegh:

Yes, very much.

Tom Barrett:

And being supportive is also critical.

Amy Vroegh:

Yes.

Tom Barrett:

Anything else you'd like to add?

Amy Vroegh:

I don't believe so, Tom.

Tom Barrett:

And as I understand it, you enjoy your job.

Amy Vroegh:

I do. I love what I do. I feel like we help our people, our consumers. You know, we've all been in those shoes once in our life probably, and we do our best to treat them the way we would want to be treated if someone was calling to tell us the same thing. So, you know, we do our best to get that consumer to take care of the account for the client and for themselves.

Tom Barrett:

Do you ever get any compliments?

Amy Vroegh:

On occasion.

Tom Barrett:

I can imagine. So here again, here are the multiple payment options that we feel are important -- in person, either CBSI or even if they pay off the creditor directly. So if they pay the hospital or the healthcare provider, mail, online bill pay is really important. Always with a payment plan, if possible. And then the ACHs are always nice to have. They make it simple and easy for both sides. We try to support each other with a win-win environment. Is that pretty accurate, Amy?

Amy Vroegh:

Yes.

Tom Barrett:

We've got a question here. Can people cancel their debt by bankruptcy? Is there a trigger that would make them take that option? Would you like to answer that now or do you want to hold till the end?

Amy Vroegh:

I can answer that now. We do have people that do file bankruptcy. Chapter 7 is the most common one and that does clear up most debt, not all debt. There's many reasons why people file bankruptcy. If they have a large medical issue that's come about and they can't afford everything that's going on. It's different for every individual.

Tom Barrett:

Okay, and is there a trigger that would make them take that option? You may not be able to answer that.

Amy Vroegh:

I really can't answer that, Tom.

Tom Barrett:

We've got a couple more questions. I'm gonna bring in Brian Grimes, who's the president of CBSI and Misty Little, who is their marketing manager. And then we're going to have time at the end of this for more questions. So keep typing your questions in and we'll answer them at the end of the call. The other thing that happens with CBSI, if someone absolutely cannot pay, I mean there's nothing we can do about it, but what CBSI does is they provide resources for affected individuals. So, Misty, would you talk for a couple of minutes about what you've seen with CBSI and how they help support affected individuals?

Misty Little:

Yes. Hi, Tom. Thank you. Especially in this time of crisis, we feel it's very important that patients and consumers know how to pay or dispute a bill, receive clarification concerning their debt, make or change payment arrangements and identify a potential identity theft. So we feel it's very important that we keep in contact with these people during this time. And our collection team is working really closely with the patients and consumers and, because of the economic hardships for some of these consumers, we've adopted a softer approach. We're always friendly, but we've really adopted an approach where we're really trying to help them out with anything, not just their debt, but any concerns that might come up during the phone call. A lot of people just want to start talking about the pandemic and how it's affecting them. We're helping them by pausing or reducing their payments. We're postponing any new wage garnishments and lawsuits right now.

Misty Little:

And, in addition, we're offering them resources. We're referring them to United Way, Iowa Workforce Development, DHS. Helping them figure out how to apply for Medicaid or possibly Hawki insurance, if they've lost insurance coverage because of this pandemic, childcare resources, food banks. And if people don't realize it, there is a 24/7 phone number that could be called in Iowa. You just dial 211 and that will connect people to somebody at the Department of Human Services. It's a live person that will take their phone calls and answer any questions they have right now. Even if somebody is just sitting at home, especially the elderly, if they're scared, if they're worried, if they're depressed or lonely. They could call this number and somebody will talk to them anytime of day about their concerns. So that's something that our collectors have really been telling people about. Just yesterday we had a collector who had a debtor on the phone who has found herself homeless, and she was very distressed and very upset. She wanted to talk about it and she just wasn't sure what to do. Our collectors don't have all those answers, but she was able to refer her to this phone number so that she could talk to somebody who could help her through those issues. So those are all things that we're trying to do.

Tom Barrett:

That's nice. Brian, you want to talk a little bit about what to look for in a collection agency?

Brian Grimes:

Yes, thanks, Tom. Thanks, Amy. Thanks, Misty, and everybody who's on our webinar today. So, yeah, just a few highlights on what to look for when you are looking for an agency. One of the main things that I always bring up is the location, or or at least the market, that a particular agency works. So working with somebody more local really does help out on the returns-wise. And the main reason being that you're able to connect addresses, data points and are able to return more over time. So, for example, we've got about 1.8 million accounts in our database, so nine times out of 10 when we have an account come in, we already have another account on that same individual. That allows us to put in more effort on those accounts, revisit them as we get new ones in, and have a valid address and phone number.

Brian Grimes:

Make sure that your agency is licensed in your area and in any markets you might be working in. Legal...the ability to pursue legal... As Misty mentioned, we're not pursuing that currently due to COVID-19, but it's certainly a valid option for folks that have a good job, are making good money, have the ability to pay, but are just choosing not to pay. It's a last-ditch effort, but it's certainly an option that you want to make sure your agency has available for you. ACA International is our international collections trade organization. They keep us up to date with all of the new compliance and legal issues going on out there. Make sure your agency is a member of ACA. That way they are up to speed with everything. Longevity: you just want to make sure you have an established agency, somebody that's been around for a little while. There are a few fly-by-night companies out there, so just do your homework on that end. An online web portal for you as a client is a really nice resource to be able to place accounts, take a look at your accounts, see the activity, run reports, and all that. And a HIPAA compliant web portal is key. So that's some of the highlights there, Tom.

Tom Barrett:

And so, Brian, I understand that many times, especially with a medical debt, there may be a hospital bill, a doctor's bill, and you have the ability to combine those into one repayment plan. Is that correct?

Brian Grimes:

Yes, that's correct. The medical industry and hospitals in the world are trying to make sure they can combine all those bills into one -- anesthesia, the lab. But it's not always going to be the case. Sometimes they're separate entities. A lot of times we're working with all those different entities and then we can combine them into basically one debt owed, so to speak. That way, we're able to touch base on multiple debts owed at the same time. It makes life a little easier for the patient.

Tom Barrett:

So it was kind of a debt consolidation process. So Dale had a question, and I don't know if you can answer it directly. Is there a trigger that would make someone take the bankruptcy option? Could you talk to that for a minute and talk about what's going on with the legal process right now?

Brian Grimes:

Yeah, sure. As far as the bankruptcy piece, there's no trigger on necessarily a consumer's end that they would file bankruptcy. There's limitations on how often you can do that. It's up to an individual how much they owe to different creditors to decide, whether it's worthwhile for them to file bankruptcy. I personally think you need to have a large amount of debt. I mean, let's say $50,000 or more before, I would consider that as an option, but it all depends on an individual's financial situation. Just so you know, all of our accounts when they come in are scrubbed to see if there's any bankruptcies on those accounts as they come in and our flagged. As far as any legal things going on right now, the governor did sign an Iowa proclamation halting any new wage garnishment. But that expired, I believe, as of yesterday. Those were just put on hold for roughly 25 days. But like I mentioned before, we're not filing any new lawsuits or any new wage garnishment as of today.

Tom Barrett:

So in some parts of the country, the courts are closed. Are your court's closed or are you still able to file legal?

Brian Grimes:

Our courts are open for the most part. A lot of hearings, physical hearings, have been put on hold or moved out to a future date, but the court system is allowing us to remotely call in on certain hearings, if need be.

Tom Barrett:

Dale, I hope that answers your question. If it hasn't, type it back in the chat box. If anybody else has questions, let us know. We've about five minutes left in this webinar. Brandy Kelly has a question. At what point will you begin collection efforts again? Brian, Misty, Amy, any of you would like to handle that?

Misty Little:

I would say right now we are still doing collection efforts. We're still taking placements. So if you're sitting in the office and maybe it's slow right now for you and you're trying to look through your book, any bad debt, we are taking those placements right now. As of right now, the only thing we're not doing is the wage garnishments, the new ones and the new judgments. But we're actively collecting.

Tom Barrett:

Randy says, Sorry... to clarify, we're waiting for a garnishment of wages. So Brian, I think you already addressed that.

Brian Grimes:

I was going to say, Tom, this is across our industry and all of us are completely baffled, but we are seeing collection rates higher than we've ever seen before and it's gotta be the contact we're having with people. Everybody's at home. I think people clean up their credit. And lastly, more liquidity has been handed out to folks than we've ever seen, especially folks that typically don't have a lot of extra cash laying around.

Tom Barrett:

Yes, the statistics that I'm reading right now say that people who were working before the pandemic started are making upwards of 45% more today with the CARES Act program. It's been widely reported in the news about the abuses, but I don't think it's been widely reported how much this, the CARES Act, has really helped individuals as well as businesses.

Tom Barrett:

Well that's all the questions we have. Are there any other questions? Type them into the chat box. If anybody would like to contact Brian, Misty or Amy, they would be more than willing to help you with any individual questions, problems or concerns that you have. I think the takeaway for me from this is that this is not the time to stop collection efforts, because we're being so successful, and people are pleased to pay off their debts. So let's see, we have another question. So when do you have a specific idea of when wage garnishments will begin again? Brian?

Brian Grimes:

I believe that they're starting basically the ones that were put on hold. It's either yesterday or today, the proclamation runs out. So all the courts, if you had an existing garnishment or any of the ones that we had ongoing that started before the pandemic, as far as what we put in place, should start back up. And I don't believe the 120-day window is extended. That's a question mark we have out there. As far as when are we going to start filing new wage garnishments. We're not doing it right now and we may be holding off for a little while longer. There's potential that the federal side of things, if the Heroes Act comes through, there could be nationwide all-out hold on that. So we're kind of holding off to see what happens.

Tom Barrett:

Yes, so keep in the back of your mind, everybody on this webinar, that things are changing rapidly. We're getting more and more clarification and we're all kind of in this together. So being flexible, being understanding and just working well together I think is the key to the success of moving through this.

Tom Barrett:

Are there any other questions? I don't think so. Everybody on the webinar: Thank you so much for your time, for your attention, and we will have a recording of this webinar prepared by next week and send it out to everybody who was on this webinar and those that signed up that couldn't make it.

Tom Barrett:

Amy, thank you so much.

Amy Vroegh:

Thank you, Tom. Thank you. Thank you everyone.

Tom Barrett:

Brian, thank you.

Brian Grimes:

Thank you. Thanks everybody. And my heart goes out to everybody in the medical field.

Tom Barrett:

Okay. And Misty, thank you for your time.

Misty Little:

Yes, thank you. I just want to add, too, if there's anybody that's on this webinar that is currently not a client of ours, I'd be happy to work with them as well, to set them up and get started on debt collection services for us. So feel free to give me a call.

Tom Barrett:

So, everyone have a great afternoon. Thank you.

How Does the Collection Process Work?

Fri, 08 May 2020 13:36:00 GMT

How Does the Collections Process Work?

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Let's Follow an Account Through

the Collections Process

What happens to an overdue account once it's sent to collections?

That may depend on the type of debt incurred. Credit card debts, medical debts, and student loan debts are the most common types of debt sent to collections, although car loans, utility bills, personal loans, and cell phone bills are also quite prevalent.

Assigned or Sold?

Creditors may either assign the debt to a collector, or they may sell it. Assigned debts are still owned by the creditor, and the collection agency takes its cues from him. For example, with an assigned debt, the collector cannot negotiate a settlement or pursue legal action without the creditor’s authorization.

If a debt is purchased outright by a collection agency, the creditor no longer has any responsibility for the overdue account.

Almost all debt collectors work on assigned debts for a contingency fee. That is, they are paid with a percentage of the total amount collected. Usually, higher percentages are paid for older accounts.

The Collections Process

Debt collectors first use letters and phone calls in their attempt to contact consumers. The purpose of this is twofold: To verify the consumer's identity and to persuade the consumer to pay his debt.

Within five days of this first contact with the consumer, the collector must issue a Debt Validation Letter. This letter is required by the Fair Debt Collection Practices Act (FDCPA).

The Debt Validation Letter must include the following:

The total amount of the debt.

The name of the creditor seeking payment.

A statement indicating that, unless the consumer disputes the debt within 30 days of the first contact, the collector assumes the debt to be valid.

A statement indicating that the collector will verify the debt by mail if the consumer writes to dispute the debt or request more information within 30 days.

A statement indicating that, if requested, the collector will provide the consumer with information about the original creditor within 30 days.

If the consumer requests debt verification, collection activities are suspended while the debt is being verified and the Debt Verification Letter is being prepared.

Thereafter, the regular schedule of collection letters and phone calls may be resumed. In all communications, the collector should respectfully request payment and explain the time frame for reporting delinquencies to the credit bureaus.

This schedule of letters and phone calls continues until a payment agreement is reached. At this point, if all attempts to collect the debt have been unsuccessful, the creditor may authorize legal recourse.

When Legal Action Is Necessary

Once a debt is very delinquent (e.g., 120 or 180 days overdue) and resolution does not appear likely, the collector may choose to pursue legal action, with the creditor’s approval. A debt collector may also pursue legal action if the debt is nearing its statute of limitations. (See sidebar below.)

The Statute of Limitations

The statute of limitations on debt varies from state to state and is categorized according to four types of debt:

Oral agreements
Written contracts
Promissory notes
Open-ended accounts

Once the statute of limitations has run on a debt, legal action may no longer be pursued.

However, collectors may still pursue recovery on these time-barred debts, so long as they comply with the FDCPA. In addition, if the consumer asks about the statute of limitations, the collector must explain that the debt is time-barred.

Please note that resolution is still attempted
throughout this legal process,

allowing the consumer every opportunity to
resolve the debt.

If the lawsuit is valid, a judgment will be issued by the court, ordering the consumer to pay the debt. Without this court order, the debt collector cannot seize a consumer’s bank account or paycheck. But with a judgment, the collector is authorized to perform certain actions in order to recover payment.

Typically, those actions would involve one or more of the following:

Garnishing a percentage of the consumer’s wages through a garnishment order, for 120 days or until the debt is paid in full. The percentage garnished is based on the consumer's income and does not drain the paycheck.

Placing a levy on the consumer's bank account or vehicle, allowing the creditor to seize the asset.

Placing a lien on the consumer's property.

Forcing the sale of an asset in order to pay the debt.

Of these options, wage garnishment is the most common action taken. It is also the only action that CBSI currently takes to resolve the debt legally. The other options, while legally available, are not very consumer-friendly.

Garnishing a portion of the consumer's paycheck is effective without jeopardizing the customer relationship, as the judgment does not indicate the client company name.

At CBSI, our collection professionals treat both our clients and their consumers with respect and dignity throughout the entire collections process. We're passionate about compliance and client satisfaction, and our recovery rate is one of the highest in the industry.

Sources:

Featured Image: Adobe Photo, License Granted
Nolo
Investopedia

Nerd Wallet

The Balance

Tax Refunds Help Pay Off Medical Debt

Wed, 08 Apr 2020 12:32:00 GMT

Tax Refunds Help Pay Off Medical Debt

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Encourage Your Patients to Use Their
Tax Refunds Wisely

Do you know the average 2019 federal tax refund was more than $2,700? Your patients can use that money to improve their financial health by paying off medical debt.

In fact, that’s exactly what a lot of families do. According to a 2018 survey from JP Morgan and Chase Institute, the week after receiving a tax refund, healthcare spending overall increases 60 percent, and out-of-pocket healthcare spending on debit cards increases by 83 percent.

This increase in healthcare spending was particularly pronounced among the bank customers with the lowest checking account balances.

Ways to Spend It

But your patients may be tempted to spend their tax refunds in a myriad of other ways. While splurging on a new wardrobe or booking a cruise sounds like fun, it’s definitely not the wisest choice for those with medical debt.

You can encourage them to invest in their financial health instead. Here’s how:

Remind them that using their refund to catch up on their debts can prevent damaging their credit score or – even worse – becoming charge-offs .

If their medical debt is more than the refund, help them work out a payment plan for the remainder, once the refund has been applied to the balance.

If the tax refund comes close to covering the debt, be willing to negotiate a settlement by accepting the refund as payment in full. (Note: Make sure your patients are aware that the unpaid portion of the debt may be regarded as taxable income by the IRS.)

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Inform your patients that legal complications resulting from medical debt can severely impact their financial well-being. In fact, medical debt is the leading cause of consumer bankruptcy .

You may also suggest that they free up cash for medical bills by taking care of other debts. For instance, if they’re able to settle credit card debt , they’d have extra money on hand to pay medical bills.

The All-Important Emergency Fund

Finally, to help your consumers avoid falling behind in the future, suggest they create an emergency savings fund . Setting aside even $500 or $1000 in a special savings account can provide a helpful buffer whenever unexpected medical bills pop up.

Most experts suggest that the equivalent of three to six months’ salary is ideal, but even a few hundred dollars in the emergency fund can save your patients from incurring medical debt in the future.

Once they’re no longer incurring medical debt, subsequent tax refunds can be used to build up this emergency fund.

For patients who are enrolled in a health plan with a deductible of at least $1,350 for an individual, you could also suggest that they open a Health Savings Account . HSAs are a tax-free way to help patients save for future qualified medical care.

Using their tax refunds to pay down medical debt may not elicit the same level of excitement as splurging on luxuries. But it can wisely position your consumers to reap financial benefits in both the short and long term.

Sources:

Featured Image: Adobe, License Granted

The Power of Credit Reporting

Wed, 11 Mar 2020 12:31:00 GMT

The Power of Credit Reporting

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Credit Reporting Is a Powerful Tool
That Must Be Used Responsibly

Jonathan receives a tentative job offer from a great company that will provide a good salary and generous benefits.

But before his hire date, the employer retracts the offer. Jonathan later learns that collection accounts on his credit report were the culprit.

Who’s Looking?

Who looks at credit reports anyway?

There was a time when only lenders and financial institutions ran credit reports. Not anymore. In today’s world, employers, insurance companies and utility companies also use credit reports and credit scores when making decisions about consumers.

In fact, according to a 2012 report by the Society for Human Resource Management , about 45% of mid-sized companies perform background credit checks on their job applicants. (Note: Employers do not have access to consumers’ credit scores, but instead see a modified version of their credit reports.)

These credit checks provide employers with insight into a potential new hire, such as:

Lots of late payments could indicate a lack of organization and/or responsibility.

Excessive debt can be a sign of financial distress, which could indicate a risk of theft or fraud.

Mishandling of finances could indicate a poor fit for a job that involves company funds.

That’ll Cost You

While a high credit score can open doors and lower interest rates and premiums, a low credit score will have the opposite effect. And just one collection account can cause a good credit score to drop 50 to 100 points.

A negative credit report can cost a consumer a small fortune in interest on a car loan. But did you know it can also increase his insurance premiums?

Take auto insurance, for instance. Insurance carriers base their premiums in part on credit scores because, statistically, drivers with lower credit scores file claims more often.

So these drivers pay more right from the start. In fact, according to The Zebra's 2019 "The State of Auto Insurance" report, “Drivers with poor credit pay more than twice as much for car insurance as those with exceptional credit.”

There are two ways bad credit can affect a consumer’s ability to rent an apartment:

The landlord may favor applicants with better credit ratings.

2. If approved, the landlord may require a significantly larger security deposit.

Knowledge Is Power

The “Big 3” credit bureaus (Experian, Equifax and TransUnion) maintain financial and personal records on more than 200 million American consumers. These bureaus merge data regarding a borrower’s historical transactions and payments with behavior analytics for certain types of debt. So they determine who is a good, mediocre or poor credit risk.

A credit report from these three credit bureaus can mean the difference in getting a job (or not) or receiving a security clearance (or not). And it’s probably the biggest factor in whether a consumer can purchase a home or a vehicle.

In addition to the Big 3, there are more than 400 regional or industry-specific credit bureaus across the U.S. These agencies provide specific information about everything from rental history, employment and medical debts. Every year, credit bureaus make an estimated 36 billion updates using data from 18,000 sources.

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Use Responsibly

The power of credit reporting involves a concomitant responsibility. Reputable medical collectors, like CBSI, do not take this responsibility lightly.

At CBSI, we take care in the way we advise patients of the potential negative impact medical collections can have on their credit reports. And we will work with the patient/consumer to keep an overdue account from being reported to the credit bureaus, if at all possible.

Our mission is to help your patients pay their debts and get back on the road to a better credit rating.

Sources:

Featured Image: Adobe, License Granted

Federal Reserve Bank of St. Louis
Debt.org
Nerd Wallet

Best Practices When Using a Collection Agency

Thu, 20 Feb 2020 02:56:00 GMT

Best Practices When Using a Collection Agency

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CBSI Webinar Transcript
(February 19, 2020)

In healthcare, as the amount of patient self-pay increases,
maximizing the amount of self-pay collected becomes crucial.
This 30-minute webinar reviews the best practices for managing patient self-pay.

Brian Grimes:

Hello everyone!

As we all know, the amount of self-pay medical debt is rising dramatically. On average, patient pay now represents 18% of provider revenue. High-deductible health plans are on the rise, and 68% of patients under 65 have high-deductible health plans.

At CBSI, we’re seeing a dramatic rise in “registered self pay.” In other words, people without health insurance. Overall, the number of uninsured patients has increased more than 12%. This is why it’s extremely important for you to maximize the amount of self pay collected -- both on the front end and the back end.

Good morning and welcome everyone! My name is Brian Grimes and I’m the director of sales and marketing at CBSI. With me is our sales and marketing manager, Misty Little. Since 1955, CBSI has provided patient-friendly collections services, primarily for healthcare. But we do serve other industries, as well. As “the collection agency that cares,” we focus on connecting with patients, resulting in better returns while fostering genuine customer relationships.

The more work that is done up front to collect payment, the better. With increasingly more self-pay patients using your services, you need to do as much as you can to collect up front.

Pre-service pricing is the most important priority. Helping your patients understand what their costs are going to be up front, greatly increases your chances of getting paid.

Friendly and consistent communication is key. Giving your patients the feeling that you are willing to work with them, not against them will foster better relationships and will help in getting payments.

Engage early with payment options. Educating your patients on different ways payments can be made will lead to more payments.

And finally, develop an insurance discovery process. Are there any payers that should be responsible for this bill? Workman’s comp, auto insurance, Medicaid Presumptive etc. An insurance discovery solution can convert 1-5% of your uncompensated care accounts.

Having a well-trained staff on the front lines is crucial for up-front collections. It can be tough to ask for payment. Make sure to train your staff to address payment issues in a tactful manner. It’s really no different than the way we train our collectors on overdue accounts.

You need to cater your approach to the specific personality of the patient. For example, if someone is very emotional, you need to remain calm and composed. Acknowledge what the individual is saying. Show empathy but, at the same time, ask for payment.

If someone is argumentative or does not believe that they owe payment, make sure you have all your ducks in a row. Produce documents for every denial or co-pay and have this ready ahead of time. If a staff member is still not able to ask for payment after extensive training, you may need to find a better fit for the position.

Intake forms and patient contact info are key to the success of your collection agency. Make sure you’re obtaining as much info as possible on your intake forms including:

DOB
SSN
Middle Initial – This is important for credit reporting. In recent years, the credit reporting agencies have tightened their requirements on credit reporting. Now if you don’t have an SSN and date of birth, a middle initial is required.
Employment – Including phone number and address. Sometimes you can get this info from the insurance cards.
Phone numbers are critical; include both landline and mobile numbers.
E-mail address – Although not widely used in collections, there’s new legislation in the works providing a safe harbor for collection agencies to e-mail.

If someone is married, be sure to collect all the same information for the spouse. In the state of Iowa and several other states, both husband and wife are responsible for each other’s medical debts. Same thing goes for minor children--both parents are responsible, regardless of what the divorce decree says.

Among all the normal disclosures, make sure your intake forms grant permission to contact patients via autodial, automated messages, E-mail, and text. It does pay to engage a professional payment service provider that goes beyond just sending statements.

Misty, can you please fill us in on what to look for in payment service providers?

Misty Little:

Having multiple payment options for your patients is very important. We all like to have options and we want the payment process to be convenient. Your more traditional patients still want the ability to pay by check and mail their payment in. They need to have this option.

Online bill pay is becoming increasingly popular, especially with the millennial population. They want to be able to access their account from their computer or phone and make their payment. CBSI receives 20% of its total payment revenue online.

Acquiring credit card information and keeping it on file for payments is another way to make sure payments will be made.

Letting your patients set up a reasonable payment plan is very important. Having to pay a bill in full can be very overwhelming for some patients, which is why some just don’t pay at all. But if they know that can set up a plan that will work with their budget, they’ll be more likely to pay.

Setting up automatic payments is also a good option. Up-front collections are best. However, we all know there will be times when you need to send someone to collections.

Brian Grimes

Misty and I get asked every day, “When is the right time to send an account to collections?” Current best practices include the following:

Once insurance has been applied (typically 30 days after service), send out the first statement.
If no payment is received, send a past-due text, phone call or email.
At the 60-day mark, send a past-due statement. It’s best if your past-due statement has a different look and feel from your first statement.
Once again, if payment is not received, send a past-due text, phone call or email.
At 90 days, send a final notice, explaining the account is being turned over to collections if not paid in “X” days. I recommend 10 days, as this creates a sense of urgency.
If no payment received, collection agency should come into play at 120 days past due.

A lot of agencies push to send your accounts at the 30- to 60-day mark. However, I think this is too soon. Patient relationships are a concern and obviously so are commissions.

However, if someone is not willing to pay after three statements and 120 days, the statistics show you’ll end up with more in your pocket by sending the account to collections than continuing to send statements.

Of course, there will be situations where you’re waiting on insurance. However, if you’re going past six months, it’s going to cost you--bad debt is very time sensitive.

Once accounts are placed in collections, we then verify addresses with the USPS.
Scrub for bankruptcies and deceased.
Score each account based off collectability .
Accounts are then grouped with any other existing accounts in our database. Currently, this happens 90% of the time.
Then send out a validation notice. The law requires that consumers be given 30 days to dispute a debt.
Each letter has a link to our online payment negotiator to set up payment plans.
Next the collection calls start.
Credit reporting after 60 days.
Legal recourse begins after regular efforts are exhausted.

Misty will now talk about what to look for in a collection agency.

Misty Little:

There are several things you should look for when considering a collection agency. Make sure you do your homework.

The location or market worked is very important. You want to make sure the agency you use works your market. Having a local database of patient contact information is extremely important for collections. National agencies just aren’t able to return as much money to you, because they don’t have the local contact information.

Using an agency that actively works your market gives them the ability to combine efforts, because they’re working with that same consumer who has debts with other local clients. So a local agency can use all the data collected to understand the collectability of an account, because they already have a relationship with that individual. The agency can also combine the accounts for that individual, which will equal a larger amount owed in total and ensures the account will be worked and revisited several times to collect payment.

You’ll also want to ask the agency about their license. Many states do require a collection license or bond. Make sure the agency you decide to use has the correct credentials for your state or partners with an agency that does.

Does the agency pursue legal action? Legal recourse is an option that works well in some states, but not all. For CBSI, it’s a last resort after all regular collection efforts have been exhausted. We only pursue legal action on accounts where we’ve been unsuccessful in collecting through regular efforts and we’ve verified that the individual is gainfully employed, and has the ability to pay but is choosing not to. Once legal recourse has been pursued, we can garnish wages to collect the debt. The garnishment process is actually rather consume-friendly, as it does not drain the patient’s paycheck and only lasts a maximum of 120 days.

Beware of agencies that send accounts to legal right away, within 30-60 days of receiving the account. This is a tactic that less reputable agencies will use to charge you a higher rate. They’ll also sometimes send a letter to your patient, threatening legal action but then never follow through with it. This practice is illegal.

ACA membership is also something to ask about. The Association of Credit and Collection Professionals establishes ethical standards for collection agencies. Compliance and regulation are first and foremost. ACA members have access to the latest industry changes and information to stay compliant. An agency that is active in its local state ACA chapter is a good sign of a reputable agency. Compliance is extremely important. Your agency must be compliant with the FDCPA (Fair Debt Collection Practices Act), as well as all state and federal regulations. Ask if they have a compliance system in place and how they handle disputes.

Longevity of the agency is also important. There are some fly-by-night agencies that come and go in our industry. Make sure your agency of choice has experience and good financial standing.

BBB – Better Business Bureau rating. Research the agency’s BBB rating. Yes, individuals will complain to the BBB just to try and get out of legitimate debts owed, but make sure your agency is responding to the complaints and does not have an unusually low rating. Using an agency who utilizes a HIPPA Compliant Online Portal is also something to look for. It’s helpful for you and your staff, as you can check on your accounts, run reports and communicate securely. It’s also a great tool for your patients, so they can make online payments to pay in full or negotiate a payment plan.

Collections approach – Make sure the agency you choose has a patient-friendly approach. Working with your patients in a caring, empathetic manner will get more results than harsh demands. Being friendly, understanding and compassionate will lead to higher returns in the long run and fewer complaints.

Brian Grimes:

One of the most important things to remember about choosing a collection agency is to not just go for the low rate. Most agencies work on a contingency basis, but a lower contingency rate is not always best for your business. Agencies who offer unusually low rates do not put the work needed into collecting the accounts. They may make one or two phone calls and give up. You want to focus on the amount of Net Dollars Returned an agency can get for you. Even with a higher contingency rate, the agencies that put in the work to collect on your accounts will recover more money in the end, which is better for you in the long run.

To determine an accurate return percentage for your agency, simply take the dollar amount they have returned divided by the total dollar amount you have placed with them. This factors in the contingency rate while focusing on the true dollars they were able to recovery for you. Lower contingency rate does not always equal savings or more money back in your pocket.

At this time, we’ll open it up for any questions you might have.

Questions:

HOW MUCH WILL YOUR SERVICES COST ME?

Many collection agencies, like CBSI, charge on a percentage based on the amount they collect, also known as a contingency fee. This fee will most likely be based on the age and volume of your receivables and will be determined after gathering more information specific to your practice/business .

HOW WILL MY PATIENTS / CUSTOMERS BE TREATED?

It’s important that the agency of your choice realizes that, although you’re owed money, you have a reputation to maintain and would like to keep a working relationship with the customer. For this reason, you want an agency that truly cares about that relationship. The collectors must be professional and helpful, as well as tactful, when speaking to your customers--never harassing or belligerent. At CBSI, we believe that being “Iowa Nice” is the right way to treat people.

HOW WILL I KNOW THE STATUS OF MY ACCOUNTS?

Your agency should provide you with monthly statements, as well as access to progress reports on your accounts. CBSI offers a user-friendly online web portal for our clients to run reports and view all activity on their accounts 24 hours a day, seven days a week. At CBSI, you can also call or email our office during normal business hours and speak to our highly skilled customer service team for updates.

WHAT IF MY MAIL IS BEING RETURNED AND WE DON’T HAVE ANOTHER ADDRESS?

A good agency should utilize “skip-tracing.” Skip-tracing utilizes state-of-the-art technology to locate consumers that have moved from their previously known address. There are many means available to an agency to skip trace, such as certain paid software programs, as well as the Dept. of Motor Vehicles, the internet, the credit bureaus or merely fishing around. A good skip tracer is like a detective; they’re rewarded when they find their subject. Also, 90% of the time, that name that you send us is already in our system, because they owe other people money as well. We have lots of ways to find updated information.

WHAT IS THE MINIMUM DOLLAR AMOUNT THAT IS WORTH SENDING TO CBSI?

Our minimum placement dollar amount is $20 typically. That would be if you had multiple accounts, maybe several small co-pays with a total of $20.

ON AVERAGE, WHAT IS THE PERCENTAGE OF ALL ACCOUNTS PLACED WITH YOU THAT ARE COLLECTED IN FULL WITHIN SIX MONTHS?

It would totally depend on how much work the client has put into the accounts, how old they are, the average balance, location, etc. In a perfect world, the industry average return rate is about 18%, and that's over the course of several years. The six-month range would be considerably lower, ranging from 5%-7% to 12%-15%. Our ultimate goal is to return about 30%, where the industry average is about 18%.

WHAT IS YOUR PROCESS FOR ACCOUNT PLACEMENTS FROM PROVIDERS? ARE WE ABLE TO UPLOAD A SPREADSHEET TO YOUR PORTAL?

Our client access web system gives you the option of uploading your own spreadsheet to our portal. We also have a form on there that you can fill out, if you're just placing one or two accounts. If you have multiple accounts, you can definitely upload a spreadsheet. We just ask that as much information as possible be included on the spreadsheet.

DOES CBSI PRIORITIZE THE ACCOUNTS BASED ON THE AGE OF THE PAST-DUE BALANCE?

That is part of it. Our system uses a whole scoring methodology based on age, collectibility, balance, patient's financial status, and our own experience with that individual.

WHEN SOMEONE SETS UP A PAYMENT PLAN, AND THEN DEFAULTS ON THAT PLAN, WHAT IS YOUR PROCESS FOR CONTINUING TO TRY TO COLLECT ON THE ACCOUNT?

That account stays in our regular collection efforts. We'll start calling and sending letters again. If there's still no payment, then we'll report it to the credit bureaus. If it's a high enough balance, we may pursue legal action. After that, they won't have the option, because we'll garnish wages.

IS THERE A MINIMUM BALANCE FOR YOU TO PURSUE LEGALLY?

Typically, it's about $500 or $600 owed to our agency. But that doesn't mean that your $20 or $50 account won't be pursued through Legal. Through right of assignment, we can assign all those debts over to the credit bureau from multiple clients being owed. We then can pursue one small claims court judgment, with all the parties included.

IS THERE A STATUE OF LIMITATIONS ON COLLECTING A DEBT?

In Iowa, the statute of limitations to pursue legal action is five years based off the last date of activity (e.g., service date, payment, etc.). There is no statute of limitations to pursue the debt through other means in the state of Iowa. It is always collectible, regardless of age. It's just the window to pursue legal action and credit reporting does have that limitation. And that statute can vary from state to state.

CAN LATE CHARGES / SERVICE CHARGES BE INCLUDED IN THE PATIENT'S DEFAULT PAYMENT BALANCE FOR CBSI TO PURSUE FOR A CLIENT?

That's definitely a possibility. We usually suggest that that be done on your end first. Once you send the bill over to us, we like for it to be the final amount owed by the patient, so the amount isn't changing. We also suggest you put some sort of disclosure statement on your patient intake form or your patient financial responsibility form that says they will be charged late fees or collection fees in the event of non-payment.

DOES THE DEBT STAY ON A PERSON'S CREDIT REPORT FOREVER, OR JUST UNTIL THE DEBT IS PAID OFF?

It basically stays on the credit report for seven years. But the credit bureaus want us to remove anything that's been paid by insurance. And for the most part, anything that is paid, we are removing. If it hasn't been paid, after the seven-year mark, it's completely gone. For patients who are curious about their credit reports, go to annualcreditreport.com .

IF WE HAVE SENT AN ACCOUNT TO COLLECTIONS, AND THE AMOUNT DUE IS WRITTEN OFF AT THE END OF THE YEAR, AND CBSI IS UNSUCCESSFUL IN COLLECTING IT, IS IT LEGAL TO ASK THE PATIENT TO PAY IN FULL THE COLLECTION AMOUNT BEFORE SETTING UP ANOTHER APPOINTMENT FOR THEM?

I'm not an attorney, but we have clients all the time who require patients to pay collection accounts in order to receive further services. Hospital accounts are a different story with regard to what they can or cannot turn down. But on the clinic side, that usually is the case, and I recommend it.

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