Tools allow members of patient access staff to screen patients for financial need early in process
Get out in front’ of push for price transparency
Developing protocols, tools, and targets to increase collections is nothing new for patient access, according to Gerilynn Sevenikar, vice president of patient financial services at Sharp HealthCare in San Diego. "What is potentially new is the profile of the patient," Sevenikar says.
At Sharp HealthCare, 90% of uninsured emergency department patients have an annual of income of $30,000 or less. Of this group, 96% are eligible for Medi-Cal, the state’s Medicaid program. "The question then becomes, how do I weave the discussion into the process without it becoming cumbersome?" asks Sevenikar.
To address this issue, patient access uses a web-based screening tool (manufactured by San Mateo, CA-based PointCare). "This directs the team right to the appropriate funding source," says Sevenikar.
If the patient is unable to pay, patient access staff must be able to offer them any of these options, she says:
make payments over time;
use a loan program that is interest-free or carries an interest rate lower than traditional credit cards;
consolidate hospital and, when possible, medical group balances;
access a patient portal to make payments;
use a discount, if appropriate.
"If a patient asks for a rate on a scheduled service, we offer substantial discounts for payment at the time of service," says Sevenikar. "We are even discussing the option of allowing the patient to design their own payment plans through the portal, using a sliding scale of time and monthly payment amounts."
There is clear evidence that the ability to collect decreases, and the cost to collect increases, when that opportunity is missed at the point of service, emphasizes Sevenikar. "In short, the value of a dollar at point of service is reduced to 33 cents when payment is delayed six months," she says. "At the end of the day, we all want to try to resolve the patient balance at the point of service."
Patient access departments also need to be willing to adopt next-generation payment methodologies, urges Sevenikar. "These include smart phone check scanning, bank transfers, text and e-mail messaging," she says. (See related stories on tools patient access needs to successfully collect, below, and how technology improves collections with high-deductible plans, p. 6.)
Nick Davis, vice president of Portland, OR-based Provider Advantage, recommends that patient access "get in front of the push for price transparency" by making these changes:
Provide pre-service out-of-pocket cost estimates that are easily understood by consumers.
"Patients want to know their true out-of-pocket cost prior to receiving services," says Davis. "They want this process to be consistent and reliable."
Remember that patients want their post-service bill to match the estimate as closely as possible.
"If the estimate varies in either direction, they want to clearly understand why," says Davis.
Be sure estimates account for all of the variables in the patient’s insurance coverage and payer contracts.
"For best optimization of the revenue cycle, hospitals and healthcare systems must lead this charge, or they risk letting the tail wag the dog,’" says Davis.
Nick Davis, Vice President, Provider Advantage, Portland, OR. Phone: (503) 601-3824. Fax: (503) 352-0266. Email:firstname.lastname@example.org.
Marsha Kedigh, RN, MSM, Director of Admitting, ED Registration, Discharge Station, and Insurance Management, Vanderbilt University Medical Center, Nashville, TN. Phone: (615) 343-0892. Email: marsha.kedigh@Vanderbilt.edu.
Gerilynn Sevenikar, Vice President, Patient Financial Services, Sharp HealthCare, San Diego. Phone: (858) 499-4215. E-mail:email@example.com.