Do your staff have trouble asking patients for money?

Teach them to 'collect with compassion'

Increasingly often, patient access staff are put in a difficult position - talking about money with patients. "In today's economy, many people have lost their jobs and their health insurance," says Debby Cornett, RHIA, corporate director of patient access, transcription, and health information management at Jewish Hospital and St. Mary's HealthCare in Louisville, KY.

"As this continues to evolve, we have to see not only our role of the registrar changing, but also the role of our financial counselors," says Cornett. "Initially, it was extremely difficult for team members to take on this new role. Some team members adapted very quickly, with the right tools, while others continue to struggle."

Even organizations that have done this for years face challenges. Kym Clift, director of patient accounts for PeaceHealth's Whatcom Region in Bellingham, WA, says that at her organization, "This is not a new role. We have always had financial conversations with patients. But this is always an area that requires continual training and retraining."

Katrina Reynolds, health care system administrative director for UNC Health Care System's office of revenue cycle management, says that "the counselors sit in a precarious position, as being stewards of the health care systems finances, in an environment where we are first and foremost here to care for patients and collectors of finances second."

At Orlando Health, staff are challenged to practice "collecting with compassion." "In our collections class, that is reiterated over and over again," says Craig Pergrem, MBA, CHAM, corporate director of patient business.

The organization's "Collecting with Compassion" class covers scripting tools to be used, as well as how to properly explain to the patient what his or her benefit information is really all about. 

"If you look at all the different plans available out there, we get confused, and we work with it every day," says Pergrem. "To be able to explain to the patient why the collection amount is what it is can be a huge hurdle to jump for the patients."

Collecting with Compassion is a new class developed by Orlando Health's revenue management training team in collaboration with access management and patient accounting. "It is just being rolled out to the areas and has not been deemed mandatory yet, as we are also trying to coordinate our pricing transparency programming into the same process," says Pergrem.

The class is taught by dedicated trainers for revenue management and includes scripting and role playing, and some calculation formulas for major payers. The trainer also stresses the fact that benefit information retrieved is only as good as the information that has been provided by the insurance companies, and if files are not updated, there could be some dated history involved. "One of the keys to this information is to listen to the customer as you are explaining their benefits," says Pergrem. "If they understand their plan, they are going to be able to interact and feed you valuable information."

Orlando Health's access staff are told to remember that it is a customer service enhancement to inform the patient of his or her responsibilities as well as collecting prior to or at time of service. "This usually means there will be very little for them to do after the procedure except to recover at home," says Pergrem. "And probably the most important and simplest rule to use: The answer is always no if you don't ask!"

At Dallas-based Baylor Health Care System, point-of-service (POS) collections training is done both on site and covered during orientation. "Obviously, someone has the potential to be uncomfortable with this if they have not had a previous position with similar expectations," says Mary Best, corporate director of access services. "Depending on the individual patient and the environment it is taking place in, it can be a difficult conversation to have.

"People have a variety of reasons why they think this conversation is not appropriate," says Best. "So if the individual doesn't have the knowledge or confidence to respond appropriately, that might cause them to back off."

Best says that some improvement in POS collections has been seen through creation of an incentive program, and continuous training and reinforcement. "We also post goals and successes of individuals, so even if they don't make the incentives, they can see where they are having success," says Best. "We have done a lot of things to try to improve that, but it will be always be a challenging situation."

Cornett says that one challenge of upfront cash collections is that it requires staff to spend more time with the patient. "However, we implemented without additional staff. The other challenge is when patients are resistant," says Cornett. "If team members understand why we implemented upfront cash collections, they are more confident when dealing with the difficult situation. This understanding requires constant support and feedback."

Cornett says that staff need to first comprehend their role in the big picture and then be given detailed scripting. She recommends having team members discuss both positive and negative interactions, and sending daily e-mails to inform the team how they are doing throughout the day.

Let staff use their own style

At UNC Health Care, the top collectors and performers among the financial counselors were identified, and asked to role play with their team members in staff meetings to demonstrate their skills.

"We have documented the best practices and have encouraged team members to adopt those strategies in talking with patients," says Reynolds. "We encourage our financial counselors to network with one another and partner with counselors that have similar styles."

Although the department developed official scripts for collections, individuals are allowed to develop their own approach and adopt their own words, as long as it is technically accurate. "We have found that this gives them ownership of their conversation with patients and gives them comfort in the subject matter instead of memorizing our words," says Reynolds.

One counselor in particular has crafted her style in dealing with patients such that the patients feel like she is their personal assistant to their financial issues. She writes her patients thank you notes for making payment to her and working with her on alternative funding sources paperwork.

"Her patients feel comfortable working with her because her respect for them is palpable," says Reynolds. "It is no surprise that her collections are the top of the team!"

During a recent staff meeting, two seasoned and top-performing financial counselors paired up in front of the team. One assumed the role of a financial counselor and the other a patient. They engaged in a dialogue about prior balances, charity care, and Medicaid screening.

Then, the counselors switched roles, varying the feedback patients commonly give. "They showed alternative approaches designed to diffuse the situation using strategic, calming language, and presented the patient with options," says Reynolds. "After the simulations were over, staff offered up their toughest examples to the duo and asked the entire team what they would do in given scenarios."

Reynolds says that the No. 1 best practice is to present the patient with options.

"That doesn't mean the patient likes any of the options, but it feels better to the patient and the financial counselor when there are things the patient can choose from in any situation," she says. She gives these additional best practices for collecting:

• Work with patients as if you are their personal financial advocate. "Encourage the patient to reach out to you any time they have questions about any of their services," says Reynolds.

• Send your patients thank you notes when they make payments to you.

• Contact patients in advance of their appointment and make agreements on what they will bring on the day of their appointment.  

• Make an appointment with your patients so that they know when you will be available for them. "Likewise, they know that they are expected to meet with you," says Reynolds.

• Collect something. "If the patient can't pay in full, collect whatever they can give you and educate on the need to pay the remainder," says Reynolds.