Is patient eligible for discount? Say so!
Access must be knowledgeable and empathetic
"We will work with you." This is the message that Junko I. Fowles, CHAA, patient access supervisor at Huntsman Cancer Hospital, Salt Lake City, UT, tries to convey whenever patients ask about their out-of-pocket responsibility.
Executive Summary
Patient access employees need to convey to patients that the hospital is willing to work with them on payment for services, but that a partnership is expected. Patient access areas are:
- informing patients of discounts upfront;
- being clear that cost-sharing is determined by the insurance plan;
- obtaining a detailed description of what services are going to be done and where.
"I stress that if the patient is willing to pay a deposit toward their visit, we can work out payment arrangements for the rest of the balance," Fowles says. "In other words, I try not to make it seem like they have to pay exorbitant fees upfront before receiving care."
Fowles informs self-pay patients right away that the price being quoted has a 30% discount applied to it. "I tell them there could be more charges added to the price estimate," she says. "However, any charges billed to the patient would have the 30% self-pay discount applied."
In addition, self-pay and insured patients receive an additional 10% prompt pay discount when the balance is paid in full. "We are willing to work with them when it comes to payment, as long as we get a deposit or copayment for services being rendered," adds Fowles.
At Hackensack (NJ) University Medical Center, self-pay patients are offered a compassionate care rate based on Medicare ambulatory payment classification (APC) rates, says George Brindisi, director of ambulatory registration. "For all others, we determine rates based on our managed care contracts," Brindisi says.
He tells patients: "We have a compassionate rate if you do not have insurance, as well as financial counselors available who can help you determine if you meet any financial assistance programs."
Brindisi says the key is for access staff to come across as knowledgeable and empathetic. "Patients want someone who understands and is, in effect, an expert and does not talk in generalities," he says.
Fowles tells patients, "I understand your concerns in getting an idea of how much this will cost. I can give you a general idea. However, the billed amount may be different due to other procedures, medications, or tests that may be required."
Fowles asks if the caller or the person they are calling for is a current patient in the hospital system. "By asking this question, we can find the correct patient and medical record number in the system to link any estimates to," she explains.
Fowles is clear that it is the patient’s insurance plan, not the hospital, that determines what cost-sharing will be done for the service being rendered.
"If the patient has questions regarding what they will owe or do owe, I would refer them to their insurance for further clarification," she says.
CPT codes needed
Fowles tries his best to give patients as much information as possible on the call. "However, if their procedure or service is complex, I ask if I can call the patient back at a later time to go over the estimate fully," she says. (See related story, this page, on price estimates.)
If the patient is new to the organization, Fowles checks the insurance information and demographics quickly to give the patient a general idea of their situation. "If the caller has the CPT code, we are able to give an on-the-spot answer nine times out of ten," says Fowles. If no CPT code is given, Fowles uses these approaches to obtain it:
• She asks for a detailed description of the procedure and insurance benefits information, and enters this information into the department’s price estimate tool (Epic PriceEstimate, manufactured by Verona, WI-based Epic).
• If the codes aren’t found in the price estimate tool, she looks up the codes in the department’s "dual estimate" spreadsheet, which lists the most commonly used CPT codes.
• She often contacts coders to obtain correct codes and escalates to her supervisor if codes cannot be located, especially for inpatient services based on ICD-9 and DRG codes.
Partnership needed
Fowles emphasizes that if the patient is willing to work with the hospital, various forms of financial help are available. This help includes payment plans, assistance applications, and drug assistance programs.
"I emphasize that our organization is far more interested in giving extraordinary care than haranguing people about paying bills first before being seen," she says.
However, Fowles also emphasizes that a partnership with the patient and his organization is a necessity. "We can only deliver excellent care if the patient is willing to do their part in ensuring that we are reimbursed for our services," he says.
- George Brindisi, Director of Ambulatory Registration, Hackensack (NJ) University Medical Center. Email: GBrindisi@
HackensackUMC.org.
- Junko I. Fowles, CHAA, Patient Access Supervisor, Huntsman Cancer Hospital, Salt Lake City, UT. Phone: (801) 587-4036. Fax: (801) 587-8269. Email: [email protected].
