Triple POS collections using this approach

Carmen Arroyo, clinic operations manager of cardiology, nephrology, and pulmonary medicine at Children's National Medical Center in Washington, DC, set a goal to increase her area's time-of-service collections by 9% over the previous fiscal year. She wound up tripling the amount collected. Here is how she did it:

First, Arroyo contacted the manager of the hospital's customer service department in the business office to discuss how to best accomplish the 9% goal. The manager agreed to meet with Arroyo and her staff to review patient accounts, insurance cards, and co-insurance.

"She showed the front-desk staff how to review past balances owed on both hospital and professional accounts," says Arroyo.

The group discussed setting up payment plans for parents who could not afford to pay these balances in full. "After just one training, we were on our way," says Arroyo. "We have always prepped clinic ahead of time, but now we actually review each scheduled patient's account."

When a registrar finds that a patient has a past balance, a copayment of more than $20, or a co-insurance payment, he or she contacts the family before their visit. "We inform families of their copays and co-insurance payments," says Arroyo. "If there is a past balance, we also let them know that we will be collecting it at their upcoming appointment."

If the patient's balance is high, staff take the opportunity to discuss what they are able to pay at their appointment. Also, staff instruct the patient to see a counselor in the financial information center to set up a payment plan for the remaining balance.

"We document our discussion in our patient account notes, in case we have a 'forgetful' parent," says Arroyo.

Managers created a time-of-service collection sheet, which is completed during clinic prep. It indicates the amount of copay or co-insurance due for the visit, any past balance owed, and the amount the parents said they would pay during the prior phone conversation.

Staff already know how much to collect, because this sheet is posted at the front desk every day. If a credit is found on an account, staff contact families and let them know that a copayment will not be due because the credit will be applied toward any balance owed.

"We generally find that families appreciate the advance notice," says Arroyo. "It allows them to come prepared and know ahead of time what their financial responsibility will be."

In the beginning, the staff said they found the process to be very time-consuming. "They have now embraced the new procedure," says Arroyo. "I believe it actually has produced a greater awareness of the hospital's financial situation."

The efforts have paid off. Time-of-service collections, which were $52,389 in fiscal year 2009, increased to $96,545 in fiscal year 2010.

"They see this change as their contribution to improving the hospital's financial strength, which is one of our pillars," says Arroyo. "The staff was completely surprised when, as a result of their hard work, they were treated to lunch at their favorite restaurant."

[For more information, contact:

Carmen Arroyo, Clinic Operations Manager, Cardiology, Nephrology, and Pulmonary Medicine, Children's National Medical Center, Washington, DC. Phone: (202) 476-3443. Fax: (202) 476-3900. E-mail:]