Tackle the toughest POS collection areas

Point-of-service collections are becoming increasingly important for patient access areas for many reasons, but this revenue doesn't come easily.

"Collections are a big topic in registration now," says Vicki Lyons, patient access manager at Baptist Hospital East in Louisville, KY. "Everything now is moving to the front end. Trying to be innovative to have the patients pay before services is a real challenge."

Getting patients to pay their copays and deductibles upfront is one of the biggest challenges that Baptist Hospital's registration areas are dealing with.

"It is a known fact that the hospital bill is one of the last bills that patients will pay, so any amount upfront we can collect is well worth it," says Lyons. "I don't think there is any great way to get patients wanting to pay what they will owe upfront. We do give a percentage off if they are self-pay and are willing to pay upfront."

Ed Erway, chief revenue officer at University of Kentucky HealthCare in Lexington, reports, 'We are revitalizing our efforts to improve the upfront collections."

First, managers gave scripts and extra training to front-line emergency department registration staff. Due to high turnover in those positions, managers incorporated training into their orientation, as well as ongoing evaluations.

The ED registration supervisor also provides incentives for higher collections with gift cards and pizza parties. "Leadership has also established metrics for time-of-service collection, and then regularly tracks the monthly collections by area and hospital sites," says Erway. "Eligibility verifying programs enable the registration staff to identify any copay responsibilities of the patients and assist in the collection process."

Barbara Thies, UK HealthCare's manager of patient accounts, says, "We focus on the patient's entire care coverage by utilizing pharmacy programs, state and federal programs, not just covering hospital bills, so that we have a healthier patient." Here are some ways Thies says the department does this:

• Staff monitor the pediatric patient population to make sure patients with long-term illness are in the appropriate state assistance programs.

If a pediatric patient is considered disabled, he or she would be more appropriately processed under adult Medicaid. The program allows a higher family income because only the patient's income is considered.

"This allows the patient's parents to be unafraid of accepting a job with a higher income, because the fear of losing medical care for their child has been eliminated," says Thies.

• Staff work with organizations throughout the state to inform Medicare patients of the best health care options.

Staff may assist individuals in applying for the Qualified Medicare Beneficiary program, a state program designed for individuals who are dually eligible for Medicare and Medicaid, or obtaining supplemental health and prescription coverage.

"These organizations will assist our Medicare population in obtaining prescription drug assistance throughout the year, not just during open enrollment," adds Thies.

• A team informs patients of their financial responsibility for physicians and hospital copays, prior to service.

"They make a telephone call, plus mail a letter to each patient, prior to service," says Thies. Staff ask that all financial responsibility be paid in advance. If the patient is unable to do this, staff ask for a good-faith deposit and a commitment to a payment plan.

"We don't pursue at this time co-insurance responsibility on hospital stays," says Thies. "But, we are looking into programs that would assist us in determining patient financial responsibility so that we can start collecting those based on our contract."

The department is working on a program to introduce to the obstetrics population, so staff can collect their financial responsibility for delivery in advance of services being provided.

"We are considering a 'Welcome to UK HealthCare' packet in which the patient has information to review, prior to being scheduled for a financial consultation," says Thies. "During the consultation, we would be establishing a payment plan with the patient to ensure all anticipated services are paid prior to delivery for the physician and hospital."

The No. 1 challenge, according to Thies, is "changing the culture of our patients." Traditionally, she explains, hospitals have allowed patients to be billed their co-insurance responsibility due to the inability to determine exactly what would be owed.

"Hospitals have not been aggressive as physician offices or free-standing diagnostic clinics on collecting copays. So patients resist, even when they have a set copay," says Thies. "Patients are typically informed by the medical team to not bring anything of value. They show up with only their insurance card, if that."

Debra A. Artwell, manager of outpatient access at Pennsylvania Hospital/University of Pennsylvania Health System in Philadelphia, says, "We have had some challenges in collecting upfront. However, not many. Most patients are well aware of their responsibility."

Each month, most registrars are at 100% in their collection rate. This means that the registrar was able to collect from every patient that he or she registered and was identified as having a copayment.

Sometimes, an authorization is required and the physician office has not yet gotten this information. This puts the registrar in a somewhat difficult position when the patient arrives. He or she is then told that an authorization from the insurance company is required.

"This is not good customer service, because the patient has to wait until that information is received before they are seen," says Artwell. "Insurance companies will not give an authorization after the fact."

The department's strategy is for the registration staff to inform the patient of any out-of-pocket responsibility before the date of service, Artwell says. In addition, schedulers advise the patients of their copayment responsibility at the time of scheduling.

"This way, there are no surprises when the patient arrives for their tests," says Artwell.

There is a monetary incentive for employees if a certain percentage is reached for that quarter. "The incentive is an organizational effort. It's based on a projected monies collected, versus actual," says Artwell. "Organizationally, we have to meet or exceed the amount expected."

When collection goals are met by registration staff at Hendrick Health System in Abilene, TX, a monetary incentive is received. "When the goals are achieved, supervisors and co-workers should extend praise individually and commend the team as a whole," says admissions supervisor Cindy Gardner. "When team members are committed to doing quality work, there is less negative feedback."

The department sets monthly goals for quality, productivity, and collections. "We have one common department goal for collections," says Gardner. "I think that the department goal, versus individual or small team goals, has been the key to our success."

If that goal is not met, there is no incentive payout; if the goal is met, then the admission's staff share 3% of the total collections, divided between all full-time employees, Gardner says. Temporary employees get 3% of their individual collections. For instance, if total collections are $250,000, $7,500 is divided between 35 FTEs, totaling $214 per employee, she says.

"This has really been an inspiration to the entire department to work as a team to reach the goal. Everyone encourages everyone else," says Gardner.

The goal is reevaluated annually. "The leadership team decides whether or not to raise it," says Gardner. "We have met the goal 10 out of the last 12 months. When we first started upfront collections, our goal was $50,000 a month. We have now graduated to $190,000 per month as our goal." In 2009, the department collected $2.65 million dollars.

[For more information, contact:

Cindy Gardner, Admissions Supervisor, Hendrick Health System 1900 Pine St., Abilene, TX 79601. Phone: (325) 670-2891. E-mail: cgardner@ehendrick.org.

Vicki Lyons, Patient Access Manager, Baptist Hospital East, 4000 Kresge Way, Louisville, KY 40207. Phone: (502) 897-8159. E-mail: Vlyons@BHSI.com.

Kerri Sternhagen, Patient Business Services Trainer, Affinity Health System, 222 W College Ave., Ste. 4B, Appleton, WI 54911. Phone: (920) 628-9028. Fax: (920) 628-9019. E-mail: kesternh@affinityhealth.org.

Barbara Thies, Manager, UK HealthCare, Patient Accounts, 2317 Alumni Park Plaza, Lexington, KY 40517. Phone: (859) 257-6182. Fax: (859) 257-8071. E-mail: bethie2@email.uky.edu.]