Now is the time to improve your financial counseling

New processes are necessary

More than ever, patient access staff are being challenged to step into a new role — that of financial counselor. Patients have more complex questions and needs, and are turning to front-line staff for answers.

At University of Kentucky (UK) HealthCare in Lexington, the patient access department recently combined the professional and hospital counselors into one unit. "The benefits we hope to achieve are providing one statement covering the entire out-of-pocket expenses," says Ed Erway, chief revenue officer. "Decreasing costs, while improving information, should ultimately improve patient satisfaction."

The department also is planning to implement two new programs. These will focus on pricing transparency and determining guarantors' ability to pay for their health care financial obligations.

"These programs will be integrated with our patient access pre-registration functions, to provide improved services to our patients before their service," says Erway.

Antionette Anderson, CHAA, CHAM, director of patient access and centralized scheduling at Skaggs Regional Medical Center in Branson, MO, says that financial counseling is a new role for patient access staff. "In my facility, I have three financial counselors under patient access," she reports. Here are their roles and responsibilities:

The emergency department's financial counselor screens patients for Medicaid and/or charity assistance when registrars are unable to collect from the patient during in-room registration. If the patient does not qualify for either, a payment plan is set up.

An inpatient financial counselor goes up to the patients' rooms, lets them know what their out-of-pocket expense is, and collects this amount. If the patient is unable to pay, the counselor screens for Medicaid or charity eligibility. If the patient does not qualify, a payment plan is set up.

"We also have a financial counselor for outpatients," says Anderson. "Any scheduled test or procedure needs to have financial clearance if the patient is self-pay or charity, before the test is scheduled."

The hospital has a monthly budget for charity care. "Anything that is not an emergency goes before a committee that meets bi-weekly," says Anderson. The committee is made up of the director of patient access, a financial counselor, the hospital's CFO, clinic administration and four physicians.

"They OK the procedure, or suggest alternative testing," says Anderson. "Sometimes, we have the ordering physician come to the committee to help the committee better understand the procedure that they are wanting to do." All elective procedures are denied.

Self-pay patients are required to talk with a financial counselor prior to scheduling. The counselor informs the patient of the cost of the procedure, and asks how they will pay for it.

"We attempt to collect 100% upfront," says Anderson. "If the patient is unable to do this, we ask for a down payment. The patient is set up on a payment plan." (See the department's matrix, which is used to set up payment plans, this page.)

[For more information, contact:

Antionette Anderson, CHAA, CHAM, Director of Patient Access & Centralized Scheduling, Skaggs Regional Medical Center, PO Box 650, Branson, MO 65616. Phone: (417) 335-7701. E-mail:

Ed Erway, Chief Revenue Officer, University of Kentucky HealthCare, 800 Rose St., Lexington, KY 40536. Phone:(859) 323-5502. E-mail:]