Patients, employers both fiscally stressed

Additional training needed

Patient access staff are encountering patients under financial stress, and the same is true for employers, notes Brett Taylor, director of payer relations for Nationwide Children's in Columbus, OH. "Unfortunately, it's just the environment that we are in," he says. "The patient's responsibility is increasing. At the same time, employers are trying to educate members on their health plan so that they can make an informed decision."

Silva Gramlich, director of registration services in the hospital's finance department, says that staff are often put in the position of letting patients know that their out-of-pocket obligation is higher than the previous year.

"It does put staff in a bad position to be the bearer of bad news," she says. "It's not a pleasant situation, and the consumer may be upset with the hospital."

Taylor says that he finds this to be more pronounced in a children's hospital. "There is a difference between the pediatric world versus the adult world," he says. "There is a little bit more emotion that comes to a day-to-day visit here, versus what you might see in the adult setting."

Staff were given customer service training to help them discuss a patient's financial status and make payment arrangements, says Judith Toth, the hospital's director of patient accounts. "We make it as easy as possible for people who do qualify to be able to get any kind of assistance they may need," she adds. "We also direct them to an outside group to get approval for any governmental programs that are out there."

Many times, patients are unaware that there may be programs to help them, especially those with language barriers, says Toth.

Competency required

A patient may have a $5,000 deductible before services are covered at 80%, says Toth. "People can have bills that are hundreds of thousands of dollars, so 20% responsibility is a lot," she says. "We see what we can do to help them with the difficult financial challenges that they are experiencing."

Gramlich says that a new model of training was created in 2010. Staff now are expected to pass a competency test. "We are now seeing this start to pay off with accuracy," says Gramlich. "In the past, they might not have selected the right insurance plan. They now take an extra second to make sure that the right ID number is typed in."

This prevents the billing team from getting a "member not covered" denial, says Gramlich.

While new staff members always took a competency test, now anyone in a patient access role is being asked to pass it, says Gramlich."If you do not pass, you have to go through new employee training. If you do not pass a third time, your log-on is revoked."

By increasing accuracy, the work that all of the various billing divisions have to do is lessened, says Toth. "If you complete a good record here, it will decrease the workload for the team that is responsible for billing or paying posting," she says. "Plus, it is a negative impact to the family when we get those mistakes. We then have to reach out to the family again and say they are not covered. That is a cost to the organization."