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Turn reluctant staff into first-rate POS collectors
More complex role
Holly Hiryak, MNSc, RN, CHAM, director of hospital admissions/access services at the University Hospital of Arkansas in Little Rock, says that while financial counseling is not a new role for her access staff members, the role has become considerably more complex.
"In our facility, we are centralizing this role for our inpatient, ancillary, and outpatient services," she says. "We are in the process of finalizing the role and expectations."
The department is seeing more self-pay patients who do not qualify for any kind of assistance, reports Hiryak, and are able to pay something toward their care. "We are also aggressively collecting at the point of service for all areas. This has been a real shift, especially for our ancillary areas."
a. for salaries, Hiryak says, "Unfortunately, we have hit a plateau for access here. The [salary of] the new financial counselor role is actually higher, which I am pleased with."
Patti Rhode, director of patient access at Affinity Medical Group in Menasha, WI, says that a process to estimate patient responsibility is used only when significant expenses are likely, as with orthopedics, surgery, and obstetrics. "We have a staff person that will guesstimate the charges to the best of their ability," says Rhode. That individual contacts the patient's insurance companies for pre-authorizations and determines what they will cover to calculate what the patient's out-of-pocket expenses will be, she says.
"They remind the patient that this is only an estimate," says Rhode. "Situations can change, which would impact the procedure, surgery, or delivery. That would, in turn, affect the final charges."
Rhode says that many insurance companies have discontinued printing copayment amounts on insurance cards, making it more difficult for staff to collect. "In some cases, we can get that information through our eligibility software," she says. "However, not all companies are contracted with them."
Much of the time, Rhode says, staff have to rely on the patient to provide the correct information. "Not all patients are receptive to paying at the time of the visit. They want us to bill them," adds Rhode. "Also, some registrars are uncomfortable asking for the copay, especially if it is not clearly indicated on the card."
More difficult role
a. Children's National Medical Center in Washington, DC, patient access staff have always been expected to collect, and this has been tracked for years, says Carole Helmandollar, executive director of ambulatory services.
"This is not a new role. But it has certainly become more difficult in recent years, with high-deductible health plans that many of our families just don't understand," she says.
Helmandollar has set up some internal competitions between ED staff and the inpatient patient access staff to promote collection activity. However, she says that "our message for staff is not to ever become confrontational, or too insistent, with the families. If staff get any pushback, they should drop it and refer the families to our financial information center staff."
Eligibility vendors staff those positions, says Helmandollar, and they are much more experienced at having conversations about finances. "While they don't actually collect from the families, they are skilled at the negotiations around this," she says. "They have been tremendously resourceful in developing a positive outcome for many of our families."
If a child has been admitted to the pediatric intensive care unit, says Helmandollar, parents sometimes become incensed that staff are asking for their copays.
"The only difficulty we have is managing the patient expectation very early in the process. This, unfortunately, sometimes causes customer service issues," says Helmandollar. "While this occurred in the adult facility where I worked previously, it seems heightened in the pediatric setting."
[For more information, contact:
Carole Helmandollar, Executive Director, Ambulatory Services, Children's National Medical Center, Washington, DC. Phone: (301) 572-3656. Fax: (301) 765-5650. E-mail: firstname.lastname@example.org.
Holly Hiryak, MNSc., RN, CHAM, Director, Hospital Admissions/Access Services, University Hospital of Arkansas, Little Rock. Phone: (501) 686-8170. Fax: (501) 603-1243. E-mail: HiryakHollyM@uams.edu.
Patti Rhode, Affinity Medical Group, Menasha, WI. Phone (920) 628-9529. Fax: (715) 823-8731. E-mail: email@example.com.]