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Asking for payment? First, give explanation
Target health insurance benefits
When a patient asks what he or she will owe for a procedure, registrars at St. Joseph's Healthcare System in Paterson, NJ, consider the payer contract, procedure code, procedure amount, and patient benefits, says Sandra N. Rivera, RN, BSN, CHAM, director of patient access.
"Registrars must be able to properly explain the health insurance benefits to the patient, including covered benefits, authorization requirements, and in- and out-of-network coverage," she says.
Most payers have a web site and customer service phone number for patients to call with any questions, notes Rivera, but patients prefer receiving a written estimate. Previously, registrars collected only on the day of service, says Rivera, but collections have moved to the pre-registration process. "This allows patients to go directly to point of service when they arrive," she explains.
Staff use scripting to practice asking for payment, and they often use the words, "Would you like to pay by cash, check, or credit card?" "They also need to understand how we come up with the estimates," she says. "They need to answer any questions the patient may have."
Give a brochure
Registrars soon will be able to hand patients a brochure with information on the payment process, financial assistance programs, and where to go for assistance, says Rivera. Physicians, patient financial services, planning and development, the hospital's chief financial officer, patient access, and the marketing department are working together to create the brochure, says Rivera.
"The brochure can be given to patients at any time in the process," she says. "We also created a patient access video that is played in our lobby. It explains the registration process to patients as they wait."
At times, staff members connect the patient directly to the insurance company via telephone to discuss their coverage, says Rivera. "This allows for the patient to speak directly to the payer and have the information explained firsthand," she says.
If the patient still is confused about their benefits, says Rivera, the case is referred to a manager. "This allows management to review any issues with the staff that may need clarification," she says. "It also helps to identify any payer trends or process changes that may need to be addressed."