Action plan maximizes payment, reduces costs

Since beginning a "financial advocacy initiative," Advocate Illinois Masonic Medical Center in Chicago has seen nearly a 160% increase in its point-of-service (POS) collections.

"Much of that includes self-pay patients," reports Philip N. Quick, CHAM, manager of patient access and bed management. "In 2010, our POS revenue was over $1.1 million."

Here are changes that were made:

Insurance is verified earlier in the process.

Although patient access leaders had electronic tools for some processes, there was no way for registrars to perform "real time" verification. "We partnered with our vendors to ensure that we could not only rapidly identify when patients are uninsured, but also do this prior to or at the point of service, rather than post," says Quick.

Registrars have financial discussions with the patient prior to or at the point of service.

"This allows us to take the appropriate actions such as applying for charity rather than seeing these accounts go to bad debt," says Quick.

A deposit matrix was established for each service line.

Once it is determined that a patient is truly self pay, deposits and/or payment plans can be established, says Quick. Self-pay patients generally are asked for a percentage of the estimated cost of the service.

"In the emergency room, it's difficult to predict the estimated cost, so we request a flat rate deposit," says Quick. "We also provide a self-pay discount, as well as a prompt pay discount."

Bed management reports to patient access rather than nursing services.

"Although we partner with clinicians to ensure appropriate patient placement, this reporting structure allows us to ensure the financial viability of the patient entering our facility prior to the bed placement," says Quick.

Registrars now rapidly identify uninsured patients who are being admitted, he says, and they can begin financial counseling prior to bed placement. "No patient is ever turned away from a service for their inability to pay," says Quick. "We provide financial assurance so patients can focus on their clinical care. We are now able to provide more options for all patients prior to service."

• Training and education was given to registrars and clinicians.

"This was a major component to the success of this initiative," says Quick. "All of these key players needed to understand the what, who, and why."

Training was broken down into these sections: inpatient, inpatient obstetrics, outpatient diagnostic, outpatient surgery, all other outpatient, and emergency department.

"Clinicians from their area of expertise were brought in from the beginning to gain buy-in and help educate," says Quick. "As we rolled out the initiative throughout the hospital, these individuals became the 'expert' in their area."

In patient access, the training started with a mandatory departmentwide kickoff on a Saturday, followed by individual and group competency-based training, says Quick. "Scripting was a major part of this training," he says. "Our staff needs to feel comfortable to talk to patients about their financial obligations and also understand them."