Ask for balance due on previous accounts

Present it in a positive way

Registrars at Fairview Northland Health Services in Princeton, MN, started collecting prior balances about a year ago, says Steph Collins, manager of patient access.

"Point-of-service collections is still a major focus," she adds. "But we have learned that the front desk needed to take a more active role in our prior balance collections."

The department has found that if patients are aware of the balance at the point of check in, they will be more open to paying because they know they will be asked for this every time, Collins says. "It is no longer just receiving a statement in the mail that is easy to forget or ignore," she says. "This requires the patient to respond in some way."

The department recently invested in software that allows front end staff to look up prior balances. 'We have started screening the next day's schedule for outpatient services, and speaking to patients about their prior balances," says Collins. "We find it very effective."

Collins estimates that more than 50%, and possibly as much as 75%, of patients have a prior balance. "Patients are informed about their out-of-pocket expenses that they either didn't know they had or had forgotten about," she says.

Offer options to patient

Fairview Northland's registrars collect prior balances using a "key words and key times" approach, which is a more flexible approach than scripting, says Collins.

"We have different key words to use at various times," she explains.

For example, if a registrar is asking for a prior balance, he or she might say, "We would like to make sure you are aware of your balances from previous visits with us. We want to verify that you are receiving statements and provide you with options, as well as answer any questions you may have. Would you be able to make a payment toward this balance today?"

"If we can present the information to the patient in a positive and professional way, we feel the patient will be more likely to make a payment on their balance," says Collins.

Registrars inform the patient that their account is close to going to collection and give the patient a chance to avoid this, she says.

Since starting to focus on prior balances, revenue collected from the front end has increased substantially in the past year, reports Collins. "We are continually tracking this revenue," she says. "We recently set up individual goals for staff that will help keep them on target."

Every registrar has a goal to collect a specific amount during each shift based on patient volume and the opportunity to collect prior balances and point-of-service payments. "The goals could change based on patient volume, shift change, or other workflow changes," says Collins. "These are tracked daily and weekly, and shared with all staff in the department."

If Collins notices many staff exceeding their daily goals, then she considers increasing the goals to encourage even more improvement. Goals also might change because a new tool is being implemented to help registrars provide more estimates upfront in various services, reports Collins.

"This will provide more opportunity to financially secure the account," says Collins. "We expect the goals to increase at that point."


For more information on collection of prior balances, contact:

• James Carey, CHAA, Patient Access Manager, University of Utah Health Care, Salt Lake City. Phone (801) 587-4033. Fax: (801)581-3827. E-mail:

• Steph Collins, Manager of Patient Access, Fairview Northland Health Services, Princeton, MN. Phone: (763) 389-6263. Fax: (763) 389-6446. E-mail: