Post-training: Increase in collections is 319%

Give staff a new level of confidence

In August 2011, emergency department (ED) registrars at University of Mississippi Health Care in Jackson were trained on patient estimator software, which increased collections by 124% compared to the previous year, while admissions areas saw a 319% increase.

Although an honest effort was being made by every patient access specialist to collect at the point of service (POS), hospital administrators weren't happy with the results.

"Our POS collection numbers still seemed low, according to hospital executive leaders," recalls Rachel Craig, MST, project manager of integrated access. "This was the incentive to peeling back the layers of our current process, procedures, and tools."

In January 2011, the Patient Obligation Education Team (POET) was formed to meet the department's mission of providing patients with payment options, financial counseling, payment estimations, and information on benefits. POET team members include directors, managers, supervisors, training coordinators, financial counselors, and patient access specialists.

The POET team worked to obtain buy-in, not only from front end revenue cycle management, but also physician leaders, back end revenue cycle management, service line leadership, and patient care advocates, says Craig. By working collaboratively with all of these areas, POET created training sessions on co-pays, coinsurance, deductibles, and out-of-pocket responsibilities. Staff members also were trained on how to educate patients on estimated charges for services, and what were acceptable payment methods and arrangements.

Many emergency department (ED) staff members didn't ask for payment because they were afraid of how patients would respond, says Craig, but scripting gave them a new level of confidence. "Being that the ED has proven to be one of the most difficult areas to successfully conduct POS collection, we honestly did not know what to expect," says Craig. After staff members were trained in the use of scripting, the ED reported an 87% increase in POS collection in April 2011, compared to a year earlier.

Brad Davis, MEd, University of Mississippi Health Care's education coordinator, says POS collections "are more about patient education than money. Training is extremely important for getting results."

Technical knowledge of deductibles, co-payments, and co-insurance is easier to teach staff than customer service and communication, says Davis. "These skills require constant and long-term cultivation," says Davis. "They do not come naturally, and there is always room for improvement. Training is the only way to get positive results." These steps are taken by the department's patient access managers:

1. First, classroom training is used to make sure staff members fully understand key health care billing terms such as deductibles, co-payments, and co-insurance.

2. Once that foundation is laid, script training is provided. This training gives employees a framework of how to ask for payment and how to handle common patient objections.

3. Role playing is used, so staff can practice these skills as a group.

4. High and low performers are paired together during patient encounters. "First-hand observation of successful collectors in action often closes any remaining performance gaps," says Davis.

For example, a few registrars hesitated to ask financially struggling patients to make payments. "This understandable concern must be thoughtfully addressed, to provide staff with the confidence they need to successfully carry out this task," says Davis.

Results are hard to gauge in a training atmosphere, however, says Davis. "Successful execution while role playing in a classroom doesn't always translate to success in front of patients," he says. "The best evidence that they 'get it' lies in their daily, weekly, and monthly totals."


For more information on training patient access staff to collect at the point of service, contact:

• Rachel Craig, MST, Project Manager, Integrated Access, University of Mississippi Health Care, Jackson. Phone: (601) 984.4929. Fax: (601) 984-4800. E-mail:

• Brad Davis, MEd, Education Coordinator, University of Mississippi Health Care, Jackson. Phone: (601) 815-9671. E-mail: