Revenue: POS collections surge from $100 monthly to $40,000

Hospital administrators challenge access

At St. Joseph East/St. Joseph Jessamine in Lexington, KY, collections in a newly opened women's hospital went from only about $100 in March 2010 to $15,000 a year later, and preadmissions collections, which were just $1,300 monthly, now range from $15,000 to $40,000. Stanford (CA) Hospitals and Clinics expects to collect $1 million more at point-of-service in 2012. In 2010, registrars at West Virginia University Hospitals — East collected 110% more than the previous year and expect to increase it another 10% in 2011.

However, most hospitals still collect under 30% of payments at the time of service, primarily because staff can't determine what patients owe, and patients aren't prepared to pay, according to a new study.

Administrators at University Health Care System in Augusta, GA, challenged access to increase point-of-service (POS) collections from fiscal year 2010 by about 8%, says Julie H. Deason, CHAA, BSHA, manager of central registration.

"This affects the entire revenue cycle," says Deason. "If an access employee can collect on the front end, it cuts down on costs for the back end to try and collect."

If registrars determine that a self-pay patient actually does have insurance by using a real-time eligibility system, for example, this step reduces work on the back end in patient accounts and collections, says Deason. "By cutting down on these accounts, FTEs have been reduced in the entire revenue cycle," she says.

The state of Georgia implemented a hospital bed tax that reduces the bottom line by 1.45% and redistributes that money in the local Medicaid programs, which means the hospital is seeing decreased reimbursement, says Deason. "The number one challenge in our organization is the growing number of indigent patients and the economy," she says.

Here are changes that the access department made:

• Access staff call patients scheduled for outpatient procedures before their registration to verify all of their information.

"About 6% of our patients pay over the phone. We are working on increasing that number," says Deason. Because patients don't have to wait to be registered, they simply sign a consent form, get an armband, and go directly to the service area, she says.

• Staff members use a real-time eligibility system to calculate the patient's financial responsibility.

The tool pulls the CPT code from the scheduling system and uses the patient's individual contract to calculate the charges, allowable amount, coinsurance, deductible, and copayment information.

"We are in Phase I of the initiative. We have seen some increase in collections, but mainly a decrease in accounts on the back end in collections," says Deason. While Phase 1 only included outpatient radiology and the emergency department, Phase 2 will include surgeries.

"This is where we will see the largest return on investment," she says. "Currently, we do not call these patients or collect on them because we do not have accurate financial estimations. We expect our POS collections to increase drastically."

New proactive approach

At University of Mississippi Health Care in Clinton, past collection efforts began only after services were provided and the patient received a bill. This process has changed dramatically and now begins when a request for service is received, says Vidette W. Owens, MHA, manager of financial counseling. 

"Several changes have been made in recent months to increase POS collections," Owens says. First, a comprehensive financial assistance policy was developed to clearly define the organization's payment expectation. "The immediate results of this initiative have been more accurate anticipation of charges, financial screening, and financial resolution prior to the patient's arrival for service."

A particular area of focus has been the financial counseling unit, which consists of these three teams:

• Team 1: Financial counselors who educate patients regarding their obligation, identify other sources of funding, and screen patients for Medicaid or financial assistant eligibility;

• Team 2: Health benefits advisors, who contact patients prior to their scheduled visit, who provide an estimate of the cost of the visit, and collect pre-payments if the patients would like to satisfy their obligation prior to arrival;

• Team 3: Financial assistance coordinators, who provide estimates for services, collect pre-payments, or establish payment plans. 

Owens says that her biggest challenge with POS collection is providing the tools needed for staff to provide an estimate, collect, and process the payment received. "What we are seeing from our efforts are patients who are educated regarding cost of service. They are willing to satisfy that obligation either prior to, or at the point of, service," reports Owens.

POS is "huge focus"

Lisa Johnson, a patient access manager at Saint Joseph East/Saint Joseph — Jessamine in Lexington, KY, says that POS collections are a "huge focus for the patient access departments within our system."

A "real time" eligibility checker tool was implemented, and staff members rely heavily upon a tool that provides estimates and patient responsibility breakdown, Johnson reports. "The effect of the economy has resulted in many patients being unable to pay, or paying very little toward their financial responsibility," she says.

The pre-registration process is vital to POS collections, says Johnson, because it gives an opportunity for this conversation to happen before the patient arrives. "POS collections have really rocketed in the preadmissions department, and we are seeing substantial increases in our OB hospital," she reports.


• Anna Dapelo-Garcia, Administrative Director, Patient Access Services, Stanford (CA) Hospital & Clinics. Phone: (650) 723-9292. Fax: (650) 498-6718. E-mail:

• Julie H. Deason, CHAA, BSHA, Manager, Central Registration, University Health Care System, Augusta, GA. Phone: (706) 774-2745. Fax: (706) 774-7606. E-mail:

• Audrey Hodson, System Director, Patient Access Services, West Virginia University Hospitals—East. Phone: (304) 596-5711. E-mail:

• Lisa Johnson, Patient Access Manager, St. Joseph East/St. Joseph Jessamine, Lexington, KY. Phone: (859) 967-5881. Fax: (859) 967-5332. E-mail:

• Vidette W. Owens, MHA, Manager, Financial Counseling, University of Mississippi Health Care, Clinton. Phone: (601) 926-3876. Fax: (601) 926-3533. E-mail: