Upfront collections set to increase by 130%

Members of the patient access staff at West Virginia University Hospitals — East collected 110% more in 2010 than the previous year and are hoping to increase that by an additional 10% for 2011, reports Audrey Hodson, system director for patient access services.

"We have a three-year goal of 130% increase in upfront cash collections," explains Hodson. "Once we reach the end of our third year, we will shift our efforts to focus on actual cash collections versus total amount due."

In 2010, upfront collections was included in the department's five annual goals for the first time. "The financial stability of our organization depends on this," says Hodson. "It is a community service for our patients to be made aware of their estimated financial obligation."

More collections on the front-end results in lower write-off dollars going to bad debt on the back-end, she explains. "Numerous changes have been made within patient access to accomplish our cash goals," says Hodson. These steps were taken:

1. Staff members in the pre-service department were given training in verifying insurance benefits, including deductible, co-insurance, or co-pay, and in looking for medical necessity, authorization, and/or pre-certification as needed. 

Staff members prepare an estimated financial responsibility for each patient based on scheduled tests and procedures, and they contact the patient prior to the service date to discuss payment options. 'This prepares the patient to pay a deposit or total financial responsibility upon presenting for care," says Hodson. "It also educates the patient on their own insurance coverage and policy limitations."

2. Front-line registration staff members were educated in asking patients for money.

The first step was making registrars aware of the financial impact of bad-debt write-offs that happen in patient accounting. "We provided staff with a process to look up charge amounts for most outpatient services," says Hodson. "They provide a good estimate for total charges at point-of-service and set standard payment amounts such as a $75 deposit for ER visit."

3. Access leaders obtained hospitalwide support.

"The change was that now we would be asking patients to make a payment at the time of service," says Hodson. "We needed total buy-in on this from area physicians, facility administration, and the board of directors."

Patients overwhelmed

Staff contact patients with scheduled procedures before their service and ask walk-in patients to pay a deposit toward services.

"We have set-up a standard guideline for the staff to follow," says Hodson. "We ask for 10% of the total charges, or a flat amount of $25, $50, or $100, depending on the services the patient is receiving."

Registrars are seeing many patients with recurring medical conditions who are "simply overwhelmed" with medical bills from hospitals, clinics, pharmacies, and physicians, reports Hodson. "We offer a charity financial assistance program to alleviate some of the financial burden for this patient population," she says.

Patients are faced with difficult decisions and anxiety about the anticipated results of tests and procedures, says Hodson. "Now, the hospital is asking them to pay for their services in real-time. They have already paid their doctor and now have to come-up with the funds to pay the hospital, too," she says.

Members of the patient access staff offer financial counseling and many payment options. "We have even made agreements with many physician offices that we will follow their payment arrangements," says Hodson. "If the patient agrees to pay the physician 30% of their portion, we will accept the same 30% deposit toward their total amount due for the hospital."