Collections in the emergency department (ED) increased by $10,000 the first month after a training and incentives program was implemented at University Hospitals Case Medical Center in Cleveland.

“The more training and support you can provide the staff, the more successful the cash collections will be,” says patient access services trainer Despina Cuva, CHAA.

Accurately understanding insurance benefits is a major focus of the training provided to patient access employees. “It is very important for the staff to know the difference between deductibles and out-of-pocket costs, and for them to be able to explain these costs to the patient,” says Cuva.

All financial counselors at Lawrence (MA) General Hospital completed the Westchester, IL-based Healthcare Financial Management Association’s Patient Financial Communications Training Program. (For more information about the program, go to http://www.hfma.org/pfcprogram.)

Gregory Kanetis, MPA, director of patient financial services, says, “It exposed them to how to connect with the patient, understanding their fears about what the bill will be, and addressing concerns.”

Next, the department will roll out the program to all registrars and the pre-registration group. “Patient access staff traditionally haven’t had the skills to deal with financial conversations and asking for money,” says Kanetis.

The department recently started recording registration and financial counseling conversations with patients. “We are going to take the information we learn about how registrars and financial counselors conduct an interview, and how we can improve, in terms of hitting those points with patients that are important,” says Kanetis.

A good quality registration is one priority, with accurate demographic and insurance information obtained, but managers also want to get a sense that the patient feels well cared for. “We will use a subset of those call recordings to see how well we are doing with connecting with the patient,” says Kanetis.

If patients learn that they have gaps in their insurance coverage, for example, managers want registrars to inform them about programs to supplement their coverage that the patient might be eligible for. “We will develop role-playing scenarios based on what we hear in the recorded calls,” says Kanetis, adding that he has found this type of training to be particularly effective for reluctant collectors.

“We take real-life experiences, ranging from a highly cooperative patient to one who is completely disengaged and won’t offer any information at all,” he says. Here are some scenarios the department has used:

• a patient with a language barrier;
• a patient with dementia who is accompanied by a family member;
• a difficult, uncooperative emergency department patient who is shouting at the financial counselor;
• a patient with no insurance and a prior balance;
• a patient with a very high deductible who is eligible for secondary insurance from the state.

Registrars, billers, and financial counselors play the role of patients. “It’s all about repetition — practice, practice, practice, so you can handle questions with confidence,” Kanetis says.

Staff members sometimes speak without confidence or hesitate before answering a patient’s question. “This interjects doubt from the patient perspective — Does he or she really know what they are taking about?” says Kanetis. “We want them to make mistakes in a controlled environment, not out in public.” (See related story in this issue on how patient access can reduce bad debt.)

SOURCES

• Despina Cuva, CHAA, Trainer, Patient Access Services, University Hospitals Case Medical Center, Cleveland, OH. Email: despina.cuva@uhhospitals.org.
• Gregory Kanetis, MPA, Director, Patient Financial Services, Lawrence (MA) General Hospital. Phone: (978) 683-4000 ext. 2916. Email: gregory.kanetis@lawrencegeneral.org.