EXECUTIVE SUMMARY
Point-of-service collections at The Cooper Health System increased by 42% in the ED, 81% at diagnostic centers, and 634% at the surgical center, due to training and process changes. Chesapeake Regional Healthcare saw an overall increase of 58%, with a 120% increase in the ED. Patient access departments credit these changes:
- Employees ask consistently for payment.
- Registrars allow employees who are patients to use payroll deductions for copays.
- ED registrars collect co-insurance and deductibles.
ED registrars at The Cooper Health System in Camden, NJ, recently began giving patients who are hospital employees a new option: to use one, two, or three payroll deductions to take care of their copays. This seemingly minor change gave revenue a major boost.
“Copay collections in the ED increased by 42%, in part because of this change,” reports Pamela Konowall, CHAM, assistant director of healthcare access. Point-of-service collections rose 81% at the health system’s diagnostic centers and by a whopping 634% at the surgical center.
In 2015, Chesapeake Regional Healthcare in North Chesapeake, VA, got serious about its point-of-service collections program. In fiscal year 2016, total collections increased 58% overall, and they increased 66% in centralized registration departments.
Patient access director Melissa A. Salyer, CRCR, says that from fiscal year 2014 to 2015, “[i]n the ED, we saw a phenomenal 120% increase in collections.”
While ED registrars used to collect only copays, they now give estimates for total out-of-pocket costs based on level of care. “They began collecting on co-insurance and deductibles, as allowed by the patient’s insurance plan,” says Salyer.
Chesapeake Regional’s patient access department increased collections with these other changes:
• Managers added clear definitions of self-pay and prompt-pay discounts to the financial aid policy.
“Pathways for patient assistance were implemented,” says Salyer. Registrars are required to review the patient’s eligibility for Medicaid and the Health Insurance Marketplace, for example.
“Staff were trained on how to recognize patients who need assistance,” says Salyer. “We refer them down the right financial clearance pathway.”
• Each registrar attended specialized training on how to use automated tools for insurance verification and price estimates.
“There had been software purchased, but there had been no formal training,” Salyer explains. “Not all staff were using the tools in the same way.”
• Pre-registration staff attempt to secure payment over the phone.
If the patient is reluctant, a promise to pay is noted in the account.
“It’s difficult to run estimates and have financial conversations during busy patient check-in times or when it is a complex surgery,” explains Salyer.
• Patients are offered a 10% prompt pay discount from their total out-of-pocket costs.
“Many patients have taken advantage of this program and return for services simply because of this discount,” says Salyer.
• Managers work hard to keep collections on the minds of registrars.
Here are some ways collections are kept “top of mind”:
- The director sends emails throughout the work week to registration and scheduling staff, and the director lists the amounts everyone collected.
- At the end of the month, the director sends an email with monthly collections by unit and registrar.
- If collection goals are met, registrars and schedulers receive an email informing them of their incentive payout. (See story on the department’s incentive program in this issue.) “Leaders need to stay involved at the front-line level,” emphasizes Salyer.
“We round on high-performing staff and encourage underperforming staff to meet goals,” says Salyer.
Set Clear Goals
Edward Din, director of patient access at Bakersfield, CA-based Kern Medical Center, is very clear with registrars about what’s expected of them in terms of point-of-service collections. In fiscal year 2015, collections increased by 56%.
“The expectation is that each health benefits advisor will exhaust all payment options, in order to secure the account for an uninsured or underinsured patient,” says Din. These options includes short-term loans, interest-free payment plans, or government programs such as Medicaid. “For the six months ending June 2016, our patient access team converted 1,028 self-pay accounts to Medicaid, representing $12.1 million in gross charges,” reports Din.
The main goal of training is to get staff to be more confident in their “ask.” “Registrars are more successful collecting if they have scripting on how to successfully request and collect patient monies,” says Din.
Recently, one registrar successfully collected on 42 of 290 “asks,” for a 15% success rate, and a health benefit advisor collected on 24 of 288 “asks,” for an 8% success rate. These employees were praised for their efforts. “While these numbers may appear low, the fact is that staff are consistently asking for patient payments of those who have a demonstrated ability to pay,” says Kern.
An estimator tool (Patient Charge from Atlanta-based Craneware) recently was implemented and makes it much easier for registrars to have a conversation about what’s owed. “The letter is provided to the patient at the bedside, to initiate the conversation about payment options,” says Din. Registrars ask for a deposit, set up short-term payment arrangements, or refer the patient to be screened for government assistance programs.
Previously, registrars called the business office or other local hospitals to “guesstimate” charges, or referred to other patient accounts for similar services to figure out what the patient owed. “Providing one-on-one observation, combined with role-playing in explaining the estimate letter contents to the patient, were the keys to success,” says Din.
Chesapeake Regional Healthcare set cash goals for centralized and decentralized registration. “These are based on historical net revenue and cash collections,” says Salyer. “The goals were set at 1% of adjusted net revenue and 30% of total patient cash.”
At first, averages were 0.5% or less of net revenue and less than 20% of total patient cash. “As the program matured and staff became more comfortable, numbers climbed to 0.8% of adjusted net revenue and 28% of total patient cash,” says Salyer.
Percentages continue to climb. In the last quarter of 2015, organizational levels exceeded the goal of 30% of total patient cash and met the goal of 1% of adjusted net revenue. Cost to collect has remained at just 2% for the department.
“As of first quarter 2016, the success has continued, with both goals continuing to be met at the organizational level,” reports Salyer. Currently, the percent of adjusted net revenue is over 1%, and percentage of total patient cash is over 40%. (See related story in this issue on collections training.)
Staff are well-aware of departmental cash goals, which are part of a scorecard of key performance indicators (KPIs) used for incentives and annual performance reviews. “Meeting the KPIs should not be optional,” underscores Salyer.
SOURCES
- Edward Din, Director, Patient Access, Kern Medical Center, Bakersfield, CA. Phone: (661) 862-4901. Email: [email protected].
- Pamela Konowall, CHAM, Assistant Director, HealthCare Access, The Cooper Health System, Camden, NJ. Phone: (856) 342-2437. Email: [email protected].
- Melissa A. Salyer, CRCR, Director, Patient Access, Chesapeake Regional Healthcare, North Chesapeake, VA. Email: [email protected].
