Patient access departments are fine-tuning the way they train employees to collect money up front from patients. Kadlec Regional Medical Center increased collections by 30% in one year with these methods:

  • New hires learn about collections only after they understand the basics of registration.
  • One-on-one training allows trainers to observe employees.
  • Employees practice scripting during classroom training.

While making rounds in the department, patient access managers at Kadlec Regional Medical Center in Richland, WA, often heard patients claim they already paid a deductible or that they were overcharged for past services.

“There was frequent payment push-back from patients,” says Jackie Jordan, MBA, CHAM, patient access and scheduling manager for the center. “Observing the conversations helped leadership develop the response we wanted registrars to use.”

The department recently implemented a price estimation tool and changed the way it trained employees to collect money from patients.

“We improved upfront collections by 30%,” Jordan reports.

Here is how the department handles collections training:

  • Employees receive collections training only after learning the basics.

All new patient access hires receive detailed training on copays, deductibles, coinsurance, out-of-pocket costs, and benefits. However, this doesn’t happen for at least 30 days.

“The initial orientation process and onboarding is overwhelming for new staff,” Jordan explains.

First, new hires work alongside experienced colleagues to gain a general understanding of the registration process.

“Then we move to the next phase of access training — collections,” Jordan says.

  • Instructors use both classroom and one-on-one training.

In the classroom, trainers reach a larger audience.

“You can answer questions for those staff members comfortable enough to speak up and practice scripting or potential scenarios with team members,” Jordan says.

One-on-one training allows employees to ask questions freely.

“It also allows for the trainer or leader to observe the team member in action,” Jordan says.

Fostering Credibility

Jill Eichele, CHAA, manager of patient access services at Littleton (CO) Adventist Hospital, says, “Consistency is huge. If we do it one way for one visit, but then do it a different way the next time, we lose credibility and decrease our chances to collect.”

The department uses these steps for collections training:

  1. Trainers start with “the basics” — defining deductible, coinsurance, copays, and out-of-pocket maximums.
  2. Trainers teach staff how to use eligibility tools.
  3. Registrars study actual eligibility responses and patient accounts so they can learn how to find the patient portion.
  4. Finally, trainers review scripting and different scenarios that might come up.

“We role play and give feedback on what worked and what could be improved,” Eichele says.

Registrars don’t ask every patient for a set dollar amount.

“Each patient is different, as are their insurance plans,” Eichele explains. “If we only ask for a set amount, we lose all credibility.”

Instead, registrars show patients how they came up with the dollar amount they’re requesting. They fully explain the specifics of the patient’s coverage.

“Patients trust that we know what we are talking about. They are much more likely to pay,” Eichele says.

The department relies mainly on role playing to get staff comfortable collecting. Still, it’s not the same as real life.

“When you have a real patient in front of you who is sick or in pain, it gets much more emotional,” Eichele notes.

Patient access managers give staff this simple instruction: Treat the patient as you would want your family member to be treated.

“We let them know there are certain situations where it is not appropriate to collect,” Eichele says.

Even if the patient isn’t able to pay the full amount requested, patient access educates them about their options so they’ll be informed when they receive the bill.

“For the most part, when the conversation is approached with compassion, patients respond well,” Eichele says.

Training is tailored to the setting, since collection methods vary depending on the type of service the patient receives. For instance, in the outpatient setting, patients receive calls prior to their visit from health benefit advisors.

In contrast, says Eichele, “In the ER, we weren’t expecting the patient, so nothing has been done ahead of time. Those registrars need more training on the eligibility tools.”

The department implemented mandatory training for anyone who isn’t meeting collection goals.

“There is a direct correlation between the ER meeting their percent of opportunities goal, and whether the facility does as a whole,” Eichele says.

Using this approach, says Eichele, “We increased the percentage of patients we collected on in the ER by 10% — and our facility overall increased by 12%.”


  • Jill Eichele, CHAA, Manager, Patient Access Services, Littleton (CO) Adventist Hospital. Phone: (303) 734-2130. Fax: (303) 734-3936. Email: JillEichele@Centura.org.
  • Jackie Jordan, MBA, CHAM, Patient Access/Scheduling Manager, Kadlec Regional Medical Center, Richland, WA. Phone: (509) 942-2797. Email: Jackie.Jordan@kadlecmed.org.

Registrars Face Patients’ Push-back

With upfront collections a top priority for most patient access departments, it’s important that staff ask “every patient, every time,” says Jackie Jordan, MBA, CHAM. Registrars follow this script:

Patient: “I already paid my deductible.” Registrar: “Let me review our real-time eligibility (registrar validates the response). The information came back from (states payer name). It shows you did pay some of your deductible, but have a remaining balance of ($), which is how we calculated your estimated cost for your service today.”

Patient: “$1,000 is a lot of money, and I can’t pay this today.” Registrar: “I hear your concerns — $1,000 is a lot of money. What amount are you comfortable paying today for your service? We can bill you for the remaining balance or refer you to our financial counselors, who will be able to help discuss options with you?”

Patient: “Do I have to pay this today?” Registrar: “We request payment at time of service.”

Patient: “I’ve been coming here for years and you have never asked me for any money at my appointment.” Registrar: “I am sorry we weren’t able to discuss this with you sooner. Yes, our process to request payment at your appointment began in 2014. We want you to be informed, so there is no surprise when you receive your bill.”

In the ED, registrars collect copays using this scripting: “I verified your insurance with (payer), and per your contract with (payer) you have a ($) copayment due for your service today. How would you like to take care of that? We take (list forms of payment).”

For scheduled services in the outpatient or inpatient setting, registrars use this scripting if the authorization is in place: “We received insurance verification and authorization from your insurance (payer name) for your procedure today. Per your contract with (payer name), you have a deductible remaining of ($) and (X%) coinsurance, for an estimated out-of-pocket balance of ($). How would you like to take care of that? We take (list forms of payment).”

Registrars use this scripting if the authorization is not obtained: “We received insurance verification from your insurance (payer name) for your procedure today. Per your contract with (payer), you have a deductible remaining of ($) and (X%) coinsurance, for an estimated out-of-pocket balance of ($). How would you like to take care of that? We take (list forms of payment).”

Three Tough Role-playing Scenarios

Here are some role-playing scenarios used to train collectors at Littleton (CO) Adventist Hospital:

  • An ED patient has a $250 copay listed on his or her insurance card. Registrar scripting: “I see your insurance card shows a copay of $250 for ER visits. I was able to verify that through our insurance system as well. How would you like to take care of that today?”
  • A patient is scheduled for surgery and has a total out-of-pocket estimate of $1,500. The health benefit advisor was not able to contact the patient prior to their appointment. Registrar scripting: “I see that our health benefit advisor, Jane, was able to verify your insurance and that your procedure is authorized. In addition, I see that she ran a price estimate for your procedure, and your estimated patient portion is $1,500. How would you like to take care of that?”
  • Patient: “I can’t pay that today. That’s a lot of money. And I’ve already paid the surgeon.” Registrar scripting: “This estimate is for the hospital charges, as the physician billing is separate. And, yes, I understand that is a lot of money. I’m sorry that we weren’t able to contact you sooner to let you know. We request that you put down a deposit toward this amount. Then, when you get your bill, you can call and set up a payment plan, or we can even screen you for financial assistance. We understand that healthcare costs may be unexpected and we want to work with you to help with that. We just want to make sure you are aware ahead of time so you know there are options when you do get your bill. How much are you able to put down as a deposit today?”