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.
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:
- Trainers start with “the basics” — defining deductible, coinsurance, copays, and out-of-pocket maximums.
- Trainers teach staff how to use eligibility tools.
- Registrars study actual eligibility responses and patient accounts so they can learn how to find the patient portion.
- 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.