In the past two years, ED collections at Rockledge, FL-based Health First have more than doubled. With results like that, one might imagine that patient satisfaction has suffered, but the opposite is true. “Through all this, we have maintained top-decile performance with our customer experience scores,” reports Kyle Crosswell, manager of revenue operations and patient access. Here’s how registrars do it:

1. Educate patients before collecting. “Having the conversation about payment is never easy, especially when someone is sick,” Crosswell admits. Registrars start the conversation by educating the patient about their benefits. Next, registrars provide an estimate of out-of-pocket costs with a detailed explanation. “Patients are likely to pay if they understand what their benefits are, and can see it in writing,” Crosswell offers.

2. Follow up with patients post-discharge. Many ED patients are unable to pay for many reasons. Most commonly, it’s only because they did not bring a method of payment with them. “We have developed a follow-up team and process for patients to call back when they get home,” Crosswell says.

3. Take partial payment. Many patients are unable to pay their balance in full, but registrars still collect something. “We work with the patients and ask for a good-faith deposit,” Crosswell says.

Most patients want to pay their responsibility. “Offering the option of putting something down toward the amount keeps the patient engaged in paying off the balance down the road,” Crosswell notes.

4. Secure buy-in from clinical team. “Over the years, we have worked with our nursing team to help everyone understand the importance of registration and collecting from our patients,” Crosswell reports.

Educating the clinical side on the revenue cycle has improved more than just collections. Registration misses fewer patients, which prevents lost revenue.

“Registrars feel part of the team, and not just the ‘money people,’” Crosswell explains. “Creating connections, regardless of your role, makes all the difference to the patient.”

5. Offer to help patients. Registrars do more than collect; they also offer many types of assistance to help patients with costs. Even when they do collect, a patient-centered approach is used.

“We explain to the patient that this is a service we offer, so they do not have to worry about the bill later once they get home,” Crosswell shares. If a procedure is elective and scheduled weeks away, it gives ample time to engage in financial conversations with the patient. This is not true for the ED setting.

“It’s always easier to have that financial conversation with elective procedures. The ED is very difficult,” laments Elkin Pinamonti, MHA, assistant director of onsite access for Novant Health’s greater Winston-Salem, NC, and northern Virginia markets.

Registrars must determine if the patient is too ill for a financial conversation. “Since our department is not privy to what is happening clinically with patients, the biggest challenge is to read the body language,” Pinamonti explains. While registrars are expected to ask for copayments at the time of the ED visit, “we have to walk that line. If there’s even a question about asking, we always say don’t,” Pinamonti says.

The biggest concern, says Pinamonti: “That we will make a patient or family worry about something financial when they are in the midst of crisis.”

At OSF HealthCare in Peoria, IL, a recent project aimed at increasing collections focused on more robust scripting and additional training.

“My team has put a lot of effort into this,” says Jessica Chase, patient access services manager for the outpatient financial clearance center. “We took the new scripting and training a step further.”

First, Chase elicited feedback from team members regarding what barriers they encountered when speaking with patients about cash collection opportunities.

“I wanted to know what our patients were saying so that team members felt more prepared for the conversation,” Chase says. Next, she asked top collectors to give some feedback on how to help patients through the financial part of the process.

“We’ve had tremendous success already this fiscal year with increasing our pre-service collections,” Chase reports.

Above all, managers emphasize listening and empathy. The goal is for patient access to “really connect with our patients,” Chase says. “We have found that if the great patient service is there, the collection results will follow.”

Tone of voice and the speed in which something is said is very important, and so is consistency in asking for payment so patients know what to expect. “Most importantly, we listen to the needs of the patient,” Chase adds. “We find the best option to help them if it’s needed.”