As collections continue to move to the “front end” of the revenue cycle, patient access is expanding pre-service processes. Loma Linda (CA) University Medical Center’s pre-service collection department calls patients ahead of time. “They are quite successful in collecting over the phone when they do the educational piece beforehand,” says Admitting Director Denise Rotolo. Employees verify demographics, inform patients of their benefits and estimated liability, and try to collect the amount due. This prevents patients from receiving a surprisingly large bill on the date of service.

“Even though everyone should know what their insurance is, most of the general public does not,” Rotolo says. “They assume they’ve got great coverage because they have insurance.”

The department has been working on point-of-service collections since 2005.

“Probably in the last three to five years, we’ve really come to maturity,” Rotolo reports. From 2014 to 2016, point-of-service collections increased by 14%. “Most of our patients understand they have a liability. They expect us to have that discussion with them,” Rotolo says.

Soon, the financial services department will engage in similar conversations.

“They are training to make phone calls to patients after they have verified benefits, authorization, and liability,” Rotolo says. “This will be in addition to my pre-service team.”

Educator Role

Mary Lee DeCoster, a Phoenix-based revenue cycle consultant, says that, ideally, patient access handles scheduling, financial clearance, pre-registration, and, ultimately, registration.

“Patients want to know ‘How much do I owe?’ prior to service,” she underscores.

The historic process of waiting for the bill after service has been provided, complete with the surprise factor, “is no longer acceptable for today’s savvy healthcare consumer,” DeCoster cautions.

Collecting at the time of service allows hospitals to reduce bad debt and stabilize cash flow. It also gives patients the information they need to decide if they wish to proceed with care and to put financing plans in place if necessary.

“Successful hospitals are collecting as much as 50% of the total out-of-pocket for scheduled patients,” DeCoster reports.

With higher out-of-pocket costs for patients due to high-deductible plans, patient access is taking on two important new roles: collector and educator. Today, these are two must-have skill sets in the patient access field. Both require excellent communication competency.

“Employees within patient access have the training and knowledge to provide meaningful education to patients,” DeCoster says.

Patients need information on insurance benefits, coverage, and options for payment. This all can be covered during a pre-service call, but only if staff are well-prepared to engage in this complex financial conversation. DeCoster says that before a discussion occurs, patient access should know whether an authorization is on file, the patient’s propensity to pay, and a detailed price estimate.

“Armed with this information, the financial clearance rep can provide education to the patient regarding their financial obligations,” DeCoster offers.

At this point, patient access can request full payment or a deposit, make payment arrangements, or refer the patient to someone who can assist with a Medicaid or charity care application.

“This step ensures there are no surprises — for the patient or for the hospital,” DeCoster notes.

When a new upfront collection process is rolled out, patients typically resist. Many argue, “I’ve never been asked to pay upfront in the past.”

“Robust scripting for financial clearance staff, provided during training, should mitigate community perception,” DeCoster says.