For the first time ever in early 2017, all four of Rockledge, FL-based Health First’s hospitals hit a long-awaited target for point-of-service collections: They all collected 2% or more of net revenue — and have not stopped hitting that mark since. The secret weapon behind this revenue cycle milestone? The department created two designated roles: collection and account creation. “We have aligned our team by their strengths,” says Betty Fallon, CHAM, a registration manager at a Health First facility in Palm Bay, FL. The hospitals have centralized preregistration for all scheduled diagnostic and surgical services. Previously, employees handled all aspects of this process. However, some commented that they really enjoyed creating accounts, but disliked collecting — and vice versa. “Collecting is a special talent,” Fallon notes. “We found our strengths within the team.”

Employees can choose which of the two roles they want. Currently, there are five collectors and 15 account creators. “When a position becomes open, we will hire for that specific role,” Fallon explains. All employees are trained in account creation and collection, regardless of their role. “They need to know how to perform both functions should the need arise for coverage,” Fallon says. What follows is more information about specific responsibilities of each role:

  • Account creators. Benefits verification is an important part of this role. So is preventing “no auth” claims denials by ensuring all required authorizations are in place. “The authorization team [members] are the ones who actually obtain the authorizations, but account creators take a second look to make sure the account is complete,” Fallon explains. For all new patients, the account creators obtain demographic information. If a patient has not been seen within 90 days, the information is verified and updated.
  • Collectors. If patients have any financial responsibility, the account collector is the one who contacts them. These employees handle all accounts with money due, and advise patients of their benefits and out-of-pocket responsibilities. “The worklist for these associates are sorted by expected date of service,” Fallon says. “Most calls are made within five business days.” Sometimes, employees have to make multiple calls just to reach the patient. When an employee reaches the patient, he or she often has to explain why they’re collecting prior to rendering services. “While we are a not-for-profit organization, it is still important for us to collect on the services we provide, so that we are able to meet the healthcare needs of our community,” Fallon stresses.

After introducing themselves, employees use this scripting: “I see that we’ve already verified your demographic information. Based on the information provided by your physician and according to your benefits, the deposit amount due for this service is ($). We accept all major credit cards and can process checks electronically. Which payment method would you prefer to use today?”

They also inform patients: “I must also advise you that this deposit calculation includes the hospital bill only. You will be billed separately for other physician services.” This reduces the number of complaints fielded by patient access due to confusion over patients receiving multiple bills. “It sets the expectation so they are aware,” Fallon adds.

The department always had called some patients preservice for collections. However, not all patients received calls due to the timing of scheduled procedures or too much volume. “In creating the collector role, we were able to increase the number of collection calls made,” Fallon says. “This results in additional preservice payments.”

Employee Responsibilities

As part of the preregistration team, all employees, whether they are account creators or collectors, have these responsibilities:

  • Greet and receive patients;
  • Verify patients’ identity, using two-patient identifiers;
  • Create accounts correctly in the system, with appropriate documentation for multiple services lines;
  • Function as a liaison between revenue operations and internal/external customers (hospital departments, patients, payers, and both employed and independent physicians);
  • Perform insurance benefit verification via online eligibility, payer portals, and phone;
  • Ensure authorizations are in place as required;
  • Create service estimates of patient financial responsibility;
  • Inform patients of payment options;
  • Collect and post patient payments;
  • Use communication management system to record all transactions.