A preservice financial collection process has been in place since 2014 at New Orleans-based Ochsner Health System. “This doesn’t include any add-ons or urgent procedures. But we do this for anyone scheduled out more than 48 hours,” says Stacy Collins, assistant vice president of patient access for Ochsner.
Over the past few years, the process has been tweaked and improved. Coinsurance is included in price estimates. More than 90% of accounts are financially cleared ahead of time, either through full payment, a payment plan, payment at the time of service, or financial assistance.
Most patients are willing to settle their balance, but only if they are contacted. “Trying to get in touch with patients during the day is difficult,” Collins laments. If phone contact is not possible, patients receive a message through the patient portal, which provides the option to pay for radiology services.
Some patients still have a small copay, but they are in the minority. A growing percentage owe hundreds of dollars or more. About 20% of patients pay over the phone. Another 250 pay through the portal each month. If patients cannot be reached ahead of time, registration engages in a conversation with these patients when they arrive for the appointment. “There are no surprises on the back end,” Collins says.
Nobody wants to find out the patient is out of network when he or she arrives for a scheduled diagnostic test or surgery. However, this can happen if insurance information is not added at the time of scheduling.
“Some patients are put on the schedule with minimal information,” Collins explains. The system is supposed to alert registrars if a plan is out of network, but the system does not include every single plan in the marketplace.
“Sometimes, it’s just an employer group that doesn’t participate, and we are not always able to catch it ahead of time,” Collins explains. If the patient is scheduled for a high-dollar service and it goes through the regular preservice process, staff always catch the out-of-network status. “But it could be that the patient is scheduled for a clinic visit, and it may get through without us identifying it ahead of time,” Collins adds.
This is not a great situation for anyone. First, registrars contact the payer to see if an exception can be made allowing the patient to obtain care in network. “If not, we work with the patient on the amount due,” Collins reports.
It is human nature to want to save money. When patients select insurance, they often choose the plan with the lowest premium without fully understanding what this really means.
“If you ask our financial counselors what they spend most of their time doing, it would be explaining benefits to patients,” Collins says.
Patients want to know why they owe a specific amount and are quite upset sometimes. Revenue cycle leaders went so far as to create a video to tell them. Produced in collaboration with the hospital’s marketing department, this video plays in lobby areas. The video, also available on the hospital website, covers terms such as copays and deductibles and how to understand a billing statement. “We are trying to do our part to educate patients,” Collins offers. “We would love to work more with our payers so they could have a hand in that as well.”
The department recently created a central pricing office staffed with phone representatives and internal consultants to field calls from price-shopping patients. Some callers were just scheduled for a diagnostic test but have not received a preservice call yet. Clinicians also call with questions on behalf of their patients.
“We are super excited about this and have gotten lots of positive feedback,” Collins says, noting patients are informed of the phone number via the website and pocket-sized cards. “Registrars can point the patient there as well if they need an estimate.”