For virtually every hospital, the patient experience is a top priority. The same is true for point-of-service collections. For patient access, this presents quite a conundrum. The question becomes: How can registrars keep patients smiling while asking for money — sometimes, a great deal of money?

For at least one registrar, the answer is some humor. The registrar lists the various payments the hospital accepts: cash, credit, or check — then adds the unexpected comment, “But no IOUs.”

“Her patients will laugh with her. She is one of the higher collectors for the department,” says Tiffanie Ball, patient access director at Rochester (NY) Regional Health (RRH).

This successful approach illustrates the limitations of scripting for patient access departments. For those who are uncomfortable even mentioning money to patients, scripting can be quite helpful. However, at times, such scripting comes off as robotic and impersonal. Ideally, says Ball, scripting should “give people a general sense of how to present information to the patient, while adding a bit of their own flair.”

High deductibles are increasingly common and often blindside patients who have scheduled outpatient procedures. “It is not uncommon for registration team members to ask for a payment that could be in the thousands of dollars,” Ball notes. Many patients are completely unaware of this possibility and are more than a little surprised. This means patient access has to step into the role of teacher. “We find that registration team members are often educating during these difficult conversations,” Ball adds.

The situation becomes exponentially more difficult when the patient says he or she cannot pay. “When the patient expresses a financial hardship, we’ve equipped the team to navigate these delicate conversations,” Ball says.

First, registrars connect the patient to the one person who can really help them. At RRH’s four hospitals, that individual is a financial case manager. “He or she is able to provide the various resources we have available, including financial assistance and payment plans,” Ball says. However, the top obstacle to successful high-dollar collections is lack of good information. “When we first saw this shift, it was a dramatic change in our collecting practices,” Ball recalls. “I credit much of our success to the tools we have been able to develop.”

It begins with real-time eligibility of the patient’s insurance. This tool gives registrars confidence that the dollar amount they are quoting is correct — not because they say so, but because the payer does. “It helps the patient understand that dollar amount we are asking directly correlates with the type of coverage they have chosen,” Ball explains. This makes it less likely patients will blame the messenger for their large balance.

Hopefully, registrars can tell patients exactly how much of their deductible is left. “We also have a great patient estimate that is built into our EMR,” Ball reports. Price quotes are much more accurate, as these quotes are based on the payer, place of service, CPT code, and other factors specific to the patient. “This takes the guess work out of estimates,” Ball adds.