What is the most difficult collection conversation? “Whenever the patient has not been made aware of what they will owe,” says Elkin Pinamonti, MHA, assistant director of onsite access for Novant Health’s greater Winston-Salem, NC, and northern Virginia markets.

Patient access preregisters as many people as possible. This gives registrars the chance to fully discuss the patient’s financial responsibility. “But we are seeing more and more add-on procedures. This makes it difficult to alert the patients prior to the date of service,” Pinamonti reports.

Typically, patients face the highest out-of-pocket costs with outpatient surgery. “That makes that service the most difficult when it is not priced and communicated to the patient prior,” Pinamonti says. Regardless of the amount, registrars have found it is possible to engage in financial conversations without too many complaints. It all starts with good manners. “We put compassion and empathy at the center of every financial conversation we have,” Pinamonti says.

Even when collecting thousands of dollars is necessary, it is still possible to convey that the patient’s well-being is the registrar’s top priority. “We frame the conversation with an educational basis,” Pinamonti explains. Patients ask many questions about what they owe and why. “When we deliver information on their options, we become an advocate,” Pinamonti says. “This reduces anxiety.” For patient access, a great deal of knowledge and training is necessary to engage patients in high-dollar discussions. “Team members also need a comfort level to ask for payment,” Pinamonti adds. Financial conversations are part of new hires’ training. “We include a focus on customer service, paired with the individual components of insurance and how it works,” Pinamonti says. Once the initial training is completed, onsite preceptors conduct simulations with team members. This helps new team members eventually engage in these discussions in the real world. “We continually re-educate so our team fully understands how to navigate these conversations,” Pinamonti notes.

It does not matter how much financial counseling training someone’s gotten at Salt Lake City-based Huntsman Cancer Hospital. He or she can expect to keep getting more training for as long as he or she works at the hospital.

“Things are constantly evolving,” says Junko I. Fowles, CHAM, supervisor of patient access and financial counseling. Authorization requirements are added, new insurance plans enter the marketplace, and required documentation changes. “It’s impossible to provide exceptional care to our patients without being informed of the latest information,” Fowles says.

Patient access staff receive training in four areas continually: system upgrades, payer updates, customer service (via online modules), and financial counseling (conducted in person). In oncology, registrars also receive specialized training in pharmacy assistance programs to help patients cover out-of-pocket costs.

Of course, all this training is not worth much if patients are unhappy. Leaders tell registrars exactly where they stand in this regard.

“We share patient comments, both negative and positive, with the team,” Fowles says. “We know exactly what our current challenges are.”