A continuous improvement event on collections took place recently at Wilmington, DE-based Nemours/Alfred I. duPont Hospital for Children. The event included all kinds of education, but role-playing turned out to be the most beneficial.

“The team put together a skit to show how the process would flow smoothly from start to finish if all communication was provided correctly,” says Stacy Hutchison-Neale, CRCR, CHAA, supervisor of the preauthorization department. Next, patient access leaders asked for the toughest collection scenarios that front-end staff had ever faced. “Scripting was drafted with the help of the staff who actually do the job,” Hutchison-Neale says.

The hospital’s family advocacy team also provided input. Their biggest concern was that patients should feel they are the priority. The goal is twofold, says Hutchison-Neale: “That associates are able to be successful, and that what we are communicating will not escalate a collection complaint.” The first hurdle was setting new expectations with families who were used to receiving bills for services. Now, costs are collected upfront for all services. “We make families aware that in most cases, this is not what the facility is saying you owe, but what your insurance company is stating is your responsibility,” Hutchison-Neale explains.

Options such as payment plans help people manage high out-of-pocket costs. Previously, registrars assumed people would be unable to pay the amount. This put them on edge before the conversation even started. “We have to stop assuming they cannot pay, and begin assuming they can until the family advises differently,” Hutchison-Neale offers.

New hires at Albany (NY) Medical Center now receive plenty of point-of-service collections training. This includes role-playing exercises, with managers playing the part of patients objecting to paying at the time of services. The comments are taken straight from the job. “This allows the new hire to familiarize themselves with some of the objections they will hear in a nonthreatening environment,” says Brenda Pascarella, CHAM, associate director of patient access. There are two common objections:

  • “My insurance will pay.” Staff response: “We verified your insurance coverage, and the representative noted a deductible (or copay) that is your responsibility. Would it be more convenient for you to pay by cash, credit or debit card, or check today?”
  • “Can I pay over time?” Staff response: “You can pay half now and the remaining balance in 30 days. How would you like to make your payment today? We accept cash, credit and debit cards, and checks.”

After role-playing, staff reflect on the encounter. “We discuss what worked and what didn’t work — and also, how they may have approached the situation in a different manner,” Pascarella says.

Several registrars had dealt with patients who brought nothing at all with them — no wallet, checkbook, or credit card — on the day of surgery. The empty-handed patients protested that they were just following instructions from nursing.

“We have worked with our clinical colleagues to overcome this obstacle,” Pascarella says. Nurses agreed to change the scripting used for presurgical phone calls. “They now remind patients to bring their financial obligation with them on their date of service,” Pascarella adds.