Patient access employees at Centennial, CO-based Centura Health are used to seeing high-deductible health plans. Still, they regularly encounter patients with little-to-no understanding of their out-of-pocket costs. A newer development: Plans that offer patients only physician coverage — no hospital benefits at all. “We must treat them as self-pay,” says Jeryl Wikoff, interim corporate director of patient access. Health share plans are another perplexing phenomenon for patients and registrars. In these plans, patients pay a monthly premium, but the plan is not insurance. These patients also are treated as self-pay.
“There is no contract with the facility. They make no guarantee of payment for services,” Wikoff explains. Often, the patient receives the funds directly from the health share group and does not pay his or her outstanding hospital bill with those proceeds. Others do not meet the criteria for financial assistance, but still cannot afford the remaining balance. These situations called for a completely revamped financial clearance policy.
“Requesting payment up front is a culture shift not only for patients, but for the patient access teams, administration, and providers,” Wikoff acknowledges. These changes increased point-of-service collections by 10% over the previous year. “In 2019, we are showing a strong average upfront collection rate of 43.4%,” Wikoff reports.
The new financial clearance policy gives plenty of options for patients to pay prior to service. “The guidelines outline the minimum deposit requirements for elective, nonurgent services to go forward,” Wikoff says. These services are excluded: Urgent or emergent services required by the Emergency Medical Treatment and Labor Act (EMTALA), organ and bone marrow transplants, and behavioral health. “Existing policy and procedures already exist for these populations,” Wikoff explains. Here are the changes:
• The new preservice process gives patients an estimate for their out-of-pocket liability. “It includes an in-depth benefit review and authorization status,” Wikoff says. The patient can either pay in full or set up a payment plan based on the price estimate. To qualify, patients must pay 50% of the required deposit amount, with the balance put on a payment plan. “Once the payer has adjudicated the claim, if the variance exceeds the estimate, a phone call is made to the patient to discuss the new payment plan terms,” Wikoff says. If the amount owed is less than the estimate, the payment plan remains intact until the balance is paid.
• Anyone in registration, financial counselors, health benefit advisors, customer service, and self-pay vendors may set up a payment plan. Additionally, the patient also can set up their own on their MyCenturaHealth portal. “Payment plans can be established at any point in the process — preservice, check-in, discharge, or post-service,” Wikoff notes.
• In the ED, the patient’s benefits are reviewed after EMTALA requirements are met. Patients can learn more about their out-of-pocket costs for the ED visit. “This benefit review helps patients prepare for the final bill,” says Nicole Roberts, patient access director at Mercy Regional Medical Center in Durango, CO (a facility affiliated with Centura Health). Patients understand not just their out-of-pockets costs on the hospital side, but also for other providers involved in their care. “The patient can elect to pay a deposit during that time or set up a payment plan from the estimate,” Roberts says.
Going forward, revenue cycle leaders are looking into asking a credit solution partner to fund the hospital 100% upfront for the payment plans. The hospital would receive full payment right away. “The added benefit is a patient satisfaction factor, by having different financing options other than just their bank account or a credit card with high interest,” Wikoff offers.
Monthly auto payments are set up on credit cards to prevent patients from defaulting. Patients set up the portal to send notification messages if the card was expired or declined for any reason, according to Sheri Lasater, director of revenue cycle and health information management for Centura Health.
• Registrars require a commitment of payment from the patient for accounts identified as high risk. This group includes accounts with high-dollar patient liability, noncovered services, or lack of authorization.
• The referring/ordering provider is kept in the loop regarding insurance issues. “It gives the patient access associate a safe place to hand over the decision,” Wikoff explains.
Provider feedback has been mostly positive. These changes give physicians the option to request a medically urgent exception or approve delayed service.
“They appreciate being part of the process instead of finding out later the service was cancelled with no communication as to why,” Wikoff says.