At Orlando (FL) Health, revenue cycle leaders were hearing many similar complaints from patients who received multiple bills after their hospital stay. Many had received other bills and paid them in full.
“Patients who had multiple services within a narrow timeframe were confused,” says Michele Napier, vice president of revenue management and chief revenue officer. Sometimes, bills included the same dates of services, but were from different providers. Napier’s department decided to make a big change by creating a “uni-bill.”
“All hospitals and physician charges are combined into one statement for the patient,” Napier reports.
More patients are paying outstanding balances on time. Napier attributes this to less confusion on whether the amounts are correct. “Patients who understand their bills are more likely to pay,” she observes.
At Indiana University (IU) Health, many patients were “overwhelmed and confused” because they received multiple billing statements, says David Burton, vice president of revenue management.
Some patients complained about bills for physician services when they had already paid for an associated inpatient stay. Others received multiple bills for one ED visit and assumed they were being double- or triple-billed.
However, that was nine years ago. At that time, the health system switched to a consolidated patient statement. “The statement clearly shows patients the amount charged for all physician and facility services,” Burton explains.
This change was developed in-house since few, if any, vendors offered this kind of solution. “Integrating two completely different patient accounting systems was a tremendous technical challenge,” Burton recalls.
The systems did not share a single unique patient identifier. Revenue cycle leaders had to build an algorithm that could match the same patient and guarantor combinations across platforms. “We also had to develop a payment allocation methodology,” Burton adds.
A single payment would need to be dispersed to multiple providers with separate bank accounts. “We also wanted to link related hospital and physician invoices so patients could see all of the bills related to their inpatient stay or outpatient procedure,” Burton notes.
That link did not exist, so an algorithm was needed to develop it. “The database and programming that support our consolidated patient statement are complicated components of our revenue cycle IT infrastructure,” Burton says.
The consolidated patient statement includes a single minimum monthly payment, an “at a glance” summary of all account activity (insurance payments, adjustments, and patient payments), and a “What You Need To Do” section explaining the next steps. Almost immediately, there was much less confusion over hospital bills. IU Health received payments faster, with fewer calls to customer service.
“It was clear the unified statement helped patients better understand what they owed and for what services,” Burton says.
IU Health also put an interactive voice response system in place. “The system allows people to make electronic payments in a way that is most convenient for them and on their schedule,” Burton explains.
For patients, it is one more way to access their account or make payments by phone or online. The health system held patient forums across the state to obtain feedback on all the changes. “Across the board, patients were pleased to be able to see their services and charges together,” Burton says. “It provided more clarity into how they were being billed.”
People also appreciated receiving less mail and fewer separate payments to track. “We continue to gather feedback about billing procedures,” Burton adds.
Revenue cycle leaders ask the hospital’s patient and family advisory committee for input, too. “The most recent feedback pointed to the need for self-service payment online,” Burton reports. The health system is looking to expand these options. Patients can make payments online by enrolling in IU Health’s patient portal, but want the ability to pay through email or texts. “Patients continue to express a desire for convenience,” Burton says.