If a patient can pay the entire balance up front, and receives a nice discount for doing so, it is a win-win.

“Prompt payment discounts decrease A/R [accounts receivable] days and reduce costs incurred. It is, overall, a patient satisfier,” says Jennifer Dyrseth, MSITAM, CHAM, CHAA, CAC, patient financial services supervisor at Olympic Medical Center in Port Angeles, WA.

These days, more people are trying to barter for healthcare. “The educated consumer is starting to expect discounts. I’m seeing facilities offer discounts of up to 20% when patients commit to satisfying some or all of their responsibility prior to service,” says LaTonya O’Neal, principal with Chicago-based The Chartis Group and a member of the firm’s revenue cycle practice.

Some hospitals offer flat rate payments for diagnostic tests (usually cardiac CT scans or ultrasounds) that insurance does not cover. The hospital receives immediate payment, and patients avoid receiving a bigger bill when the claim is denied. “The trend is moving toward hospitals offering set rates for services where insurers typically do not cover the services, or for patients with high-deductible plans,” O’Neal says. With firm policies and scripting in place, discount-seeking patients are all treated the same. “If the process is tightly managed, prompt pay discounts can be a good thing for revenue cycle metrics,” O’Neal says.

However, staff need to be ready to respond to impossible demands. At Olympic Medical Center, some people ask to pay Medicare rates. Others want to pay what they heard someone else was charged at a different hospital. “We are seeing strange requests for discounts come up, certainly,” Dyrseth says. Here are some requests, and demands, registrars are hearing:

“Another hospital offered me a bigger discount.” This is actually a good ice-breaker. “It opens up a discussion about comparing discounts apples to apples,” Dyrseth explains.

Hospitals offering bigger discounts might be charging much more to start with. Sometimes, the “cheaper” amount quoted by the other hospital omits some hidden charges. “Patients usually don’t realize that hospital discount policies vary widely,” Dyrseth adds.

Some hospitals offer discounts only if people pay ahead of time. Others allow discounted care at the time of service or even after the first billing statement goes out. “Some offer a flat discount. Others offer a higher discount for higher balances,” Dyrseth notes.

For instance, a hospital might offer a 20% discount on balances under $10,000, and a 30% discount on higher balances. Whenever patients mention other hospitals, Dyrseth notes Olympic Medical Center was designated as a facility offering the lowest prices in the state for many major medical procedures. “This educates people that we are not price-gouging,” Dyrseth says. If someone does not qualify for a discount or for charity care, registrars give the reason. “I make sure they know it’s not a personal decision, and that it’s based on policies, laws, or tax codes,” Dyrseth says.

“You gave my friend/neighbor/relative a better discount.” This is an especially common tactic in rural areas, where patients struggle for healthcare access. “You’ll see patients communicating with each other about discounts,” Dyrseth says.

Some people mention that a well-off friend with considerable assets received a large discount or some financial assistance. They want to know why they cannot receive the same discount. “Usually, their friend didn’t share with them that they were struggling financially, or that they’re self-employed and get to deduct expenses,” Dyrseth says.

If a patient brings up somebody else’s supposed discount, registrars do not go into the account to check. They do not have permission from that other patient to discuss their income, family size, or other personal details. Instead, registrars take a “customer is always right” approach by not challenging the claim. “The instinct is to always trust what the patient is saying, or at least trust that the patient thinks that they know,” Dyrseth says.

The registrar does not argue the point, and instead redirects the discussion to something more productive: what can be done for the patient they are working with.

“I want to speak to a supervisor.” If a hospital issues discounts on a case-by-case basis, that can expose the whole facility to more scrutiny, according to Dyrseth.

A worst-case scenario: Registrars insist no discount is possible, but a higher-up grants it. “The message to the patient is that the front-end staff member is either lying, or doesn’t know what they are doing,” Dyrseth says. This only encourages people to demand a supervisor anytime they don’t like the registrar’s response. That hurts both revenue and morale. “Nobody wins in these cases,” Dyrseth notes.

Ideally, registrars find a way to talk about other possibilities, such as loans or online payments. “We have found that the more options we have for patients, the more likely they are to pay their bill,” Dyrseth says.

If discount demands cannot be met, staff encourage screening for financial assistance. “They usually qualify — for a bigger discount,” Dyrseth says.