Talking to patients about money is never easy, so some staff avoid it altogether. “As a rule, people don’t like to discuss their finances. It’s very personal. It can be even more difficult when they have a medical issue and don’t feel well,” says Lora Redden, CRCE-I, senior director of revenue cycle at Texas Health.

Patients have to pay more out of pocket today than ever before. Any unexpected cost can put a financial strain on families. “We discovered several instances where we needed to develop a standardized approach for holding financial conversations,” Redden says.

The new process enables patients to receive the same message from preaccess to the central billing office. Still, two situations remain particularly challenging:

  • Cost-sharing plans. “These plans are sold to individuals on the basis that they are not insurance. They don’t operate the same as insurance, nor are they regulated by any insurance board,” Redden explains. Unhappy patients often are stuck paying large balances.
  • Out-of-network plans. This means Texas Health is not contracted with the health plan, leaving patients with higher costs. Engaging in conversations about all these situations was difficult for staff. “We didn’t think traditional on-the-job training or role-playing exercises were enough,” Redden notes.

The department created a policy that is clear on how to manage all of the different conversations, including scripting for front-line staff. All preaccess, patient access, and billing staff underwent training. “This consists of in-depth steps on how to manage each situation, decision points, and scripting,” Redden reports.

Next, the preaccess department created a financial concierge program. “Our process often involves a multitiered approach. The financial concierge may include the entity leadership and revenue cycle leadership to review cases,” Redden explains.

This ensures the patient receives the care they need, regardless of his or her ability to pay. “The financial concierge remains available to the patient for any financial questions, up to and during their medical care,” Redden says.

If healthcare is unplanned, that calls for a completely different approach. “Working in an ED environment definitely requires empathetic communication,” says Sharita Butler, MHA, patient access director for three Texas Health facilities near Dallas.

ED registrars often are presented with individuals who are homeless, unemployed, or financially unable to make even a small deposit. “Another challenge that the team is often faced with is when a patient states they do not want to pay for this service,” Butler says. By connecting with the patient at time of registration, the team ensures that some payment can be made in most circumstances.

The most challenging situation: When patients ask why the cost is so high. Scripting is used to answer this difficult question. Patient access staff show the patient detailed benefits and explain the out-of-pocket expense is based on their insurance carrier. “This is a skill set that takes time for the employees to fully embrace,” Butler says.

New hires work with experienced registrars. “We then perform mock scenarios, where we are the patient and the employee has to request payment,” Butler explains. This allows managers to give real-time feedback. “We also teach by example, and share recorded interactions with patients during check-ins,” Butler adds.