Do you think this patient is going to pay the bill?

Software takes out the guesswork

Patient access staff at Tallahassee (FL) Memorial Hospital are about midway through implementing new software, which Joan S. Braveman, director of patient access and financial services, says "will really take us to the new level."

This software does an address and credit check at the time of registration. "Right now, we have a lot of patients who don't even give us their correct addresses in the emergency department, and in our urgent care center as well," says Braveman. "And we have a very educated uninsured population. When asked for ID, they claim they don't have any with them and tell us, 'Well, I'll just go to the emergency department because you have to take care of me.'"

As a patient was being registered under one name, the triage nurse noticed he already had a wristband on. "It was from another hospital in town and had a totally different name on it," says Braveman. "Ultimately, that account goes to bad debt and you have no way to get ahold of the patient."

The new software provides some defense against situations like this. It uses many different databases from retailers and credit reporting agencies to verify that the patient's stated address is correct. If the patient actually has another address on file, this is flagged on the screen.

"It comes back to you with a pop-up saying the patient actually lives at this address. Then we have an opportunity to say to the patient, 'Is there another address I might find you at?' Of course, some people are going to tell us no. But for the most part, I think it's going to work well," says Braveman. "We'll have a valid address we can send a bill to."

Resources are prioritized

For each patient, a "propensity to pay" indicator is given, using a red, yellow, or green light. This is based on several factors, including the patient's credit score and his or her history of paying medically related bills.

"A red light means that the patient will never pay the bill, a green light means you can count on it, and yellow means it's kind of iffy," says Braveman. "This helps staff to prioritize their work."

For a "red light" patient, staff might ask providers whether the service is actually needed that day, or whether it could be scheduled for a future date after the patient is able to pay for the service upfront. "We're primarily doing that for very expensive things, but we will start doing it across the board," says Braveman. "We will only cancel with the physician's permission, and we're obviously never going to deny anyone medical services that are urgent."

If a patient has a green light, he or she is offered a prompt-payment discount. "And obviously, our prediction is we're going to get the money right now," says Braveman. "That will help us on the front end. It will also help us on the back end, though, because we won't spend a lot of time with 'red light' patients."

For uninsured patients who are approved for Medicaid, the system can request a 90-day lookback. This means that if the patient had an uncompensated service during that time frame that went to bad debt, the hospital can now get paid.

Likewise, if the patient isn't approved for Medicaid at the time the service was done at Tallahassee Memorial, but is approved for Medicaid within the next 90 days, the hospital gets paid, even if this occurs in a different city or state.

The "yellow" patients are where most of the staff's attention is directed, since there is a good chance their interaction can result in additional payment. "You never know why a person is 'yellow,' and so, that is exactly where our energy is going to go," says Braveman.

If a patient is recently unemployed, for instance, he or she might qualify for charity, or a patient can be made aware of the hospital's discount policy. "That, to me, is one of the most intriguing features of the system," says Braveman. "Because right now, when the customer service people are calling patients, all they know is if the patient owes us money. They don't know a lot more than that."

Knowing something more about the patient, even if it's only that they have a "green" indicator, meaning a good credit history, helps to direct the call. "On the business office side, we can get all the way to the detail of their credit report. But obviously, for confidentiality reasons, we would not make that information available to all of our staff," adds Braveman.