Mix upfront collections with patient satisfaction

‘Advanced collectors’ add expertise

Is it possible to recreate the feel of an old- fashioned doctor’s office and enhance patient satisfaction while increasing upfront collections?

That was the goal when the physician group practices at the University of Texas Medical Branch (UTMB) in Galveston deployed experienced registration personnel to outpatient clinics to collect payments and/or make

payment arrangements at the point of service.

These new "advanced collectors" — drawn from the central outpatient registration staff with no net increase in FTEs — are cutting billing costs through upfront collections and working with patients on payment schedules for money owed both to the medical center and its physician

group, says Eugene Felter Jr., assistant director for the division of financial representatives, UT-MED Financial Services. That operation is the billing arm of the center’s physician group.

"The idea was to bring back that old doctor’s office feeling, when somebody was right there to talk to you about your account following the visit — not just today’s balance, but the past-due balance."

Until recently, Felter explains, registration personnel at the clinics would ask patients for the payment for that day’s office visit, but past due accounts were left up to physician billing office personnel, who would call patients at work or home about unpaid bills.

"There’s a better collection ratio at the time of service, and it also improves patient satisfaction," he says. "Most patients want to resolve their bill, but when it gets to be 30 days later, it’s not at the top of their list of concerns."

The idea behind the new program is that by sitting down and talking with a patient about the bill, the advanced collector can overcome obstacles to payment, eliminate forgetfulness, and resolve patient questions, Felter notes.

"They may be disputing a charge, which we can help them with, or they may want to wait until after the insurance pays [its share of the bill]," he adds. "We say, ‘We can tell you with 90% certainty, judging from past experience with your insurance company, that it will be this much.’ Anything we can get upfront is a bird in the hand."

UT-MED’s physicians were at first reluctant to do aggressive point-of-service collection, Felter says, and financial managers have learned through experience that "in the long term, if the physicians are displeased, you’re dead in the water." The financial services management team won them over by stressing that the advanced collector is not just a collector, but also a resource — for both the patient and the personnel in the physicians’ practice sites.

Having advance collectors with the right qualifications for the job is a crucial part of the program’s success, Felter points out. The employees were handpicked to fill this role, drawing from the experienced registrars who make up the central out-patient registration staff and looking in particular for good people skills and a professional image.

Although the advanced collectors are based at the practice sites, they report directly to Felter. Regular registration personnel at the practice sites now report to the medical director of each prac-tice. Previously, all registration personnel in the practices had reported to Felter, practice nurses reported to nursing, and so forth. That was changed when the medical directors argued that there were too many "chiefs" running the clinics.

The central outpatient registration staff provides quality assurance monitoring and training for the physician practice registrars, and Felter gives feedback to the practice management team on any accounts rejected by the billing office, he says.

The financial services management team developed detailed policies and procedures for the advanced collections/payment program. The team specified that patients included in this process be identified by their inability to make payment for services provided that day or by outstanding balances in excess of $100. The current day’s services are calculated, and both the physicians’ and the hospital’s billing systems are checked for previous balances.

Acceptable outcomes of an advanced collections interview are:

• full payment for services;

• partial payment with an established payment plan for the balance;

• establishment of a payment plan for the total balance;

• referral of the patient to other third-party resources;

• as a last resort, application for UTMB charity care;

• investigation of patient inquiries regarding billing.

Here’s how the procedure works: Outpatient services associates (OSA), who refer patients to advanced collectors, receive a copy of the collection list for each clinic day’s appointments. Each clinic has a method of identifying patients on the collection list to ensure they are processed through the OSA disposition area at the end of their visit.

If an OSA tries to collect for a patient visit amounting to more than $100, whether it’s on the list or not, and the patient can’t pay, he or she is referred to an advance collector. The OSA even escorts the patient to the collector.

Detailed instructions are provided for the advanced collector on pursuing each of the payment options. For example, the collector can discount bills the patient pays in full by 5% if the balance is between $200 and $2,000, and by 10% for any bills over $2,000.

For those making contract payment arrangements, the standard policy is a loan term of six months for accounts of less than $500, and 12 months for more than $500. Payments are split proportionately between the medical center and the physicians group — based on the amount owed each.

Felter says he’s pleased with the success of the system thus far. Although relatively new, the collection rate is 15%, compared with a 17% collection rate for the traditional billing operation. That percentage is expected to increase, but already it means the financial services operation is spending less money on traditional billing and collection procedures, he notes.