Collections are now at $540,000 monthly

Manual process is now automated

Before an automated tool for insurance eligibility and benefit identification was implemented at Wheaton Franciscan Healthcare in Glendale, WI, the collections process was "very manual," says Terri Miles, patient access manager.

"Previous to having this tool, we had just a single person working on point-of-service collection, using information provided by our precertification department," she reports.

A single person in each of the healthcare system’s southeast Wisconsin markets used a grid prepared by finance that included procedures; the average costs, both contractual and total; and a benefit sheet. "This was prepared by our precertification department and sent their way, to manually calculate the patient’s responsibility," says Miles.

While this process helped to determine patient responsibility for some high-cost services, employees were limited to using charts and graphs provided by finance to calculate the total charges. "Because we weren’t using CPT codes, there were sometimes discrepancies between the estimate and what the patient actually owed," says Miles. "This tended to negatively affect patient satisfaction."

Tool determines estimate

With the technology, insurance eligibility, benefit identification, and the estimate process are now a standard piece of the preadmit/admission process.

"We use this same tool to determine the estimate using the expected CPT code and the facility’s charge history," says Miles.

The goal is to talk to every patient who will have an out-of-pocket responsibility, even though services will not be denied if the patient chooses to be billed. "We also use this conversation to determine if a patient may need a payment plan for their portion or may possibly be eligible for any type of assistance," says Miles.

The department has set a goal to collect $648,000 per month. "Over the last six months, we averaged slightly above $540,000 per month, after having about 4,700 patients each month pay upfront," reports Miles.

In terms of associate productivity, the department’s prior expectation of talking with four patients per hour has not changed. This expectation is despite the fact that additional responsibilities have been added, such as creating the estimate.

"With the technology the time needed to complete these processes usually hasn’t taken that much more time to complete," Miles explains.