95% of revenue collected at time of service: Exceed low hanging fruit’
Much untapped revenue is at stake
When patient access staff at Danbury (CT) Hospital first began collecting copays, they focused on scheduled patients only.
"In 2006, we collected less than 50% that was due at the time of service," reports Cindy Thomas Lowe, CHAM, patient access director.
By centralizing scheduling and financial clearance through the hospital’s Contact Center, staff members achieved consistency in verification processes. Registrars now know the amount due at the time of service, from daily reports and notes within each pre-registration.
Lowe says that due to scripting, tracking collections, and "sending statistics to show our success to all, we are now consistently collecting 95% or more that is due at the time of service."
Amber Reeff, director of patient access systems at Virginia Mason Medical Center in Seattle, says, "Healthcare needs to function more like retail: a transparent cost, and paying before you leave."
It costs an organization more to bill for small charges such as copays than to have a robust collection process at pre-arrival and/or arrival, according to Reeff. "By engaging our patients prior to services being provided, we can help identify the cost of care and work with them on payment options," she adds.
Virginia Mason makes 2 changes
Virginia Mason’s patient access areas made these changes:
• Employees were given "financial sensitivity" training to help them feel more comfortable asking for payment and collecting balances on accounts.
• Patient access leaders became more transparent with collections by reporting how much was collected by each team member on a daily basis.
"This provides close to real-time collection performance. It allows the leadership team to see who is excelling and learn why," says Reeff.
If hospitals don’t do upfront collection well, the lost revenue is "immeasurable," says Reeff. She suggests considering how much it costs to produce statements, staff the customer service department, answer questions about the patient’s bill, and do third-party collections.
If the money was simply collected upfront instead, says Reeff, "all of those costs could be used to support the organization’s value-added needs."
Educating members of the community on their insurance benefits, as well as providing patients with options to meet their financial responsibility prior to or at time of service, are two top priorities for patient access leaders at Florida Hospital East Orlando, reports Ramon A. Rivera, MBA, director of patient access.
Price estimator tools were implemented to meet these goals. "This allows us to get as close as possible to final patient responsibility, based on historical data, CPT codes, and payer information," says Rivera.
Educate clinicians on role
The emergency department (ED) is an especially challenging area in which to collect, due to the patient’s condition, length of stay, and layout, says Rivera. He says 39% of the hospital system’s current year-to-date upfront cash has come from the ED setting, which equates to roughly more than $14 million.
"Treat-and-release ED patients are a good portion of visits for a majority of hospital campuses, as more and more patients find themselves without a primary care physician or insurance," adds Rivera.
One challenge with ED collections is simply finding the right time to enter the room to have the conversation at bedside, without interrupting patient care or invading the patient’s privacy. Clinical partners lacked understanding of the job function of a registration representative and the bad debt amounts that resulted from patients not being seen by patient access, says Rivera.
"Opening the lines of communication has assisted the clinical leaders to educate [their staff] on the importance of making time for registration to see the patient at the bedside," he says.
Now, clinicians are more willing to convey to the patient that they are "in good hands" with registration, so patients feel comfortable with the collection discussion. For example, an ED clinician might tell a patient, "Our goal is to reduce any anxiety that may come with the financial aspect of a hospital visit. We have a great team of registrars that are here to help go over your insurance benefits and provide payment options that meet your needs. For your convenience, they will be visiting you during your stay."
"This makes the patient experience a priority, while increasing financial stability for the organization," says Rivera. "The collection interaction is not seen as strictly business.’"
Collecting from inpatients at the bedside is another challenging setting, says Rivera, as the patient’s financial responsibility can change from day to day as charges are accrued.
"Patient condition can be a barrier, as well as knowing the right time for visiting: after a radiology exam, when the doctor is not in room," he adds.
Patient access assigns specific personnel by inpatient unit to build relationships with case management and nursing managers. "When our partners know that a patient needs to be seen prior to discharge, they will call the assigned registrars to come up," says Rivera. "This eliminates the back and forth or guessing game." (See related stories on unsuccessful collectors, right, and 30-minute training sessions on collections, p. 4.)
- Cindy Thomas Lowe, CHAM, Patient Access Director, Danbury (CT) Hospital. Phone: (203) 739-8204. Fax: (203) 739-1905. Email: Cynthia.Thomas@wcthn.org.
- Amber Reeff, Director, Patient Access Systems, Virginia Mason Medical Center, Seattle. Phone: (206) 341-0661. Email: Amber.Reeff@vmmc.org.
- Ramon A. Rivera, MBA, Director of Patient Access, Florida Hospital East, Orlando, FL. Phone: (407) 303-8628. Fax: (407) 303-6471. Email: firstname.lastname@example.org.