Extensive POS education preceded collections push

Registrars coached on how to ask’

Palmetto Health employed a multifaceted approach to educating registrars when the Columbia, SC-based organization undertook an ambitious point-of-service (POS) collection project in 2002.

In addition to creating a comprehensive POS manual, explains Charlene Cathcart, director of admissions and registration, Palmetto designed two POS collections classes — one focused on such details as using a credit card machine, writing receipts, and balancing out at the end of the day, and another aimed at teaching registration employees how to request payment.

Getting employees to feel comfortable asking patients for money proved to be a challenge, she adds. "We actually tried for probably a year and a half on our own to teach people how to ask," Cathcart notes. "In June 2004, we decided to bring someone in from the outside to try to get those collectors who needed help and people who were not comfortable with the whole process into a different kind of training," she adds.

Following a recommendation by a member of the multidisciplinary team overseeing the collections project, and with the assistance of the organization’s education department, she says, management engaged the Dallas-based Medical Business Institute (MBI) to join the effort.

An educational consultant with MBI did two three-hour sessions in one day, with 95 employees participating, Cathcart continues. "She did the training from the standpoint of, You’ve got to make people pay.’ [As a result,] our collectors who were afraid to even ask were able to come to a happy medium."

That session "was a real turning point," adds Rebecca Richardson, CPA, CIA, director of management support services, who helped oversee the POS project. "[The trainer] legitimized asking for money — that it is something you need to do for your organization, and that it’s becoming common industrywide," she adds.

"We learned a lot from that session on how to get people to the next level," Cathcart adds. "Something clicked for the supervisors who work at the access points. They realized that the best way to role-play is to put the weakest collectors with the strongest ones, and let one be the patient and one the collector, and then switch roles."

She also created a list of dos and don’ts to remember when educating staff. For example, Cathcart advises against underscoring the importance of collecting payments up front by talking about the time value of money.

"Most people don’t understand that because it’s not real to them," she suggests. "Do talk to the staff about the cost of billing the patient vs. collecting on the front end. It’s pretty easy to come up with a dollar figure. The woman who spoke at our education session said it costs about $9 to bill a patient."

As part of their training, registrars took a competency quiz to determine how well they could read and understand insurance benefits, Cathcart adds. As part of the test, they were given a list of benefits and treatment information for fictitious patients and asked to calculate how much their payment should be.

While designing the cash collection program, Cathcart says she has come up with a list of pitfalls and obstacles that can sabotage the effort:

• Lack of knowledge and education about POS collection

Identify all those who touch the process — patient, physician, ancillary department personnel, guest services, customer relations, and senior management — and determine the best way to communicate the necessary information, she suggests. Physicians, for example, were sent a letter from the CFO explaining the program, while other groups received training.

• Expectations not set

To avoid this pitfall, Cathcart says, Palmetto Health put up signs in collection areas and inserted notices in surgical packets.

• Staff fear of resistance

Having registrars role-play with more seasoned collectors, bringing in the MBI consultant to conduct classes, and discussing the program in staff meetings was Palmetto’s solution. In addition, she recommends posting collection results and recognizing outstanding collection efforts.

• Not knowing what to collect

Cathcart suggests developing pre-defined deposits for each area or providing extensive education on how to read and understand insurance benefits. "Any time we know what a particular insurance will pay, we ask for that amount." In South Carolina, she adds, a state employee has to pay $75 for each hospital visit, but the insurance card may or may not state that.

• Lack of standardization of entering insurance benefits

An initial problem for Palmetto Health’s program, Cathcart notes, was that when registrars called to verify insurance benefits, they would record the information as the insurance company gave it, which resulted in data being in different order, and would sometimes abbreviate strangely.

To remedy that, Cathcart preset the order and content of the data, and using the insurance user-defined fields in the computer program, set up questions that, whenever possible, had a "yes" or "no" answer. "If it was something having to do with money, we had the computer convert it to currency, so the [registrar] didn’t have to worry if a number was a percentage or a dollar amount," she says.

• Lack of clear policies and procedures

Be aware that policies and procedures could be written in a way that is hard for the average person to understand, Cathcart suggests. "Use routine language.

"Make sure they’re accessible," she adds. "We put them on the hospital’s intranet web site. All of the staff have access to the intranet, so they can click on that manual any time they have a question, and we didn’t have the cost of printing 200 or so manuals."