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$50 million of self-pay accounts converted monthly
Self-pay collections have doubled in the past year at Dallas-based Parkland Health & Hospital System.
"Inpatient, outpatient, and emergency department point-of-service collections have all improved. On average, we’re up $100,000 a month in collections," reports H. Gene Lawson Jr., senior vice president of revenue cycle.
One reason is that patient access staff offer prompt pay discounts, payment plans, and combinations of both. "Key factors for us are to know how much to ask for and the development of tools that tell us how much the patient can pay," says Lawson.
Parkland has developed tools that indicate the patient’s propensity to pay. Registrars can tell if the patient meets Federal Poverty Income Guidelines (FPIG). "We think of it as a filter that first tells us if they would qualify for Texas Medicaid or one of 100 other financial assistance programs," says Lawson.
On average, $50 million of self-pay accounts are converted to one of these sources of assistance. "Without this process, we would try to collect from the patient," he explains. "Finding a source of funding reduces the number of self-pay patients in need of financial help."
Parkland is exploring methods of using a sliding fee scale based on where the patient is on the FPIG scale and reducing the deductible based on the patient’s ability to pay. "Our charity policy covers Dallas County residents up to 200% of FPIG," says Lawson. If patients between 100% and 200% of the federal poverty level purchased insurance through the Health Insurance Marketplace, they still might qualify for some form of charity.
"We’re exploring methods of having some charity applied to the deductible of these patients," says Lawson. "This would occur after the primary payer has paid."
Previously, patient access employees at Fairfield, CA-based NorthBay Healthcare relied solely on Federal Insurance Contributions Act (FICA) scores and credit reports to assess a patient’s ability to pay. "But that always left a lot of unanswered questions," says Lori Eichenberger, interim senior director of revenue cycle management,
The department implemented a propensity to pay tool (PayNav, manufactured by Passport). Now, staff can see if all of a patient’s negative credit is related to healthcare, for example. "People often pay their health bills last, so you need tools to help you creatively find a way to make determinations about their ability to pay," Eichenberger explains.
In one case, she saw that an uninsured patient had limited income and low rent, but the patient had just one more car payment left. "I was able to determine that while she may not be able to make payment until then, it will free up $275 a month," she says. "It’s given us a better picture of our patient’s situations."
Financial counselors also use a tool that tells them whether a patient is eligible for Medicaid or charity care (Charity Guide, manufactured by Passport). In some cases, patient access staff change the patient from self-pay to charity, even without getting any information directly from the patient. "I would prefer to talk with the patient, but that’s not always possible," says Eichenberger.
The reason is that many emergency department patients are treated and released before financial counselors are able to meet with them. "In the absence of a discussion, patient financial services staff make sure we extend charity where appropriate," she says. "If they can’t pay the bill, they can’t pay the bill."
The tool also tells registrars if the patient is eligible for a discount. "The tool is helpful to us in reaching not only those admitted as inpatients — those we’ve always had a good grip on — but also uninsured patients using the emergency department," Eichenberger says. (See related story, below, on tools used for price estimates.)
Lori Eichenberger, Interim Senior Director, Revenue Cycle Management, NorthBay Healthcare, Fairfield, CA. Email: LEichenberger@NorthBay.org.
H. Gene Lawson Jr., Senior Vice President, Revenue Cycle, Parkland Health & Hospital System, Dallas. Email: firstname.lastname@example.org.
Lori A. Schwieg, CHAM, CPAR, Manager, Quality Assurance, Training, and Projects for Patient Access, Children’s Healthcare of Atlanta. Phone: (404) 785-7194. Email: email@example.com.