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Are registrars uncomfortable asking patients for money?
You'll need new training approaches
Patient access departments are increasingly focused on upfront collections. Yet staff thrust in this new role often are somewhat uncomfortable with asking patients for money.
"This once was a standard practice decades ago, but then went out of vogue. It became almost insulting to ask patients for money," says Katherine Murphy, CHAM, director of access services at Nebo Systems, a subsidiary of Passport Health Communications Inc. in Oakbrook Terrace, IL. "Now we have to have that flexibility again, and we are relying on the people in the front to have the skill set to do that. They need the ability to show empathy and collect money from sick people."
This particular skill is more important than ever, emphasizes Murphy. "We are in an industry and economic climate that demands we change how we do business in health care. I have seen hospitals in the Chicago metropolitan area close their doors!" she says. "We have to step up to the plate and make change happen."
You'll need to do three things, says Murphy: Coach your existing staff, recognize your "super star collectors," and create incentive programs for everyone involved the process.
If staff are uncomfortable in this role, this can have an adverse impact on collections, according to Peter Savini, vice president of revenue cycle management at Catholic Health Initiatives. "They will either avoid the discussion altogether or become discouraged when patients challenge them," he says.
Your goal: No surprises
Along the pre-access path, collection can be structured in a variety of ways. For example, at the time of scheduling and preregistration, an estimate for the service or expected balance due after insurance can be provided. This can be done either via a manual process or with an automated payment estimator.
"The first attempt to introduce the concept that a payment is expected could be done at that time," says Murphy. If the payment is not completed, then a call can be made to patients reminding them of their appointment. At that point, another attempt to collect, or discuss financial assistance, can be made.
At that point, if you are still not successful in collection, patients can be reminded of the fact that payment will be expected at the time they check in for their appointment.
"Patients are used to paying by phone when ordering from a catalog, or may routinely pay for purchases online," says Murphy. "Now it's health care that will be in this mix. With today's automation, a patient can even pay online before an appointment, in the most-wired scenario."
The idea, says Murphy, "is to not surprise the patient when they arrive for service."
To make the most of collection opportunities, patient access managers need to minimize the impact on staff. You can do this, says Murphy, by providing two things: automation and user-friendly processes.
"It is not just scripting and customer service training that is important," says Murphy. "It is creating best practices that make the collection process easy. That includes informing the patient before arrival when possible."
This "minimizes any negativity and stress on everyone involved in the process," says Murphy.
Without automation, staff may end up searching through a chargemaster, because they are not clear on pricing bundled procedures or missing the calculation of certain costs, such as contrast material.
"Automation also allows for easier tracking of payments and collections for employee incentive programs that should be considered as a part of this," says Murphy.
Share collections data with staff
After Kaiser Permanente Mid-Atlantic Region in Rockville, MD, implemented a regional point-of-sale system at its facilities, increased collections were seen. "In addition, staff became more aware of the importance of copays," says Tanya M. Edelin, director of cash collection & systems.
A dashboard was created to monitor collections, including the percentage of copays collected by staff. "We use that information to drill down and determine if there are any issues we need to improve on so that we can better collect," says Edelin.
Occasionally, the data will reveal the need for additional training for staff on a given patient's benefits and what the patient will owe.
"As our tools to predict patient liability were enhanced, staff's level of comfort to request money became a non-issue," says Edelin.
For the first time, staff had accurate information about what to collect from the patient for all types of payer plans, including high-deductible plans, which may result in payments due at the end of a visit.
"Prior to implementation, we weren't doing the best in terms of upfront collections," says Edelin. "In the past, revenue collection wasn't considered a fundamental part of providing patient care. What we are driving forth is that as a part of your performance, not only is there a clinical expectation, but there is also a financial expectation to charge patients appropriately."
The idea is that patient service encompasses a whole list of components, not only "Did I get them into the doctor on time?" says Edelin.
First and foremost, staff are trained to be patient and respect the confidentiality of the patients they are speaking to, says Karen Pugh, the organization's medical center administrator.
"Staff defer more in-depth conversations to member services or patient financial services," says Pugh. "We also partner with our revenue cycle experts to engage staff on the importance of revenue collections."
Initially, training consisted of targeted application navigation. However, this has progressed to "building an understanding of the business case for revenue collection," says Pugh.
Kaiser uses an interactive, real-time approach, which explains the fundamentals of revenue collection and how the roles and responsibilities of each health care team member impact the revenue stream.
"As we move forward, we're looking to build more interactive and online tools that will allow training to be ongoing and proactive," says Edelin. "Revenue collection is emphasized as fundamental to the business."
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