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Don't ask staff to collect without accurate info
Give them much-needed confidence
If a registrar tells a patient that he or she owes $500, he or she might be faced with the question, "Well, where did you get the amount of $500 from?"
"If they don't know how to answer that question, it can cause a lot of folks not to be comfortable asking the question in the first place," says James Carey, CHAA, patient access manager at University of Utah Health Care in Salt Lake City.
The department recently invested in creating a Microsoft Access system software tool, developed with the help of Chicago-based Huron Consulting Group, to give staff the ability to give accurate estimates for a patient's out-of-pocket responsibility.
"It uses the CPT procedure codes the patient is going to have for outpatient procedures and the ICD-9 diagnosis codes for inpatient," says Carey. "It also takes into account the insurance contractual amount, and the patient's coinsurance and maximum out-of-pocket."
This tool was a "huge help" for registrars, who are much more confident telling patients what they will owe, says Carey. "At our surgery check-in, especially in orthopedics, we always ask for any small amount a patient owes," says Carey. "Staff are trained in how to answer questions about the estimate we provide up front."
After a major push to improve upfront cash collections, registrars now have the ability to ask for payment on outstanding balances, reports Carey. Previously, if a patient owed a balance of $500 from multiple previous visits, for example, staff wouldn't have asked for payment. "Now, we will ask them for that outstanding balance at check-in for their upcoming procedures," says Carey. "We ask them what they can pay on their current outstanding balance today."
Walking a fine line
When point-of-service collections initially was being rolled out, Carey took great pains to convey to staff that the idea wasn't to upset patients.
"There is a fine line between trying to collect and harassing someone," he says. "Some patients may have just found out they will owe $2,000 for the procedure they are having."
Registrars still are instructed to bill patients if requested, but at least inform the patients about their liability. "Our biggest issue was always that they didn't understand the reasoning for the calculation of the estimate they were asking for," says Carey. "Previously, we had instances where the registrar would actually ask for a deposit that totaled more than the procedure itself."
These instances occurred because staff lacked access to accurate information about the patient's liability, but this situation is no longer the case, says Carey. Without the estimation tool, he explains, staff might have asked for the patient's entire $2,000 deductible without realizing that the procedure cost was only half that amount, for example.
Now, staff plug in the patient's benefits and the CPT code for the procedure, and the tool automatically deducts the insurance company's contractual amount. "This tool is taking into account that even though the procedure is $1,000, the insurance company's contractual amount is 50% of that," says Carey. "So we are really working off $500."
The tool works the same way for self-pay patients, who receive an automatic 30% discount. "There is an option the staff click for self-pay, which plugs in the 30% discount," says Carey.
All of four of the department's registrars are now comfortable asking for payments on estimates upfront, because they know the amount they are asking for is more accurate, he reports.
Registrars encourage patients to contact the payer directly if there is any confusion about their coverage. "We are seeing much higher deductibles and coinsurances. It can be a bit of a shock to patients," says Carey. "One of the messages that we tell our check-in folks is that it's really between the patient and their insurance company." For example, a registrar might say, 'This is the information we were given on this date by your insurance company, but feel free to verify your benefits with them. Here is the number to call."
At times, a patient informs the registrar that he or she met more of the deductible than was apparent when the registrar verified the benefits. "Insurance companies may take a long time to process a claim," says Carey. "A patient may have had a procedure the previous month, and in actual fact met their deductible, but the insurance company has not yet processed it."
In this case, the registrar simply takes the patient's word for it. "We never want to get into a situation where there is any kind of back-and-forth with a patient on how much they owe," says Carey.