Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

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How to Retool Patient Collection Procedures to Boost Revenue

Developing a streamlined but personalized series of patient collection procedures helped one practice increase engagement and revenue.

- Days in A/R and cost to collect have always been challenging metrics for healthcare organizations to manage; however, today’s payment environment brings additional difficulties.

Patient collection procedures and revenue cycle management

The average annual out-of-pocket costs for employer insurance plans rose almost 230 percent between 2006 and 2015.  Today’s patients are not only unaccustomed to shouldering so much of their care costs, but they may also have difficulty paying.

The patients at Central Maine Orthopaedics (CMO) were no exception. The busy, mid-sized practice headquartered in Auburn, Maine, provides services such as orthopaedic surgery, podiatry, sports medicine, spine care and pain management to approximately 450 patients daily.

Many of these patients, such as those undergoing costly knee or hip surgeries for instance, have care costs much higher than a small co-payment. Despite processes such as collecting down payments and establishing payment plans, CMO’s patients frequently didn’t pay or stopped making payments before their balance was paid in full.

Identifying workflow inefficiencies and barriers to payment

The CMO team quickly identified one of its main challenges was getting payment from patients at time of care, due to workflow and process inefficiencies. For example, staff was unable to take payments at their workstations when they were having payment conversations with patients because each office location had one or two credit card machines for several people to share.

Staff frequently had to leave patients to go swipe their credit cards. Then, staff often waited for a turn while patients waited at the front desk. Taking payments by phone was especially cumbersome, as staff would write the information down, end the call, then process all phone payments at the end of the day. If the card was not approved, another call would be placed to the patient.

Ideally, staff needed focused, one-on-one time with each patient to discuss and set up the best payment option, then collect the initial payment.

Another example of ineffective processes was CMO’s payment plans. This option, which is especially important for practices offering higher cost procedures such as surgeries, was ultimately unsustainable due to the extensive manual work required to set up and maintain plans.

They also realized their installment minimums were too low, making payback periods too long. The plans also required a great deal of work for patients: they had to remember to make payments, taking action by calling, sending via mail or logging on to yet another portal for online bill pay, because CMO did not have an automated system for reminders or payment processes.

Frequently, patients never made another payment after they left CMO’s office. CMO leadership lacked flexible payment options to support patients’ rising financial responsibility and knew it was time for a change.

Overcoming challenges with a payment process that empowers patients

CMO evaluated numerous patient payment technologies and implemented a solution to support proactive patient payment processes at the time of care. CMO leadership knew automation would be key to their team’s success, as it would enable them to focus more on critical tasks such as financially counseling patients rather than walking back and forth to credit swipe machines.

In addition, CMO leadership and staff saw the opportunity to help patients by creating processes that benefited them. They understood the difficulties many of their patients faced in understanding their financial responsibilities and paying in full—especially when having surgery or ongoing care management for chronic conditions.

The new processes would arm patients with the information they need, along with options so they could choose the optimal payment scenario. The new streamlined time-of-service workflow followed these steps:

• Present a care estimate

• Discuss the amount due at the time of service and secure commitment to pay

• Discuss payment options such as a scheduled payment plans for post-service, thus ensuring the balance is paid in full

• Collect and securely store the patient’s debit card, credit card or automated clearinghouse (ACH) information

• Turn on the patient’s automated payment plan, which sets the recurring payments in motion

The new process enables each team member to have focused, one-on-one financial discussions with patients, thus facilitating the optimal payment plan to ensure CMO receives the full amount owed.

It also enables team members to quickly and easily collect credit or debit card information while at their workstation, thus promoting productivity and maintaining the flow of financial discussions.

A focus on empowerment to give patients options and information

The scheduled payment plans address several challenges at once. Patients have choices, which gives them more control: they choose the day of the month for their payments and have input regarding the amount and duration of the plan. They also no longer forget to make payments because the technology automates this recurring process.

The CMO team benefits as well. Once they store the patient’s financial card information and set up the payment plan, their work is done. CMO now has one person in charge of payment plans; she “flips the switch” at the agreed upon time and monitors payment activity; however, the technology doesn’t require any manual ongoing work to maintain the plans. It’s fully automated.

Reducing cost to collect while increasing patient payment revenue

CMO’s main objective was reducing days in A/R, but the organization also moved the needle on another challenging KPI: cost to collect.

CMO now sends 28 percent fewer paper statements. In addition, within the first six months, the practice has tripled the number of payments taken via automated scheduling.

CMO leadership is pleased with the team’s ability to work more accounts in a shorter amount of time. This improvement not only accelerates cash flow and increases efficiency, but also helps boost the team’s morale and give them a sense of accomplishment.

Most of the payment process is now automated, but it’s by no means impersonal. In fact, the automation has enabled staff to refocus on the patient, finding the right payment option and ensuring they’re comfortable with making the payment. And that’s a win-win for both the organization and the patients it serves.


Kathie Phillips is Supervisor of Revenue Cycle Operations at Central Maine Orthopaedics, and Jeff Wood is Vice President of Product Management at Navicure

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