- In a time of healthcare consumerism and high-deductible health plans, the patient has become a major revenue source for healthcare organizations. But without strong point-of-service patient collection strategies, providers could be seeing their payments walk right out the door with their patients.
Healthcare organizations traditionally called on payers to collect payments for services furnished, but patient financial responsibility has significantly increased. Almost three-quarters of providers reported a boost in patient financial responsibility in 2016, InstaMed reported in June 2016.
High-deductible health plans continue to drive patient financial responsibility increases as they make patients more financially accountable for healthcare. According to a 2015 America’s Health Insurance Plans report, about 19.7 million individuals had a high-deductible health plan as of January 2015, increasing from just 17.4 million individuals in 2014.
Although many providers are seeing the change in revenue sources, some healthcare organizations still have not implemented effective point-of-service patient collection strategies. An Availity study showed that hospitals only collect at their office or organization from 35 percent of patients, representing just 19 percent of patient financial responsibility.
Yet, 90 percent of physician practices in the study agreed that point-of-service patient collections were key to healthcare revenue cycle success.
To improve point-of-service collections, healthcare organizations may want to consider educating front-end staff, moving back-end revenue cycle management functions to the front office, implementing electronic payment methods, and boosting price transparency.
Train front-end staff to have difficult patient financial responsibility discussions
Healthcare organizations should go back to the basics to boost point-of-service patient collections by ensuring that front-end revenue cycle management staff understand patient financial responsibility.
Having financial discussions with patients has been a pain point for many healthcare organizations. Only about 57 percent of providers always have a financial responsibility discussion with patients, a Navicure survey from May 2016 showed.
But healthcare organizations can empower their staff to reach out to patients at the point-of-service about payments due by refreshing staff on what patient financial responsibility is. The more staff understand, the more comfortable they may be with having difficult financial discussions and asking for patient payments upfront.
Iroquois Memorial Hospital serves an example of how better front-end staff education can boost point-of-service collections. Rebecca Wright, Vice President of Strategic Planning at the 25-bed community hospital, told RevCycleIntelligence.com in November 2016 that she noticed among her front-end staff a “lack of understanding on what the big picture was, including how patient responsibilities were calculated and what was actually needed to process a claim.”
Wright focused on educating staff on the patient financial responsibility basics, such as defining key terms like co-pay and deductible. She also encouraged staff to learn about what other front-end responsibilities other employees managed.
With more front-end staff education along with a revised revenue cycle management approach, the hospital increased point-of-service collections by 300 percent and even realized a $7,000 per month collection goal for point-of-service payments.
Wright attributed some of the hospital’s success to the educational campaign.
“Staff will definitely be more confident if they understand and have the information in front of them and understand what they’re actually asking for,” she said. “It comes across in their confidence levels and patients pick up on that. They’re more trusting of our healthcare organization if confidence is portrayed from the beginning.”
Healthcare organizations can also give front-end staff scripts to follow. The Healthcare Financial Management Association suggested using scripts that focus on asking how the patient will pay at the point-of-service or methods of accepted payments rather than implementing scripts that only ask if the patient can pay at the point-of-service.
Transfer revenue cycle management functions from backend to front office
Frontend staff may benefit from additional point-of-service patient collection training, but healthcare organizations should also consider shifting more backend revenue cycle management functions to the front office.
Healthcare revenue cycle management can be a fragmented system, causing communication lines to break down between what the backend and front office need to improve point-of-service patient collections.
Wright noticed a similar challenge with Iroquois Memorial Hospital’s revenue cycle management system. Without more communication between the frontend and backend staff, patient financial responsibility collection in general was lacking.
“The biggest thing I noticed was - and it’s not just here, it’s everywhere - the entire revenue cycle was, prior to the changes we’re seeing, a very segmented process,” she said. “People only were familiar with their role whether it was registration or scheduling or billing. They only understood what their role was.”
Healthcare organizations can start to create a more seamless revenue cycle management system by improving patient registration and requiring staff to identify patient financial responsibilities upfront.
Some primary frontend revenue cycle management processes are patient registration and eligibility verification. Enhancing front office and backend communication can help patient registrars collect accurate and necessary demographic and insurance information upfront.
With the appropriate information in the system, revenue cycle management staff can better calculate accurate payment estimates at the point-of-service and backend staff can submit cleaner claims the first time.
“From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration,” Gary Marlow, Vice President of Finance for Beverly Hospital and Addison Gilbert Hospital, said in a 2015 interview. “That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible.”
Backend and frontend staff should also communicate more to identify patient financial responsibilities. From insurance verification to potential claims reimbursement amounts, determining what a patient will owe involves most pieces of the revenue cycle management system.
Staff should work together to understand what services a patient’s health plan will cover, how much the health plan will pay, and what patients will owe. By knowing the exact patient financial responsibility amounts, front-end staff can communicate that number to patients and backend staff can better track what will be paid and by whom.
Consider implementing consumer-friendly electronic payment options
Healthcare organizations may want to consider installing more electronic payment methods in their office and on their websites, especially in a time where credit cards and smartphone payment apps are overtaking cash and checks.
Manual patient payment methods can slow down collection timelines at healthcare organizations and make point-of-service collections nearly impossible. One case of inefficient patient collections was Family Health Care Medical Group of Modesto.
“Our number one problem was that our billing staff was only available to take payments by phone during normal business hours,” Tabitha Hickerson, CPC, the medical group’s Billing Department Manager, said in a October 2016 interview.
Hickerson mentioned that the telephone-only method limited when patients could pay their medical bills and how they could make a payment.
While healthcare organizations face challenges with manual processes, many patients are also calling on providers to implement electronic payment options. The Instamed report revealed that 70 percent of healthcare consumers preferred an electronic payment method, such as credit cards or eChecks, and another 64 percent expressed interest in using a mobile payment system, such as Apple Pay, Samsung Pay, or Android Pay.
In addition to patient wishes, the report showed that providers could face losing customers if they do not implement electronic payment methods. Roughly half of the consumers surveyed stated that they would change providers for the ability to pay using a preferred method.
Healthcare organizations can implement electronic patient payment methods by investing in a credit card machine to run cards or partnering with a third-party merchant service. But many providers have also found success with automated medical billing solutions and web-based payment options.
Family Health Care Medical Group of Modesto, for example, installed a vendor-sponsored web-based patient payment service that made paying for medical bills more convenient. Other healthcare organizations have partnered with their portal vendors to integrate medical billing into the patient portal.
By having the ability to run a patient’s credit card to obtain a co-pay or allowing patients to pay before an appointment through a website or portal, healthcare organizations have the potential to increase point-of-service collections.
Increase price transparency to help patients understand financial responsibilities at point-of-service
Healthcare organizations may want to take a lesson from the retail industry and increase their price transparency strategies to grow point-of-service patient collection rates. If patients know how much healthcare services cost upfront, they may be more prepared to shell out the money at the point-of-service.
Despite the potential benefits of boosting price transparency, 54 percent of acute care hospitals reported that their organizations are ill-prepared to provide price information to patients, a February 2016 Pioneer Institute study showed.
The institute also found that providers are not conveniently giving price information to patients if they give it to them at all. After an investigation, researchers reported that 14 of the 54 hospitals contacted could not complete price estimates and calls inquiring about price were frequently transferred “back to the operator, billing, financial aid, patient registration, ‘upstairs,’ ‘over there,’ or ‘downstairs.’”
Using a more retail-oriented approach, however, can improve healthcare price transparency. For example, Oklahoma-based INTEGRIS Health implemented a price quote tool that can provide almost 240,000 price quotes for outpatient procedures. The healthcare system also touted that the tool presents accurate price quotes that are between 3 and 5 percent of the actual final charge.
With the tool, INTEGRIS Health increased point-of-service collections from $1 million in 2008 to $18 million in 2015.
Healthcare organizations can implement solutions like INTREGIS Health, but they can also estimate accurate price estimates by using historical claims data.
“Since obtaining current allowable amounts directly from payers can be challenging, to say the least, providers should use software tools that assess historical data and estimate allowable expenses for specific payers and procedures,” wrote Sean Lundy, CMPE, Hand & Wrist Center of Houston.
Improving point-of-service patient collections may seem like daunting task for healthcare organizations. But tracking down patient payments after a visit adds up with the multiple mailings and collection agency enlistments.
Healthcare organizations, however, can implement more effective point-of-service patient collection strategies to keep revenue streams flowing.