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Upfront Customer Sensitive Collection Techniques

Presented by: Chuck Seviour Vice President - Revenue Cycle

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Agenda

• Collections in the Emergency Department• Collection of Co-pay at Clinic Registration• Collection Balances at Clinic Registration• Patient Financial Counseling

Agenda

Fact:

With increased deductibles, co-payment, co-insurance and out-of-pocket maximums, patient-access staff must stay up-to-date of the latest coverage to estimate bills correctly and manage patient’s expectations.

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Early and Continued Recognition is Essential

• Today over 48,000,000 Americans are uninsured

• Last 3 years over 90,000,000 are uninsured for a period of at least 60 days

• Over 6,000,000 of today’s uninsured earn incomes over $50,000

Providing a cost estimate improves the patient experience

“Patients are more satisfied with their hospital experience when they understand their financial responsibility before services are provided…”

― Keith Mertz, Relay Health

Early Recognition is Essential

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Collection Control Points

• Hospital– Pre-Admission– Admissions– Emergency Department

• Clinic– Scheduling– Registration

Patient ProfileCollection Control Points

Give your internal and external customers the information necessary to make an educated decision…

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Why Collect at Point of Service

• The minute a patient is discharged, he or she becomes a debtor and all other bills gain priority over the medical

POS Collections

Fact:

A significant portion of people living in poverty will not participate in financial counseling.

HFMA estimates that on average 25% of self pay is more likely charity.

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How do patients priorities their medical expenses?

USA Today article, National Consumer Law Center “Guide to Surviving Debt” stated in 2002:

An unsecured debt, such as hospital and medical bills, is a priority & there is rarely anything that these creditors can do to hurt you in the short term. Many won’t bother to try to collect in the long term.

Fact:

According to a recent study, consumers are more likely to pay the mortgage, insurance loan, and utilities before their healthcare bills. They are also more likely to pay for cable TV, internet, lawn care and the newspaper.

Patients Priorities

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Compare your information to a $5,000.00 car loan

Fact:

The average worker is paying nearly $4,000.00 toward the cost of family health insurance.

$5,000.00 car loan

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Courtesy, Compassion, Dignity and Respect

• Required when making any contact with the patient

• In many cases, this is the first a patient has received a phone call from the clinic or hospital

• Patient information and identification of patient’s present financial situation is a key to the success of any patient contact regarding payment of services

Fact:

Historically over 25% of insurance and patient information is inaccurate if not collected at the date of service or prior to the date of service during a preregistration process.

Treating your patient

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Recognition of Non-discounted dollars

As a part of ongoing training, it is important that the staff understand the importance of non-discounted dollars to the facility.

Non-discounted dollars

With a little training we can become more comfortable relaying and gathering pertinent patient information and decrease the number of abandon calls by patients who become frustrated with the process, thus, increasing our opportunity to either procure essential billing information or actually “collect” Self Pay dollars that are due.

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Improve Your Bottom Line

Bottom Line

No community is unique – all communities have patients and all patients have needs. The job of an effective POS is to help patients understand the needs of the hospital.

The bottom line is patients have a personal responsibility to pay for their services.

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How do we do this?

• Low key approach• Written scripts• Ask for payment

How do we do this?

Fact:

A recent study found as much as 31% of self pay revenue written off to bad debt collection actually met provider charity-eligibility guidelines.

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HIPAA

“It’s Part of the new governments emphasis

on patient privacy, Ma’am.”

Fact:

As a part of ongoing training, it is important that the staff understand the importance of non-discounted dollars to the facility.

HIPAA

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Common Patient Questions or Comments in the ED and Clinic

Why do I have to pay this now? You never asked for a co-pay before.

I don’t have any money with me.

Why can’t you just bill me?

I left my checkbook in the car.

My ex-spouse is supposed to pay all medical expenses for my child.

I work here. Why do I have to pay now?

?

Common Patient Questions

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Purpose of Co-Pays in the Emergency Department

• Co-Pays in the ED serve three purposes:1. Financial – Collection of non-discounted Self Pay

dollars2. Contractual – it is an agreement between insurance

company and patient3. Educational – helps patients realize they must pay

the Self Pay portion of their bill whether in the ED or owed for other hospital services performed

• It is imperative to train staff to properly collect in the ED

• Scripting, role-playing, and practice will increase the effectiveness of training and increase your co-pay collections

Purpose of Co-Pays

Fact:

An effective Self Pay collection process can reduce your days in A/R and bad debt by as much as 25%.

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Approaches to ED Collections

• Admission person asks for co-pay once screening is complete

• Finish application and as for co-pay in patient’s room once physician exam is complete

• Patient is directed back to admitting area so admission can collect when done in ED

• Others may have nursing staff handle in facilities where admission personnel are not available 24/7

Approaches to Collections

Fact:

Once patients understand the concept that co-pays are part of their bill, a typical hospital will increase payments and improve timeliness of payments.

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Co-Pay Collections in the Clinic

• Collection of co-pay should be quick and non-threatening

• This interaction with the patient should be less than one minute

• Patient will typically ask a few questions and make their decision to pay or not

Fact:

Patients will bring their payment when they realize they have a responsibility to pay at the time of service. Implementing successful co-pay processes will allow clinics to collect thousands of dollars that no longer linger in either Self Pay or bad debt.

Co-Pay Collections

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Collecting Patient Balance at Registration

• Understand that many patients have the ability to pay balance in full if asked

• Recognize the opportunity to have a patient pay balance in full at the time they pay their co-pay

• Balance in full becomes a normal routine through appropriate scripting and insuring the patient is treated with respect

Collecting Balance

Emerging Revenue Cycle

The emerging revenue cycle shifts the bulk of patient account management activities, such as patient identification, payment estimation and collection, to PRE-SERVICE, when it is easier to collect and identify alternative sources of payment.

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Collecting the Balance in Full

• When collection Balance in Full, insure the patient understand you are requesting this in addition to the co-pay

• Remember! This discussion is to take place at the same time you are

discussing the co-pay, unless it appears that an intervention by a financial counselor is necessary

• Patient will have been told about this collection when they made the appointment The schedulers will include this in their phone call with the

patients indicating both the co-pay and the balance will be collected at clinic registration

• If patient is not responding well, explain the process and educate them for the next visit.

Collection Balance in Full

Fact:

Federal and state lawmakers and consumer advocates have taken action to ensure that low income uninsured and underinsured Americans are charged fair prices for their care and are protected from aggressive debt collection practices.

Many healthcare providers are struggling to determine and implement proper, consistent processes to apply these discounts and sharing these prices at point-of-service.

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Role of the Financial Counselor

• The financial counselor will have maximum effectiveness when they contact the patient

• Collection of money, though the top priority, does not mean non-collection has resulted in a poor call with the patient

• Educating our patient about their fiscal responsibility is essential in the contact process

Fact:

Surveys consistently indicate that over 60% of patients rank knowing what the procedure will cost them as their #1 concern; in knowing the cost, 30% of patients recover faster than patients who don’t have a clue what the procedure will cost.

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Practice, Practice, Practice

• Scripting Samples for: Emergency Department Clinic Co-pay Balance in Full

Practice, Practice, Practice

Fact:

As much as 35% of self pay revenue and 25% of cash comes from households lacking full credit file or credit score.

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Effective Scripting in the ED is Essential

“Mr. Jones, while your insurance will cover most of the procedure in the ED, your insurance also calls for a co-pay which they do not pay the hospital. Your co-pay is $75; we need you to take care of that with cash, credit card or check today.”

In the Midwest over 89% of admits into the ED are nothing more than a level 1 clinic visit.

Effective Scripting in ED

Fact:

It is estimated, next year over thirty percent of patients will have a minimum, $3,000.00 deductible and carry higher co-pay requirements than in the past.

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Effective Scripting: Questions and Answers Regarding Collection of Co-Payment

Why do I have to pay this now? You have never asked for a co-pay before?

Mr. Jones it’s not that we haven’t collected the co-pay before it’s just that insurance companies have indicated they want us to collect it at time of service. Your insurance requires the co-pay and that is why we are asking for it.

I don’t have the money with me.

Mr. Jones, I can certainly understand that you may not be prepared to make a payment because that is a new process. Please review this patient hand out. It will explain our co-payment requirements and please remember to bring the co-pay with you the next time you come in to see the doctor.

Effective Scripting

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Effective Scripting: Questions and Answers Regarding Collection of Co-Payment

Will you treat me differently if I don’t make the co-payment?

Our mission is to provide you the best possible health care. Financial issues will never interfere with that mission. And, our staff members are here to work with you to develop the payment plan that works best for you.

Why can’t you just bill me?

Along with providing you the best possible care, another part of our mission is to control costs, as much as we can. Unfortunately, billing is an expensive process due to such things as postage increases. So, by collecting this payment now and creating savings in the billing process, we are better able to hold down future health care costs.

Effective Scripting

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Effective Scripting: Questions and Answers Regarding Collection of Co-Payment

I left my checkbook in care.

Mr. Jones, I can certainly understand that you may not be prepared to make a payment without your checkbook. We do accept cash and credit card it that will help. If not please review this patient handout and the next time you come in we would appreciate you having your co-pay available.

My ex-spouse is supposed to pay all medical expenses for my child.

Your insurance requires this co-payment, and it applies to whoever brings your child in to the hospital. After making this payment today, you can make arrangements for reimbursements with your ex-spouse.

Effective Scripting

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Effective Scripting: Questions and Answers Regarding Collection of Co-Payment

I work here. Why do I have to pay now?

Mr. Jones, as you know, our mission say that we will provide the best possible health care and that we will do our best to control the cost of health care. As employees, we all play a role in carrying out our mission, and one way we can do that is by supporting the hospital’s co-payment program. There are many ways we can assist you in planning for your payments, and this allows us then to help hold own your health care costs.

Effective Scripting

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Effective Scripting: Financial Counseling

Mr. Jones I am calling regarding your upcoming procedure and want to let you know that it appears that insurance will cover a major part of the procedure. In fact, you will have an approximate out of pocket expense of $500.00.

Mr. Jones, given the out of pocket is approximately $500.00, we would like to have you take care of $100.00 of this balance the day you come in for your procedure. What we will do is put the balance of $400.00 on your account and you can use the normal payment process going forward.

Mr. Jones I am calling regarding your upcoming procedure and I wanted to let you know it appears your insurance will cover a major part of your procedure. Your approximate out of pocket expense will be $500.00. Mr. Jones we have various payment options available to you and we expect you to talk to a financial counselor about the best option. We want you to realize with will be required payment once you leave our facility.

Effective Scripting

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Questions

Questions

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Thank you

Thank you

For more information please contact:Chuck Seviour, VP Revenue Cycle200 14th Avenue East, Sartell, MN 56377Office: 218-770-0637 Cell: 218-770-0637Email: chuck.seviour@arraysg.com

Ashley Holmgren, Marketing Coordinator200 14th Avenue East, Sartell, MN 56377Office: 320.534.3642Email: ashley.holmgren@arraysg.com