2Optimizing Pre-Service Collections Presented by Michelle Tremé
3Pre-service Collections Improve Patient Satisfaction and Overall Financial Health Patients appreciate knowing their estimated cost of services in advance so they can focus on their health.Reduces bad debt, because patients are more likely to make better financial decisions when they can plan for the expense before they actually incur it.Cuts down on the billing resources hospitals use to collect after services are rendered.Patients who are unable to pay can be identified early in the account cycle, allowing time to meet with a financial counselor.No surprises about the cost of services enables patients to make more informed choices; like possibly defer non-urgent services, or decide a non-urgent service is cost prohibitive and explore alternatives with their physician.
4“More than 8 in 10 Americans report that upfront cost estimates would have a positive impact on their decision to continue using a provider.”Source: TransUnion Healthcare “New findings on consumers’ views of billing experiences and what they mean for you”
5Outside Forces Affecting Hospital Revenue Cycles in the Near Future
6Source: USA Today “Dilemma over Deductibles: Costs Crippling Middle Class”
8Common Excuses for Not Collecting… “Staff doesn’t have time”“Staff has trouble reading benefits from the 271”“Not sure what portion of the benefits may have been met already”“Cannot collect co-insurance because we don’t know our contract rates with payers”“The staff is not comfortable asking for money”“Our patients wouldn’t pay anyways”
11Discounts, Deposits, and Payment Plans Do you offer Self-pay discounts?Do you offer Prompt pay discounts?What is an acceptable deposit amount for a high dollar estimate?What are your Payment Plan guidelines?
12SchedulingHow far in advance do you want to schedule non-urgent services?Pre-AuthorizationsHigh DollarTime ConsumingAdd-On VolumesAdd-ons under 48 hours prior to service cause…- Less time to determine benefits- Less time to contact the patient to collect
13SchedulingHow should a Scheduler handle non-urgent underinsured and self-pay patients?Require clearance from financial counselorCheck propensity to pay
14Source: The Academy of Healthcare Review “Patient Access Benchmarks” SchedulingWill a non-urgent service be scheduled if the patient cannot meet their financial responsibilities?Source: The Academy of Healthcare Review “Patient Access Benchmarks”
15SchedulingWhat information is required to be collected at the point of scheduling?DemographicsInsurance and coordination of benefitsProcedure codes and diagnosis codesPre-authorization information
16Pre-Registration / Registration Days OutHow far in advance of the date of service should pre-registration occur?Average = 5.3 daysMonitor and control daily add-ons to increase pre-registration days out
17Pre-Registration / Registration Insurance VerificationExpectations for verifying insurance eligibility and benefits?Verify benefits for ALL payers? Or, just eligibility in certain instances?MedicareMedicaidWhat tools are used to verify benefits?Integrated Verification ToolPayer WebsitesPhone
18Pre-Registration / Registration EstimatesHow are estimates calculated?MethodsToolsDiscountsWill you collect estimates over the phone during pre-registration? Or, prompt the patient to bring the payment at the time of service?73% of surveyed hospitals attempt to collect estimates during pre-registration (Healthcare Business Insights: “Best Practices in Patient Collections”)Conveying estimates prior to the date of service informs the patient and allows multiple opportunities to collect.
19Pre-Registration / Registration PaymentsWill partial payments be accepted?Will staff attempt to collect outstanding balances on prior services?Can registrars set up payment plans?“Yes” to all of the above allows opportunities to increase collections, reduce A/R, and prevent bad debt.
20Pre-Registration / Registration MedicareMedicare Secondary Payer and other dual eligibles?Not beneficial to collect up front from patients with more than one active coverage.What is the process for when Medical Necessity fails and an Advanced Beneficiary Notice is issued?Prompt the patient for paymentRefer to financial counselor
21Financial CounselingUnder what circumstances should a financial counselor be contacted? Who should contact them? And when?Financial Counselors should be contacted by staff as soon as the need is identified.Patients that are given instructions to call the financial counselor often times never call.Should the Financial Counselor collect payments due from non-urgent financially capable uninsured and underinsured prior to clearing the patient to be scheduled?Yes. Follow organization’s outlined procedures regarding discounts, deposits, and payment arrangements.
23Financial Clearance Policy Implementation Administration ApprovalCritical that pre-service collections is part of a formal hospital policySupport of the policy from the board, CFO, and other leadership impresses the importance of the process to staff across all departments in the organization.Policy enforcement is important, even if a patient complains.
24Financial Clearance Policy Implementation Communication!Remember that a pre-service collection policy may be a culture change for the hospital staff, as well as patients. It may take a little time, but the culture will start to shift. Patients will expect to pay in advance, and many will actually embrace it.
25Financial Clearance Policy Implementation Communicate the PolicyPatient Access StaffupdatesRegular staff meetingsPeriodic TrainingPerformance expectations and goalsRequest Feedback
26Financial Clearance Policy Implementation Communicate the PolicyHospital Departments and Physician’s OfficesGain support by explaining how up front collections effects the entire revenue cycle and benefits the whole organization.Both areas can be very helpful with setting expectations for patients to be asked for payments before services are rendered.Coordination between supervisors and departments can quickly identify process breakdowns.
27Financial Clearance Policy Implementation Communicate the PolicyPublicNewspapers, hospital website, signage, and brochuresInclude acceptable forms of paymentConsider sending letters or s to pre-registered patients informing them of their estimate and payment options
28Tools for Collecting Benefit Verification Price Estimation Payment ProcessingKiosks
29Tools for Collecting Benefit Verification Integrated Eligibility Tools Accurate benefit verification of most common payersResponse time under 30 secondsEasy process flow when integrated in registration pathwaysAllows for a seamless flow of information into a price estimatorPayer WebsitesGood for payers that cannot be accessed by the integrated verification toolServes as a back up if integrated system is experiencing problemsSupervisors should maintain logins for everyone that verifies insurance. Be sure to terminate the login when employment ends.PhoneNot the ideal method to verify benefits, but serves as a good back upKeep a list of payer’s current phone numbers stored in a shared document that can be easily accessed
30Tools for Collecting Price Estimation Software Easily calculate estimates for co-pays, deductibles, and co-insuranceLoaded with data files of organization’s CDM and payer contracts.Data feeds from your registration software enables the automatic flow of information into the estimate, like demographics and insurance information; as well as benefit information like co-pays, co-insurance, and any remaining deductible and Out of Pocket amounts.Provides a summary letter of the estimate that can be printed or ed to the patient.
31Tools for Collecting Web-based Payment Processing / E-cashiering Easy for Pre-registration staff to take payments by phonePossible for patients can make payments onlineReceipts can be ed or printed at the time of paymentIntegrated payment platforms allow patient payments to be linked to registration and accounting mechanisms; therefore payments can be posted immediately.
32Tools for Collecting Kiosks Increases collections by requesting and accepting paymentsOffers the option for patients to pay outstanding balancesReduces wait times and speeds up the check-in processPatient forms are signed electronically
33TrainingEducate staff about the importance of pre-service and point of service collections as it relates to the financial health of the organization.Financial Clearance Policy training.Test staff knowledge on how to read and interpret eligibility responses.Customer service skills.Note everything! “If it’s not documented, it didn’t happen!”
34TrainingMake sure collectors have a thorough understanding of key terms, including: contract rate, in-network, out-of-network, co-pay, deductible, co-insurance, and out-of-pocket.Increases confidence, thereby making it easier to collect.Test staff by calculating estimates manually.
37TrainingScriptsCreate a flow chart for staff to follow when attempting to collect that includes different scenarios.Be sure to over-emphasize the word “ESTIMATE” during training. Never use words like “quote.”Teach staff to use a disclaimer, “Your Estimate is based on hospital charges for the scheduled procedure. You may be billed for any other charges that apply.”Provide scripting to all staff that interacts with patients on how to respond to questions or complaints about pre-service collections.
38TrainingScriptsUse phrases that encourage the patient to make a payment.“Based on your insurance coverage and the scheduled procedure, your estimated amount due is $ We accept Visa, MasterCard, Discover, and electronic check payments. How would you like to take care of that today?” Opposed to, “Would you like to pay today?”“Since you will not be paying over the phone today, how will you be paying at the time of service?”“Since you cannot pay your estimated amount due, how much can you pay today?”“It is now our hospital’s policy to collect estimated amounts due prior to the time of service. It helps us better serve our patients by informing them of their estimated responsibility, and it cuts down on our billing costs.”Do not communicate a minimum amount due until you have exhausted other options.
39Training Scripts Role Play Role Play with different scenarios until staff feels comfortable with scripting. Let staff members challenge each other.Meet with staff regularly, and openly engage them to share scripting ideas based on their interactions with patients.Include scripting in new-hire training.
40Reporting and Monitoring Continuous reporting and monitoring on a monthly, weekly, and even daily basis is key to success.Share reports with your staff regularly to show them you are paying attention, and convey the significance of what you’re monitoring.
41Reporting and Monitoring Set performance goals that are measurable and attainable. Base goals on industry and organizational benchmarks.Amount Collected vs. Amount Available to Collect for each registrarNumber of accounts with available collections vs. number of accounts collectedPre-Service Collections vs. Point of Service CollectionsPre-Registration Days Out, track and trend over time.Add-ons per dayInsurance Verification Rate = Registrations with Insurance Verified / Total RegistrationsPre-Registration Rate = Total Pre-Registrations / Total ScheduledPOS Collections as a Percentage of Net Revenue
42Pre-Service Collections Vs. Point of Service Collections
44Reporting and Monitoring IncentivesRecognition, gift cards, free lunchConsider incentives for meeting goals, and higher incentives for surpassing goalsApply a team incentive approach which encourages individual participationShare performance scores to create friendly competitionRealize that goals must be adapted for each area or shiftAsk for feedback about which incentives are most encouraging
45Tips for SuccessAccountability - Hold supervisors accountable for their staff’s performance, as well as the individual staff members. It helps create a culture of high performance standards.Standardize collection efforts across all of your organization’s sites to ensure patients are provided with a consistent experience.Handling staff members that are resistant to performing pre-service collections because they feel uncomfortable:Let them know collecting is a requirement of their job. Update the job description if collecting is not already included.Staff should sign off that they have been made aware of any new policies, processes, or procedures.Offer more training and practice sessions.
46Tips for Success Don’t get caught up exceptions! Pre-service collections should not be an “all or nothing” strategy.If your organization is not able to call to pre-register and collect estimates from all scheduled patients due to staffing issues, consider prioritizing patients scheduled for high dollar services.