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Overhauling its pre-service and point-of-service (POS) collection procedures produced immediate results for the Cincinnati/Springfield, Ohio, region of Catholic Health Partners (CHP). Pre-service collections grew from $540,000 in 2010 to $3 million in 2012, while POS collections increased from $5.4 million to $5.8 million during that time.Like all health systems, CHP sought to improve its self-pay collection approach because patient payments are increasingly important to the system. "A solid pre-service and point-of-service collection process has initial and lasting financial implications and effects on our organization," says Denise Gibson, divisional manager, revenue cycle, patient financial services, for CHP's Cincinnati region.CHP uses five patient-friendly strategies to boost self-pay collections, including staff training and the adoption of new technologies. One key improvement, according to Gibson: the ability to generate real-time reports that track the collection success of each staff member and the department as a whole. These reports support CHP’s efforts to coach staff members on how to use patient-friendly techniques to increase collections. "One of the biggest benefits was leveraging the power of reporting," she says.
CHP seeks to help patients understand their financial responsibilities by making pre-service telephone calls to discuss estimated out-of-pocket responsibilities, payment options, and the availability of financial assistance. "Customer pre-service contacts create the first impression for the patient. We must provide first-class service to set the tone for the patient’s journey of care as well as educate and manage the financial expectations for the patient prior to care," Gibson says. "All efforts are made to avoid upsetting patients by showing compassion and assuring them that no aspect of care will be jeopardized if payment arrangements have to be made," Gibson says. "In the global realm of things, what other industry in the country offers thousands of dollars in services without requesting some form of deposit or payment—or at least a discussion about future payment terms?"
The initiative began in 2011, when collection goals were established for patient access agents and registrars. Developmental coaching, patient-friendly scripts, frequent feedback to staff members, and celebration of accomplishments also were introduced with successful outcomes. Pre-service collections increased by 163 percent from $540,000 in 2010 to $1.4 million in 2011. POS collections increased by 7 percent from $5.4 million to $6.1 million during that same time."Proper scripting is essential to building trust with the patient and creating a compassionate experience centered around the patient’s health and financial information," says Jody Patton, regional manager for customer pre-service at CHP. "Agents are mentored to exude confidence, which acts to motivate patients to manage their financial liabilities during the pre-registration and registration process."Agents and registrars are also coached to avoid "demotivating" phrases and instead engage the patient in conversation. "Directive phrases can be interpreted as being aggressive, forceful, or high-pressure," Patton says. Agents replace the following demotivating phrases with positive language.
Staff are also trained to avoid closed-ended questions that prompt the patient to say "no," thereby ending the conversation. Examples include:
CHP staff instead use language that prompts patients to offer payment. Here are two examples:
"Scripting is continually evaluated to ensure a soft, professional, and confident approach," Patton says. "Staff are encouraged to ask questions that promote conversation and to create additional chances for discussion, clarification, and possible negotiation regarding patient amounts, as well as to arrange payments according to the individual patient’s needs."
To build on its first year of success, CHP acquired new technology in 2012 to support pre-service and POS collections. It chose a system that captures and processes patient payments made online as well as at the point of service in real time, eliminating the need to manually post payments, which can introduce errors.Onsite, the system is integrated with an electronic credit card reader so registration staff do not have to enter credit card numbers, verification numbers, and expiration dates. "Any reduction in manual entry will result in increased speed of registration," Gibson says.After implementation, the CHP region experienced a 25 percent increase in the average number of credit card and eChecks (payments made directly from a bank account) taken each month. Moreover, pre-service collections grew from a monthly average of $118,227 in 2011 to $253,975 after patients could choose online payment. That translated into a 115 percent increase for the year, from $1.4 million to $3 million in 2012. Reports generated by the new system confirmed that many CHP patients preferred to pay their healthcare bills online without interacting with a member of the collection staff. CHP’s next step is to add interactive voice response (IVR) capability so patients can use a telephone keypad to pay their CHP bills. "This will give our patients another way to access our payment system without customer service intervention, thus freeing up time for our staff to handle other calls," Gibson says. "Easy patient access for Internet and IVR payments are examples of having a solution that is user-friendly for the patient as well as the staff."
As a divisional leader, Gibson needs reports that allow her to analyze the effectiveness of the collections program. She generates monthly reports of the payments collected by the pre-service and the access team. The reports allow her to analyze trends at the facility level, including:
Meanwhile, Patton reviews several departmental statistics every day, including pre-service collections, accounts completed, and in-bound versus out-bound calls. This allows her to track the department's productivity. Daily results are displayed on a bulletin board and emailed to each staff member for review. Patton can also create reports about each staff member's collection performance on a real-time basis. These data can be used to identify problems that require additional coaching or to highlight staff members who are showing stellar performance. Scorecards, such as the one below, are an important part of the employee performance tracking process.
Average collections are calculated on a daily, weekly, and monthly basis to determine benchmarks for the pre-service collection team. Annual goals for the department are adjusted each year at the time of annual performance reviews. "It’s important to us that the team understands that their performance drives the internal goals, so they strive for personal bests and are engaged in customer pre-service performance as a team," Patton says. "The ability to provide feedback driven by factual information supports the credibility of the process, personal accountability, and team successes."Individual staff members can also use the reports to track their own performance. "Reporting of the individual results is key to employee engagement," Patton says. "By having access to real-time, to-the-minute reports, agents can guide their own results."
Collection performance is tied to individual and group incentives available to members of the collection teams. "Recognition is essential to personal growth and confidence, so periodic team-building challenges come in the form of contests," Patton says. One recent contest gave staff members the opportunity to earn hospital logo wear, coupons for a "jeans week," free coffee for a year, and gift cards. "Out of all of our team members, 50 percent received the top-tier prize pack and rewards were given to 100 percent of the team," she says. "These exercises assist in team building and incentivize the team and individual efforts as well."
Lola Butcher is a freelance writer and editor based in Missouri. Interviewed for this article:
Denise Gibson is divisional manager-revenue cycle, patient financial services, Mercy Health, a part of Catholic Health Partners, Cincinnati, and a member of HFMA’s Southwestern Ohio Chapter.
Jody A. Patton is regional manager for customer pre-services, Mercy Health, a part of Catholic Health Partners, Cincinnati, and a member of HFMA’s Southwestern Ohio Chapter.
This article is based on content shared during HFMA’s webinar, "Take Your Point-of-Service Collections from Good to Great: A Catholic Health Partners Study."
Publication Date: Wednesday, July 24, 2013
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
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