By helping patient financial services personnel feel comfortable asking for money from patients at the time of service, OhioHealth has captured millions of dollars in point-of-service collections—and empowered staff to more effectively help patients resolve their accounts.

At a Glance

At OhioHealth, three factors for success have supported the organization’s ability to increase collections while easing the transition to consumer-directed health care for patients and staff alike:

  • Establishing internal transparency for collections efforts
  • Setting target goals for collections by facility and department and regularly sharing the results with leaders and staff
  • Monitoring patient complaints, sharing them with revenue cycle staff, and using them to identify areas where process improvements are needed

Nearly eight years ago, when I joined OhioHealth as system vice president, revenue cycle, I broached the idea of point-of-service (POS) collections with teams of customer service and collections staff during my first week in the position. Some of them looked at me wide-eyed; some, with disbelief.

“We don’t do that here at Ohio Health,” one staff member explained. “We don’t ask patients for money.”

“Well,” I responded, “I think we’re going to start doing that.”

It was an example of a change in culture that was about to take place at OhioHealth in our revenue cycle department. 

Senior administrators at OhioHealth were beginning to emphasize the need to reduce bad debt and improve patient collections across the organization. But this message had not yet reached front-line revenue cycle staff. At that time, billing statements were simply sent to patients, and if, after 45 days, the self-pay portion of an account had not been received, the account was sent to an extended business office. Not only did this entail an additional expense for the health system, but it also presented challenges in regard to consistency of messaging with patients because the communications were being managed by a third party. Leaders at OhioHealth believed our organization could do a better job of collections if we held our own people accountable. 

OhioHealth worked toward developing an “It’s OK to ask patients for money” mind-set among members of our revenue cycle team. Today, our call center collects millions of dollars in payments each year—more than $1 million in credit card payments during the month of March 2013 alone and $19 million in total POS collections in FY13. Just as important, this approach has helped to identify patients in need of financial assistance sooner—and enables patients to work with staff in resolving their accounts in a way that makes them feel good about the process.

How OhioHealth Did It

That initial conversation with staff from our revenue cycle customer service and collections teams highlighted an opportunity to educate staff on our organization’s expectations related to revenue cycle performance and service.

We began by asking collections staff simply to request a payment from any scheduled patient they spoke with that week who owed a balance on an account. A sample discussion might have begun, “I see you have a $50 copayment for your account. I’d be happy to take that payment over the phone for you today.” In the first week, staff collected $45,000 from this approach.

This type of messaging—built around the assumption that a patient will pay his or her bill—not only is more effective in prompting patients to make a payment, but also helps to more quickly identify patients who are struggling financially and who might be in need of assistance. 

For instance, by asking a patient, “Is there any reason you cannot make this payment today?”, a staff person might learn that the patient’s spouse is out of work or that a financial hardship of another sort has made it difficult for the patient to pay the bill at that time—information that the patient might not have shared with the staff member had the question not been asked. The staff member can then respond by helping to determine whether a patient might qualify for the health system’s financial assistance program or for Medicare or Medicaid and directing the patient to the appropriate resources. 

On the other hand, if the answer is, “No, there is no reason I can’t make this payment today,” staff can use that information to move forward with resolving the account at that time. This conversation also provides an opportunity for staff to explain how the amount due was determined, how much the patient’s insurance company has paid or is expected to cover, and more.

Scripting for conversations such as this was developed by OhioHealth leaders and staff, rather than by a consultant. Although we have modified our scripting over the years, the basic premise for conversations such as this is the need to honor patients and to make them feel good about discussing their financial responsibility for care or services rendered. We do not use any hardcore collections tactics; we simply ensure that patients are treated with respect and that the messaging is consistent from the front end of the revenue cycle to the back end. We also negotiate payment schedules with patients. We do not charge interest for account balances that are resolved over time, but we do have expectations related to the length of time it should take for patients to resolve accounts, and we work with patients in establishing a payment schedule that is acceptable to both parties.

We also believe in providing patients with a number of options to resolve their account—such as by mailing a check or providing the checking account information by phone, by paying online, or by paying through an automated telephone system. Also important, is the ability to reach a member of our customer service team outside of normal business hours. OhioHealth established a call center that operates six days a week, from 7 a.m. to 8 p.m. Monday through Friday and until noon on Saturdays. The call center is staffed by 60 FTEs—up from the 16 FTEs who staffed our call center eight years ago. Our call center staff manage between 8,000 and 10,000 calls a week from customers.

We want customers to call us. That’s an important differentiator in our strategy. Some organizations prefer to include as much information as possible on the billing statement so that patients will not feel the need to contact the hospital or health system. We believe that patients who are interested in resolving their accounts will call us—and such calls give us an opportunity to ask for payment, too. We use unattended messaging technology to make the initial contact with patients we are trying to reach, so that staff are not spending time leaving voicemails for patients who may not want to talk with us. But when patients do call us, we want to make sure we have a live person on the line to respond. And where account balances exist, we provide options: “Were you aware that we could put this balance on your credit card today? Or, we’d be happy to accept an electronic check. Do you have your checkbook handy?”

In addition, instead of having two separate teams for customer service and collections, OhioHealth trained revenue cycle staff to be proficient in both functions. The health system also brought its extended business office function back in house, hiring people to manage aging accounts, at a savings of $500,000 per year.

It’s important to recognize that not all staff will feel comfortable asking patients for money, even with training. Identify each staff person’s strengths and match his or her strengths to the appropriate role in the business office or revenue cycle department. For example, some revenue cycle professionals are more comfortable working on accounts behind the scenes; some focus solely on call center activities. In hiring people for our call center, we focus on people who are very conversational in nature, who are capable of offering excellent customer service, who have engaging personalities, and who can communicate well with others. About a quarter of the 16 people who originally answered phone calls related to billing have remained in our call center as we’ve redesigned our approach. Others have pursued new positions in the revenue cycle department or within the health system where their skill sets can be better applied.



Resources Support a Positive Experience

A change in culture such as that which has taken place at OhioHealth, in which revenue cycle staff feel comfortable requesting payment from patients, requires more than staff training and scripting. It also requires an investment in technology and other resources that support collections taken over the phone or online.

For example, when I first joined OhioHealth, the customer service department had one PC that could accept credit card payments. Right away, I realized we would need to install the appropriate software on each customer service PC so that customer service staff could accept payment from their own workstations, rather than having to walk across the room to input the information into the system. We also invested in a portal that enables patients to make payments online as well as technology that allows patients to pay by telephone without speaking to a customer service representative.

OhioHealth also contracts with Medicaid eligibility program vendors that work with patients who could potentially qualify for Medicaid and enroll eligible patients for Medicaid services at no cost to the patient. This service helps patients access needed resources while enabling OhioHealth to receive payment for services that might otherwise have been uncompensated care. 

Another tool we aquired helps to determine whether a patient qualifies for the health system’s financial assistance program quickly—while the patient is on site, when possible. A staff member works with the patient to complete the application electronically; the application is then routed to a professional in our business office for review and eligibility determination. 

Our insurance eligibility system helps us verify in real time—both at the point of care and before and afterward—information related to a patient’s coverage, including benefits coverage, copayments, coinsurance, and deductibles. The tool supports OhioHealth’s ability to discuss patients’ financial obligation for care and services before services are rendered and collaborate with patients in developing a plan for resolving individual accounts. 

Additionally, all self-pay and charity accounts are reviewed by a vendor regularly to determine whether the patients to whom these accounts belong have obtained Medicaid since their last visit or are covered by private insurance. Through this process, OhioHealth has uncovered millions of dollars on qualifying accounts that might otherwise have been written off as bad debt. 

Lessons Learned

The ability to empower both staff and patients to effectively resolve accounts in ways that protect patients’ dignity and leave them feeling good about the process will become even more important for hospitals and health systems in an era of decreasing margins and payment reform. At OhioHealth, our efforts have increased patient collections, resulted in greater patient engagement, and eased the transition to consumer-directed health care for patients and staff alike.

There are a number of lessons OhioHealth has learned through this initiative.

Establish internal transparency for collections efforts. Internal transparency builds leaders’ confidence that payment is being handled fairly and appropriately. Explain why the organization has adopted a specific approach, how the organization’s financial assistance programs work, and the benefits that a POS collections effort can provide for patients. Be sure to include nursing leaders in these discussions, as their support is critical to the success of a POS initiative. Additionally, revenue cycle staff should always take care to ask nurses’ permission before approaching a patient within the hospital setting so that they may be sensitive to the nature of the patient’s illness and his or her ability to communicate with finance staff. 

Set target goals for collections and share progress with revenue cycle staff. At OhioHealth, our POS collection goals are developed by facility and down to the department level based upon the percentage of opportunity. We regularly provide feedback to individual registrars and financial counselors, comparing their individual collections with the target. A focus on target goals by facility and department has enabled OhioHealth to increase POS collections year over year.

Monitor complaints and share them with revenue cycle staff. Our organization has established a patient complaint log where calls received from unhappy customers are recorded, investigated, responded to, and tracked by category of complaint. This is a great tool for identifying areas where process improvements are needed within the revenue cycle and within our organization. The number of complaints we receive is very minimal, but being able to quantify and communicate such complaints to executive leaders is critical to establishing transparency and trust.

Jane A. Berkebile is system vice president, revenue cycle, OhioHealth, Dublin, Ohio, and a member of HFMA’s Central Ohio Chapter.

Outstanding Performance

OhioHealth is one of four health systems that were honored with HFMA’s 2013 MAP Award for High Performance in Revenue Cycle.

Publication Date: Sunday, September 01, 2013

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