Next year, out-of-pocket financial responsibility for health care could be as high as 32 percent per family, and increased coverage for those who were formerly self-pay patients will not guarantee full payment. 

This will require hospitals to proactively communicate with and educate patients regarding their financial responsibility for care and services received—and to advocate for those patients who are in need of assistance, two presenters at ANI: The HFMA National Institute shared on Tuesday. 

During a session on Medicaid eligibility conversions and point-of-service collections, April Langford, CPA, vice president, finance for the University of Pittsburgh Medical Center (UPMC), and Julie Kay, executive director, PatientMatters LLC, shared how to empower employees in identifying patients who could qualify for financial assistance throughout the continuum of care. 

At UPMC, such strategies have increased point-of-service (POS) collections from an average of $16 million per month in Fall 2012 to more than $20 million in both March and April of this year, and have reduced bad debt while improving productivity and enhancing patient relationships. Key takeaways from the presentation include the following:

  • Build the organization’s patient financial advocacy program based on a proactive approach in communicating and educating patients about their financial responsibility, integrated throughout the revenue cycle.
  • Incorporate assistance in finding financial solutions for underinsured or uninsured patients into the revenue cycle using electronic tools, thereby positioning your organization to deal with Medicaid expansion and insurance exchanges. Use electronic tool for tracking applications and as part of the overall assistance process.
  • Develop detailed process steps and scripting tools to assist staff at all POS collection points.
  • Segment self-pay accounts receivable based on a propensity to pay scoring process, which should then dictate collections workflow for self-pay accounts. This allows the organization to use a variety of tools and assign resources where different approaches are effective, rather than take a “one size fits all” approach.

Publication Date: Tuesday, June 18, 2013