Jeni Williams

It takes more than a friendly presence for finance staff to provide excellent customer service. Here, healthcare providers and thought leaders share strategies for improving the consumer service skills of your finance department. 


At a Glance

Strategies for improving the consumer service skills of finance staff include:

  • Hire employees who have a customer service background.
  • Work with your human resources department to provide customer service training.
  • Monitor new hires extensively.
  • Offer front-end employees scripted language for situations they may face on the job.
  • Measure the quality of customer service provided.
  • Provide incentives for performance.

Three years ago, the University of Pittsburgh Medical Center took a close look at its training program for finance employees and realized it was missing one critical element.

UPMC's finance employees were well versed in "Insurance 101" and how to use systems for billing, registration, scheduling, and dmission/discharge/transfer. What employees lacked were "soft skills"-skills such as the ability to communicate effectively with patients, empathize with their needs, and skillfully negotiate for payment. Ultimately, the weaknesses in their soft skills affected the quality of customer service that finance staff provided, says Karen Shaffer-Platt, senior director of registration, scheduling, and IT for the physician services division of UPMC, located in Pittsburgh. "We definitely saw a gap between the technical skills that our staff possessed and their soft skills. We saw it reflected in our patient satisfaction scores and in the 'secret shoppers' that we do, and we really saw it evidenced in our customer-service complaints," Shaffer-Platt says.

"Some of the situations that patients are dealing with require a lot of empathy. For example, patients don't ask to become ill, but we're asking them to pay for their care. Many times, health care is not a planned expense for patients. We recognized the need to walk that fine line between financial efficiency and empathy and clinical support."

UPMC worked with its human resources department to revamp its training program and turn its finance staff into "patient ambassadors," adding a week of customer service skills training to the two-week training geared toward specific job functions. The health system also began to look for a different type of candidate to fill its front-end finance positions.

"We started looking for candidates who had a customer service type of background, with the idea that we could teach them the financial skills and knowledge they would need," says Monica Joyce, director of UPMC's patient ambassador program. "We actually changed the job descriptions for these positions to reflect the importance of customer service. During our three-week training program, new employees are exposed to key events they would have on the job, such as collecting copays and working in situations that require a lot of empathy."

Three years later, UPMC's customer service initiatives are making a significant difference not only for patients, but for the entire system. Patient satisfaction scores have increased, ranking in the 90th percentile in three out of four key service areas measured by the finance department. Customer complaints have diminished, no-show rates are down, employee retention rates in finance are stronger, and registration accuracy has increased. Enhanced customer service also has strengthened UPMC's copay collection rates, which are now in the 87 percent range, Shaffer-Platt says. Formerly, copay collection rates were in the low 60s for UPMC's academic physicians and in the low 70s for its community practices.

"This is a huge commitment that our system has made, and it has had a strong revenue outcome," she says. "We're constantly measuring the customer service our finance employees provide and keeping the bar high."

At a time when patients are becoming more discerning about where and how they will receive medical services, the value of excellent customer service in health care has never been higher. In the finance department, this means not only providing staff with the tools to help patients understand their financial obligation for services rendered, but also ensuring that staff treat patients with empathy and respect at every point in the revenue cycle.

But finding the balance between technical skills and communication skills has proven to be a challenge for healthcare finance departments. Many are turning to the customer service industry to recruit employees who can deliver the level of service required.

"It's easier to teach someone a system than to teach them to be nice," says Craig Pergrem, corporate director, patient business for Orlando Regional Healthcare System, Orlando, Fla., whose system employs six full-time trainers to strengthen the customer service skills of finance staff.

There's an art to providing excellent customer service in healthcare finance. Here, providers and healthcare thought leaders share what it takes to provide high levels of service for patients-and strategies for strengthening customer service in your finance department.

What It Takes

Ask a manager what customer service qualities finance employees should possess, and "personable" would rank highly on the list. But it takes more than a friendly presence to provide excellent customer service.

"As nice as an employee might be, if the employee can't answer a customer's questions and can't get the customer the information he or she is looking for, that employee still hasn't provided good customer service," says Suzanne Lestina, technical manager, PFS/revenue cycle, HFMA.

The best front-end finance employees not only are personable, but also have the training and tools to communicate the patient's expected financial obligation for service. "Before an employee transitions to live, the employee should be completely savvy on the hospital's computer system and any systems they have to access," Lestina says. "Employees also should be completely trained in customer-service skills and be able to communicate with patients in an effective manner. They should have a broad understanding of the revenue cycle and how their work has an impact on the organization's revenue cycle. The question is, how long will it take for your employees to learn these things? The amount of time it takes to learn these skills could vary by individual."

In the past, front-end staff weren't expected to discuss a patient's financial obligations for care and service. Now, these employees are increasingly asking for copays before care or service is delivered-and for some, the transition has been an uncomfortable one.

"It's one thing to be a registrar, which is a nice and friendly position. It's another thing to ask for money, which is really quite confrontational," Lestina says. "It's very different from asking for a patient's insurance card, and not every employee has the skills or the desire to ask for money."

Additionally, the amount of data that staff must collect from patients in a short amount of time challenges their ability to engage patients in a personal yet efficient manner. "They have so much information to gather that it's very easy for employees to go into a robotic mode of just asking questions of patients," says Steve Marshall, director of patient financial services for Methodist Medical Center of Illinois, located in Peoria, Ill. "I would say that both the technical aspects of their roles-getting all the information that is necessary to register the patient accurately-and the customer service aspects are equally complicated."

There are specific customer service skills that finance staff can learn to enhance their communication with patients in situations such as this. "A very simple thing to do is to tell the patient, 'I want to make sure that I input your information accurately, so I'm going to look at the screen while I'm talking to you, but I'm still listening to you,'" says Terry Allison Rappuhn, project leader of the PATIENT FRIENDLY BILLING® project, a national collaborative spearheaded by HFMA to improve patient financial communications. "It's a very simple way of letting the patient know that you care-that you're listening to the patient while you're looking at the screen, but you're also trying to make sure everything is accurate."

Signs of Trouble

The challenge of meeting consumer expectations for higher service in patient finance lies not only in equipping staff with the appropriate skills, but also knowing when the level of customer service your department provides is faltering.

"Ironically, a lot of providers that are in the most trouble may not know it, because they may not be measuring the things they need to measure," Rappuhn says.

Signs of trouble include an increase in the number of customer complaint calls your system receives per 1,000 bills issued and the number of complaints that are escalated to supervisors. "When you see spikes, that can indicate that there are problems," says Orry Jacobs, senior adviser, 3M Health Information Systems Consulting Services, Atlanta. "Additionally, if your self-pay collections start to drop, that can be an indication that there is a customer service issue."

Watch for a surge in the number of denials as well. "A high number of denials is a red flag that you're not engaging your patients in the right way," Rappuhn says. "It means that you're not getting accurate information from the patient or that the patient is not involved when there are problems with the account."

Distress signals also could come from your employees, in the form of decreased employee satisfaction scores or employee retention rates. For example, when employee retention rates decline, "Very possibly, employees could be leaving the organization because they haven't been trained properly," Jacobs says. "They may be frustrated in their dealings with patients because they feel they can't do their jobs effectively."

Strategies for Improvement

How can you strengthen the quality of customer service that your finance department provides? Healthcare providers and thought leaders suggest these strategies.

Hire employees who have a customer service background. Then, train them in specific revenue cycle functions, such as communicating financial expectations to patients. In its 2006 report, Consumerism in Health Care, the Patient Friendly Billing project recommends providers seek employees from customer service industries such as hospitality, credit card companies, banking, insurers, and even funeral home collections. "If you think about the skills you need to deal with people who are experiencing a very frightening time in their lives, people who work in funeral home collections have to be empathic and sensitive to customers' needs, but also have to work toward finding a solution for payment," Rappuhn says.

Work with your human resources department to provide customer service training for finance staff. "Not only do employees need initial training in customer service skills when they are hired, but they need ongoing training as well," Lestina says. Training can be provided in a variety of ways, such as on-site presentations from trained facilitators, video presentations coupled with workbook exercises, one-on-one training with a mentor, and e-learning.

At Methodist Medical Center of Illinois, a four-hour program focusing on customer service skills for front-end revenue cycle staff has been broken up into hour-long segments, so that training can be incorporated as part of departmental meetings. "Our employees say the training has really helped them visualize interactions from the patients' point of view," says Marshall of Methodist Medical Center. "They've learned not only how to communicate verbally with patients, but also how to present themselves as more approachable through their body language as well."

Monitor new hires extensively. At UPMC, new employees do not work independently until they've had training and exposure to some of the more sensitive situations they'll deal with on the job and how to handle them.

Offer front-end employees scripted language for situations they may face on the job. "We asked our employees, 'What are the top 10 challenges you are faced with on a daily basis?' Then, we created a script for each one of those situations," says Shaffer-Platt of UPMC. "Don't underestimate how much your employees are looking for guidance on how to answer the most challenging questions they receive from patients."

Measure the quality of customer service provided by your finance staff. Jacobs of 3M Health recommends tracking the nature of customer complaint calls to your finance department. "A pattern of calls about specific types of issues may indicate that your staff need additional training on how to handle those issues," he says. After complaints are dealt with by employees, follow up with customers to gauge the level of customer service provided. "The goal is not to demean the employees, but to really reach the employees and help them achieve their customer service goals," says Lestina of HFMA.

Another way to measure employees' customer service skills is to listen in on calls periodically, then offer feedback to employees on behaviors that could be modified to enhance service. For example, at UPMC, calls to registration, scheduling, and customer service are recorded, then reviewed by supervisors, who evaluate an employee's customer service skills using a report card developed by the system "The ability to provide real-time feedback for our employees has been very effective," Shaffer-Platt says.

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Provide reinforcement of customer service skills learned. For example, send out daily service tips to staff by e-mail to remind employees of the skills they've learned in training. Share revenue cycle metrics with staff. "It's important that employees have a big-picture view of what's going on in the hospital revenue cycle and how their work interacts with the rest of the department," Lestina says. "It also adds a little bit of competition: 'Look at how much cash we have; look at what this does to our days in accounts receivable.'"

Recognize excellent performance, both individually and as a group. At Methodist Medical Center, which recently improved patient satisfaction scores in ambulatory surgery and the emergency department through its customer service initiative, the hospital sponsors "employee of the month" and "employee of the year" celebrations to recognize outstanding performance. Individual departments that achieve patient satisfaction scores in the 95th percentile are recognized by hospital leaders, who bring baskets of candy to the departments to celebrate the achievement. "These celebrations are very affirming for our employees," Marshall says. "They're part of our culture."


Jeni Williams is a senior editor in HFMA's Westchester, Ill., office.

Publication Date: Monday, October 01, 2007

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