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Revenue cycle departments can be more responsive to patients if they upgrade the role of the patient financial services (PFS) counselor to a patient business service executive, says Terry Armstrong, president of State Collection Service, Inc., Madison, Wis., a revenue cycle service company. This professional would have wide latitude to assist patients with both front-end and back-end revenue cycle processes.
The patient financial service executive would be the primary patient contact supported by other staff, including registrars, billers, coders, and call center staff. Complex patient accounts would be handled exclusively by the patient financial service executive.
Revenue cycle leaders who upgrade the PFS role need to consider the cost of training and higher compensation for staff with additional expertise. Armstrong acknowledges the challenge but says improving patient experience can lead to quicker payment from patients.
Armstrong also suggests that organizations consider changing the name of the revenue cycle department to something that patients can more easily understand, such as patient business services. “With everything that’s happening in health care today, it’s time to really look at your overall organization,” Armstrong says.
“I’m more convinced than ever that hospitals have to organize as more of a service organization,” says Armstrong. “Creating a better experience in the revenue cycle requires adapting or creating a new patient financial services role to respond to the rise in healthcare consumerism. As more and more patients become responsible for managing their healthcare services, they will have more questions,” Armstrong says. “And, hospitals should have the answers.”
Access the Related Tool: Patient Business Services Organization Chart
Armstrong says some hospitals have begun to adapt their patient financial services to reflect a higher level of service. For example, in a few revenue cycle departments, the work is divided. An assigned PFS counselor addresses patient questions from registration to discharge and another PFS counselor is assigned to handle patient accounts after discharge.
Other revenue cycle departments are assigning patients to specific PFS counselors, who then “follow” the patient from the front end to the back end of the revenue cycle. Some hospitals have expanded their patient counselor roles to include the duties of a navigator to assist with state exchanges, and some have even outsourced these navigator PFS duties to an outside vendor.
For many revenue cycle departments, the fundamental problem with customer service is that staff, especially those on the front end, lack the clinical and business knowledge required to handle complex patient questions, says Armstrong. The result is that patients calling with an eligibility question, for example, are too often transferred from one staff member to another to get an answer.
“I think the frustrating point for patients today is that you’re always talking to somebody different,” he says.
Not getting patient questions answered correctly or in a timely manner can have serious business implications if consumers choose to seek care from other providers, Armstrong says.
For organizations to provide higher levels of customer service, the frontline role must be given more prominence in the revenue cycle department structure, says Armstrong “You don’t have to change your organization significantly, but you do have to create the position,” Armstrong says.
Although many organizations have implemented a navigator role, Armstrong says these positions mainly address helping patients find coverage through the state and federal health insurance marketplaces. The new patient business service executive role would extend beyond the role of a navigator and report to the director of customer service.
“A few hospitals are already drawing clear reporting lines from patient financial services to a customer service director, and I predict others will follow suit,” says Armstrong.
Staff in this role should have a wide range of knowledge in the following areas:
Revenue cycle operations. The patient business service executive should be familiar with processes at the front and back end of the revenue cycle. As a result, this staff member is equipped to address most patient questions in one phone call or during one in-person visit, Armstrong says.
Clinical terminology. The patient business service executive should be familiar with general clinical terms and care treatment.
External issues. The patient business service executive should be familiar with industry trends. For example, this staff member would have a general knowledge of health reform and its resulting impacts. Revenue cycle leaders would have to develop a comprehensive curriculum in clinical terminology and coding, customer service/public relations, and managed care/reimbursement.
To quickly address patient issues, the patient business service executive, whether internal or outsourced, would have the authority to obtain assistance from other areas of the revenue cycle (i.e., patient access, utilization review, health information management, and billing) and within the hospital or healthcare system (e.g., managed care, clinical operations, etc.).
Overall, the patient business service executive would have to be able to walk the patient through the revenue cycle process and foster a belief that “if you have to go in for a procedure or other healthcare service, this provider is the greatest place to go to,” Armstrong says.
For example, one hospital reinforces patient trust by assigning patients to specific PFS counselors, who then follow the patient from the front end to the back end of the revenue cycle. The advantage to this approach is that a counselor who is familiar to the patient can address thorny payment-related questions at any stage in the payment process, Armstrong says.
If instituting one comprehensive role that addresses patient questions from the front end to the back end of the revenue cycle is not feasible, Armstrong says organizations can consider the following options:
Assigning patients to specific PFS staff. One staff member may manage patients with last names beginning with A through L, while another would cover patients with names beginning with M through Z, etc.
Triaging patient questions. Less complex questions can be handled by frontline staff and more complicated questions can be sent directly to staff with specific expertise.
Training back-end staff. Provide more comprehensive training to staff on the back end of the revenue cycle so these staff members can fill in when front-end operations needs assistance.
A rise in the number of newly insured patients as a result of health insurance exchange plans and Medicaid expansion, greater out-of-pocket patient costs, and increasing calls for price transparency require a fundamental shift in how revenue cycle staff view their roles.
“It may be too early to tell, but as Medicare and other payers reimburse partially on patients satisfaction, customer service and handling the patient right the first time, will be critical. Also, I think more patients are willing to pay a bill if they’ve had a good experience and if they understand the bill,” Armstrong says.
Karen Wagner is a freelance healthcare writer and editor who contributes regularly to HFMA publications.
Interviewed for this article:
Terry Armstrong, president, State Collection Service, Inc., Madison, Wis., and a member of HFMA’s Tennessee Chapter.
Forum members: Please comment below (scroll down past the advertisements to the comment section.)
Publication Date: Thursday, April 17, 2014
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
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.
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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.
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Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
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.
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.
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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.
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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.
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Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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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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Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
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Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
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How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Copyright 2016, Healthcare Financial Management Association.
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