Most patients don’t differentiate between the front end and the back end of the revenue cycle. One solution might be to train staff to handle both responsibilities.


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.

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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 

Early Adopters

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.

Addressing Patient Frustrations

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.

Acquiring Expertise

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.

Exploring Options

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.

Assessing Cost to Value

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.

Discussion Starters

Forum members: Please comment below (scroll down past the advertisements to the comment section.)

  • What are the challenges to providing better customer service in your revenue cycle department?
  • Do you think an upgrade patient financial services role would help your revenue cycle department deliver better customer service and improve performance?

Publication Date: Thursday, April 17, 2014