Part of the hospital’s strategy is to focus on small balances that make a big impact on the bottom line.


In early 2012, St. Francis Hospital, a 376-bed regional health system in Columbus, Ga., abandoned its manual price estimation workflows in favor of more automated processes designed to improve point-of-service (POS) collections.

“We needed to revamp what we were doing,” says Linda Glass, director, patient access services. “Our POS collections were not high enough and all of our front-end processes were manual.”

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When patients requested estimates, staff referred to large spreadsheets that listed allowable charges by payer for the most common procedures. Staff would group registrations by insurance company so they could confirm benefit amounts over the phone with each payer.

“After verifying benefits, staff would calculate estimates, and if patients came in and said they had met their deductible, staff would have to recalculate the estimate,” Glass says. “It was a very time-consuming process.”

Focusing on Automation

When Glass was hired to lead the patient access services team in 2011, she started investigating better ways to offer patient estimates and improve POS collections. “The year before I came in, we had only collected $500,000 on the front end,” she says.

In particular, Glass wanted to focus on bills less than $500 that were often not being collected and small balance write-offs of less than $15 that were never billed to patients. “We wanted to catch these balances at the time of service,” Glass says.

One of her department’s first steps was changing employee scripting to encourage more pre-service and POS collections. “Employees who had been in health care for 20 years did not understand this mind-set change at first,” she says. “But we needed staff to explain to patients what their benefits were so they would have a truer idea of their patient responsibility.”

Glass soon realized that her team needed to do more—and that automating the process would be highly beneficial to her hospital’s bottom line. Specifically, she was interested in a tool that would provide real-time statements of each patient’s financial responsibility based on benefits information listed on payers’ websites.

Gaining buy in from her CFO was not difficult. “Our CFO believed in automation,” Glass says. “He appreciated that we could do tasks in a few clicks that were taking 10 or 15 minutes.” It also helped that Glass got all of the right people involved at the beginning. Specifically, she convened a team that included representatives from patient financial services, case management, medical records, chargemaster, contracting, physician billing, and the business office. Together, they developed a “shopping list” of ideal features in an automated patient price estimation tool and narrowed the number of possible vendors to five.

Leaders invited each vendor to make a presentation to the team during the same week. The following week, the team discussed the solutions and made their selection. Because St. Francis was purchasing physician offices, it chose a technology that would also allow them to create estimates in these settings. Until then, many patients had been canceling hospital procedures they had scheduled through their physician office after receiving estimates during pre-registration. “We thought if we could provide estimates in the physician offices, then that would make a difference in reducing cancellations,” Glass says.

Rolling Out New Workflows

Staff had to adapt their workflows with the new system. “They were used to batching patients with the same payers together and completing those estimates all at once,” Glass says. “Getting them away from that took some fine-tuning. It was definitely a work in progress for a year.”

The hospital also invested in additional computer displays for registration staff. “Each staff member had been using just one screen, but we realized that was old school,” Glass says. Instead, it wanted staff to dedicate one screen to the registration system and one screen to the automated patient price estimation tool. “We want staff to call patients three to five days before their procedure, and as soon as patients provide their insurance information and it is entered into the registration system, staff can use the estimator tool while patients are still on the phone,” she says. After providing an estimate, staff can ask the patients if they would like to pay their portion immediately or when they come in for the procedure.

The price estimation tool also allows front-end staff to calculate discounts for self-pay patients. “Now, the whole process is streamlined for the registration staff,” she says.

Glass and her team also developed a workflow that allows physician offices to contact the hospital’s patient access services team to arrange financial counseling, if needed.

Within the first two years of adding the new processes and tools, St. Francis increased POS collections by 37 percent. The hospital also reduced surgery cancellations and improved its relations with physician offices, Glass says.

St. Francis Hospital Improves POS Collections by Providing Price Estimates
St. Francis Hospital Improves POS Collections by Providing Price Estimates

Today, staff can provide an estimate for any procedure in the chargemaster. For surgeries, pricing is developed using an average “common visits” estimate based on surgeries from the previous year.

Exploring Lessons Learned

Glass offers the following advice for organizations that want to leverage automation and new workflows to improve POS collections.

Gain buy in from the administration. “Without the administration’s total acceptance and support within the facility as well as throughout the community, we would not have been successful,” Glass says.

Prepare the workforce for the transition as early as possible. Glass and her supervisors stressed how the new technology and processes would make tasks much easier for staff. They also provided customer-service training to help staff communicate with patients about their financial responsibilities during pre-registration and registration.

To help ease the transition, the vendor provided several days of on-site training on the automation tool for patient financial services staff. The company also offered on-site support when the hospital took the tool live.

Allow plenty of time for IT. St. Francis’s implementation of the automation tool took 90 to 120 days. Some implementation delays were the result of additional time needed by the hospital IT staff to create interfaces with the automated technology.

Use collections reports to identify staff who need additional support. Low collections on scorecards may reveal when individuals are hesitant to ask patients for money up front and could benefit from additional coaching.

Embrace scripting and prescribed workflows. “If we ask for all of the patient responsibility and the patient cannot pay it, registration staff can ask for half and put the patient on a payment plan for the other half,” Glass says. In more complicated cases, staff members can involve their supervisors, or they can call physician offices to determine if delaying procedures is an option. When faced with potentially delayed procedures, many patients choose to pay their portion up front.

Keeping Staff Motivated

Glass says keeping staff updated on their performance has helped sustain St, Francis’ steady increase in collections.

Every January, she hosts an evening meeting with her staff to discuss the previous year’s performance. Then every July, she hosts a similar meeting to detail the team’s progress so far and what they can improve the second half of the year.

During these meetings, leaders recognize high collectors with awards such as gift cards. “It helps show staff that the hospital recognizes the hard work they are trying to do,” says Glass.


Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill., and a member of HFMA’s First Illinois Chapter.

Interviewed for this article: Linda Glass is director, patient access services, St. Francis Hospital, Columbus, Ga.

Publication Date: Saturday, October 01, 2016