PATIENT FRIENDLY BILLING® findings have been distilled into the following Standards of Excellence.
Introduction
For eight years, Patient Friendly Billing has studied ways to make the patient’s healthcare financial dealings more streamlined, understandable and friendly. Many reports, resources and tools have been created and disseminated throughout the healthcare industry. Now it is time to compile this body of knowledge into concise standards.
Hospitals that achieve these standards will have logical, patient-focused financial processes. They will be able to treat all patients with dignity and respect, using processes personalized for each patient’s specific financial situation. This includes prompt identification of financial assistance needs and automatic follow up on those needs.
As a result, hospitals should see tangible, measurable improvements in patient, employee and physician satisfaction with financial processes, improved cash flow and lower costs to collect. Ultimately this will build trust between the hospital and the community.
Standards
The following eleven standards were used as the basis for interview questions in the 2009 Patient Friendly Billing Standards of Excellence project. Many of these standards include more detailed explanations. Follow the links for more information.
1. Establish (and/or upgrade) customer service standards and skills throughout the organization. Apply a social work approach.
2. Clinical staff and staff with high patient contact support, buy into, and have an understanding of the financial processes.
3. Coordinate training, protocols, and data flow with physician offices.
4. Inform patients in advance about financial expectations (and as soon as possible for unscheduled or emergent services).
5. Provide on-line billing, payment, and financial communication accessibility.
6. Establish and implement policy to evaluate all financial assistance polices against Patient Friendly Billing checklist.
7. Use consumer tools for upfront, transparent, and effective financial communication.
8. Simplify and automate the financial assistance application process.
9. Implement Patient Friendly Billing guidelines and models of letters, bills, statements, and web site, etc. to improve communications with patients.
10. Scheduling and registration should be convenient for the consumer and cost-effective for providers.
11. Simplify contractual relationships with managed care and other health insurers.
Detailed Explanation of Standards
1. Establish (and/or upgrade) customer service standards and skills throughout the organization. Apply a social work approach.
a. A social work approach takes into account the following protocols:
i. Desire to help improve a situation
ii. Ability to solve problems
iii. Provide relevant and timely information
iv. Coordinate and monitor financial information and outcomes
b. Use comprehensive financial scripting to guide staff when communicating with patients
i. Define specific patient scenarios
ii. Develop scripts for each scenario with consistent language
iii. Train staff on use of scripts
c. Use training to enable staff to meet the skills needed for their position as identified in (1.e), below.
d. Use assessment tools to measure effectiveness of customer service skill sets
e. Define the level of authority for each position for final decision making
f. Within your staff each of the following skills should be present so that the patient experience is seamless. An individual employee’s skill set should be based on the level of interaction with the patient.
i. Ability to clearly communicate information—i.e. patient and provider are able to reach a mutual agreement on how the patient balance will be satisfied
ii. Must be an effective and compassionate listener
iii. Ability to understand and apply insurance benefit information and calculate patient obligations
iv. Full knowledge of all state and federal health services assistance programs
v. Understand and apply protocols of other supporting financial policies (i.e., charity care, discount, etc.)
vi. Must have critical thinking skills (ability to think independently and make sound business decisions)
vii. Working knowledge of the complexity of the revenue cycle and the interactions of the key departments through the various phases and processes
2. Clinical staff and staff with high patient contact support, buy into, and have an understanding of the financial processes.
3. Coordinate training, protocols, and data flow with physician offices.
4. Inform patients in advance about financial expectations (and as soon as possible for unscheduled or emergent services).
a. All scheduled patients are contacted regarding their financial liabilities prior to services being rendered
b. All non-scheduled patients are contacted at time of service and/or no later than discharge from facility regarding their financial liabilities
5. Provide on-line billing, payment, and financial communication accessibility.
6. Establish and implement policy to evaluate all financial assistance polices against Patient Friendly Billing checklist and ensure each of the following questions are established and documented.
a. What services are discounted?
b. Who qualifies for discounted or free care?
c. What discount levels are offered?
d. How are policies communicated?
e. How are unpaid patient accounts resolved?
f. What structures and systems are in place to implement and administer policies effectively?
g. What is the relevant legal and regulatory context?
7. Use consumer tools for upfront, transparent, and effective financial communication.
a. Implement electronic insurance verification and eligibility tools
b. Implement electronic contract management tools
c. Implement electronic predictive payment tools
d. Implement a phone reminder system (i.e., pre-service communication compliance) for:
i. Appointments
ii. Automated communication to patients on financial outcomes
iii. Charity care status
iv. Automated notices of reapplication procedures
v. Prompt pay discount reminders (i.e. payment within certain time frames qualifies and allows the patient to receive a discount—payments can be made by phone)
8. Simplify and automate the financial assistance application process.
a. Identify legal requirements
b. Eliminate non-essential information
c. Build the process on the information already available from tools used to determine the patient’s ability to pay
d. Make application available on line
e. Offer application in various languages based on community needs
f. Define and implement reasonable documentation requirements considering legal requirements. Use tools and other databases to gather information not available from the patient.
9. Implement Patient Friendly Billing guidelines and models of letters, bills, statements, and web site, etc. to improve communications with patients. All financial communication should include the following:
a. Should be written at a junior high reading level or lower
b. Should contain no abbreviations, codes, or healthcare jargon
c. Large font size (12 or larger)
d. All text in dark colors
e. Minimize backgrounds, logos, and distracting pictures or colors
f. Clearly identify amount due from patient
g. Patient data elements should not include protected identifiable information. Patient data elements should typically include the following:
i. Patient name
ii. Patient address
iii. Patient account number
iv. Responsible party
v. Insurance company
vi. Date of service
vii. Payable information
h. Charges should be presented at the same level as it is on most insurers’ explanation of benefits for the type of services provided
i. Payment due date
j. Method(s) of payment information
k. Provider contact information
l. Should be consistent and uniform in look and “feel”
10. Scheduling and registration should be convenient for the consumer and cost-effective for providers.
Seamless
a. Obtain all financial and demographic information prior to the visit.
b. Coordinate this information among physicians, hospitals, and other providers throughout the system.
c. Implement data retrieval capabilities both internally and with other providers and health insurers to help ensure data accuracy and consistency. Use technology with the ability to link to insurer online tools, store patient demographic and insurance information, generate patient estimate letters, automatically send patient information throughout the system, and interface information into the hospital financial system.
d. Update patient demographic and insurance information using databases or clearing houses.
e. Adopt CORE standards; use only vendors that are CORE certified (encourage current vendors to become certified).
f. Use technology to remind patients of appointments and financial obligations.
Convenient
g. Provide services in the evening and weekends where cost-justified so that it is more likely that patients can receive services at convenient times.
h. Offer 24/7 patient access for self-scheduling through multiple venues (e.g., self-service Internet portals, integrated voice response systems, check-in kiosks).
Organizational
i. Use central scheduling so that patients can easily coordinate multiple appointments.
j. Schedule by CPT code, procedure, DRGs, etc., instead of simply filling time slots.
k. Have the scheduling function report through the revenue cycle organization or otherwise ensure that they are closely linked.
l. Dedicate a trainer/coach to build integrated scheduling processes and education programs.
m. Gain clinical staff support for a patient-centric, streamlined scheduling and registration function. Clinical staff should understand scheduling protocols, benefits, internal resources, and expectations.
11. Simplify contractual relationships with managed care and other health insurers.