At Duke University Health System, a three-hospital system in Durham, N.C., patient collections are handled by in-house staff and two collection agencies. The agencies and the staff members are subject to the same quality and productivity standards.

 An Agency Scorecard

The health system uses an agency scorecard to assess how well agencies resolve accounts. The scorecard measures:

  • Timeliness
  • Documentation
  • Appropriateness of patient interactions
  • Accuracy of how accounts are resolved

These measures are similar to the overall effectiveness ratings that are used to evaluate internal billing staff at Duke. This consistency in measures allows Duke to compare the performance of each agency and to benchmark agency performance against their staff collectors' performance.

"We hold them to the same measures as we hold ourselves, and we always compare how we are performing versus the vendor," says Scott Hawig, divisional CFO, Duke Patient Revenue Management Organization.

Quality Reviews

To monitor the tone of the collection efforts, agency and staff collectors are subject to quality reviews. "For our internal staff, we record patient collection phone calls, and we specifically selected vendors that offer the same recording capabilities," says Hawig. "For our staff, we audit a number of those phone calls every month, and we do the same for the collection agencies."

The approach, designed to ensure that bill collectors represent Duke in the proper manner, is costly. Hawig says both the recording software and the data storage requirements require significant investment, but are worthwhile. Even though collectors know they are being recorded, the quality reviews do reveal the need for continual training.

"We still occasionally have issues with how collectors answer a technical question, but there are very few relative to the softer skill attributes like their tone or how a patient was greeted," says Hawig. "If a particular patient is upset, we look to the collector to be able to calm the patient down and address the patient's concerns."

The quality reviews for bill collectors are part of Duke's quality assurance program for all revenue cycle functions.

"We believe that performing quality reviews throughout the entire revenue cycle-not just for customer service, preregistration, and admissions, but also for charge capture and coding, billing, collections, credit balance resolution, and payment posting-is the right way to go," says Hawig.

The ongoing reviews allow Duke managers to identify problems more quickly, provide more timely feedback and training when needed, and identify potential process improvement opportunities.

"There is ROI in terms of more stable cash flow and operating performance," says Hawig.

Publication Date: Friday, May 01, 2009