Catholic Health Partners is making it easier for patients to make pre-service and point-of-service collections, while ensuring staff have the training and tools they need to improve performance.


Overhauling its pre-service and point-of-service (POS) collection procedures produced immediate results for the Cincinnati/Springfield, Ohio, region of Catholic Health Partners (CHP). Pre-service collections grew from $540,000 in 2010 to $3 million in 2012, while POS collections increased from $5.4 million to $5.8 million during that time.

Like all health systems, CHP sought to improve its self-pay collection approach because patient payments are increasingly important to the system. "A solid pre-service and point-of-service collection process has initial and lasting financial implications and effects on our organization," says Denise Gibson, divisional manager, revenue cycle, patient financial services, for CHP's Cincinnati region.

CHP uses five patient-friendly strategies to boost self-pay collections, including staff training and the adoption of new technologies. One key improvement, according to Gibson: the ability to generate real-time reports that track the collection success of each staff member and the department as a whole. These reports support CHP’s efforts to coach staff members on how to use patient-friendly techniques to increase collections. "One of the biggest benefits was leveraging the power of reporting," she says.

Pre-Service Contacts

CHP seeks to help patients understand their financial responsibilities by making pre-service telephone calls to discuss estimated out-of-pocket responsibilities, payment options, and the availability of financial assistance. "Customer pre-service contacts create the first impression for the patient. We must provide first-class service to set the tone for the patient’s journey of care as well as educate and manage the financial expectations for the patient prior to care," Gibson says.

"All efforts are made to avoid upsetting patients by showing compassion and assuring them that no aspect of care will be jeopardized if payment arrangements have to be made," Gibson says. "In the global realm of things, what other industry in the country offers thousands of dollars in services without requesting some form of deposit or payment—or at least a discussion about future payment terms?"

Patient-Friendly Scripts and Staff Training

The initiative began in 2011, when collection goals were established for patient access agents and registrars. Developmental coaching, patient-friendly scripts, frequent feedback to staff members, and celebration of accomplishments also were introduced with successful outcomes. Pre-service collections increased by 163 percent from $540,000 in 2010 to $1.4 million in 2011. POS collections increased by 7 percent from $5.4 million to $6.1 million during that same time.

"Proper scripting is essential to building trust with the patient and creating a compassionate experience centered around the patient’s health and financial information," says Jody Patton, regional manager for customer pre-service at CHP. "Agents are mentored to exude confidence, which acts to motivate patients to manage their financial liabilities during the pre-registration and registration process."

Agents and registrars are also coached to avoid "demotivating" phrases and instead engage the patient in conversation. "Directive phrases can be interpreted as being aggressive, forceful, or high-pressure," Patton says. Agents replace the following demotivating phrases with positive language.

  • Instead of "You need to," they use "As a service to you."
  • Instead of "We require," they use "For your convenience."
  • Instead of "You have to," they use "To manage this account now."
  • Instead of "Our policy states," they use "I will be happy to take your payment today."

Staff are also trained to avoid closed-ended questions that prompt the patient to say "no," thereby ending the conversation. Examples include:

  • Would you like to pay…?
  • Is there a problem with…?
  • Is there a reason you haven't…?

CHP staff instead use language that prompts patients to offer payment. Here are two examples: 

  • "Your (insurance) company/card indicates that $__ is due today." 
  • "For your convenience, we accept check or credit card. Which will you be using today?" 

"Scripting is continually evaluated to ensure a soft, professional, and confident approach," Patton says. "Staff are encouraged to ask questions that promote conversation and to create additional chances for discussion, clarification, and possible negotiation regarding patient amounts, as well as to arrange payments according to the individual patient’s needs."

Self-Pay Technology

To build on its first year of success, CHP acquired new technology in 2012 to support pre-service and POS collections. It chose a system that captures and processes patient payments made online as well as at the point of service in real time, eliminating the need to manually post payments, which can introduce errors.

Onsite, the system is integrated with an electronic credit card reader so registration staff do not have to enter credit card numbers, verification numbers, and expiration dates. "Any reduction in manual entry will result in increased speed of registration," Gibson says.

After implementation, the CHP region experienced a 25 percent increase in the average number of credit card and eChecks (payments made directly from a bank account) taken each month.

Moreover, pre-service collections grew from a monthly average of $118,227 in 2011 to $253,975 after patients could choose online payment. That translated into a 115 percent increase for the year, from $1.4 million to $3 million in 2012. Reports generated by the new system confirmed that many CHP patients preferred to pay their healthcare bills online without interacting with a member of the collection staff.

CHP’s next step is to add interactive voice response (IVR) capability so patients can use a telephone keypad to pay their CHP bills. "This will give our patients another way to access our payment system without customer service intervention, thus freeing up time for our staff to handle other calls," Gibson says. "Easy patient access for Internet and IVR payments are examples of having a solution that is user-friendly for the patient as well as the staff."

Performance Reports

As a divisional leader, Gibson needs reports that allow her to analyze the effectiveness of the collections program. She generates monthly reports of the payments collected by the pre-service and the access team. The reports allow her to analyze trends at the facility level, including: 

  • Payments by type (eCheck, cash, or credit card) and type of credit card
  • Whether the payment was approved, denied, adjusted, voided, or credited 
  • Where payments were taken (e.g., main registration, discharge office, physical therapy)
  • The time that each payment was taken
  • The average payment dollar amount taken by staff member, by location and by day of the week
  • Whether payments were made via the patient portal on the Internet

Meanwhile, Patton reviews several departmental statistics every day, including pre-service collections, accounts completed, and in-bound versus out-bound calls. This allows her to track the department's productivity. Daily results are displayed on a bulletin board and emailed to each staff member for review.

Patton can also create reports about each staff member's collection performance on a real-time basis. These data can be used to identify problems that require additional coaching or to highlight staff members who are showing stellar performance. Scorecards, such as the one below, are an important part of the employee performance tracking process.

Exhibit - Scorecard

Average collections are calculated on a daily, weekly, and monthly basis to determine benchmarks for the pre-service collection team. Annual goals for the department are adjusted each year at the time of annual performance reviews. 

"It’s important to us that the team understands that their performance drives the internal goals, so they strive for personal bests and are engaged in customer pre-service performance as a team," Patton says. "The ability to provide feedback driven by factual information supports the credibility of the process, personal accountability, and team successes."

Individual staff members can also use the reports to track their own performance. "Reporting of the individual results is key to employee engagement," Patton says. "By having access to real-time, to-the-minute reports, agents can guide their own results."

Staff Recognition

Collection performance is tied to individual and group incentives available to members of the collection teams. "Recognition is essential to personal growth and confidence, so periodic team-building challenges come in the form of contests," Patton says.

One recent contest gave staff members the opportunity to earn hospital logo wear, coupons for a "jeans week," free coffee for a year, and gift cards. "Out of all of our team members, 50 percent received the top-tier prize pack and rewards were given to 100 percent of the team," she says. "These exercises assist in team building and incentivize the team and individual efforts as well."

Lola Butcher is a freelance writer and editor based in Missouri. 

Interviewed for this article: 

  Denise Gibson is divisional manager-revenue cycle, patient financial services, Mercy Health, a part of Catholic Health Partners, Cincinnati, and a member of HFMA’s Southwestern Ohio Chapter. 

  Jody A. Patton is regional manager for customer pre-services, Mercy Health, a part of Catholic Health Partners, Cincinnati, and a member of HFMA’s Southwestern Ohio Chapter.

This article is based on content shared during HFMA’s webinar, " Take Your Point-of-Service Collections from Good to Great: A Catholic Health Partners Study."

Publication Date: Wednesday, July 24, 2013