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Following is Section 3 of the Patient Financial Communications Best Practices. This section addresses communication in advance of service. See the complete Patient Financial Communications Best Practices.
3.1. Discussion participants: Appropriately trained provider representatives will have these discussions with the patient or guarantor. Patient should be given the opportunity to request a patient advocate, designee or family member to assist them in these discussions.3.2. Setting for discussion: Discussions will occur using the most appropriate means of communication for the patient. These discussions may take place via:
3.3. Timing of discussion: A reasonable attempt will be made for discussions with patients to occur as early as possible, taking place before a financial obligation is incurred up to the point at which care is provided. Timely discussions will ensure patients understand their financial obligation and providers are aware of the patient’s ability to pay and/or source of payment.3.4. Registration, insurance verification, and financial counseling discussions: Provider organizations will maintain a thread of pre-registration discussions that occurred with the patient. If pre-registration discussions took place, these discussions will not occur again.3.4.1. Registration: The provider organization will first gather basic registration information including demographics, insurance coverage, as well as determining the potential need for financial assistance.3.4.2. Insurance verification: The provider organization will review insurance eligibility with the patient to ensure information accuracy. Uninsured patients will be informed the goal of collecting information is to identify paying solutions or financial assistance options that may assist them with their obligations for this visit.3.4.3. Financial counseling: If appropriate, patient is referred to a financial counselor and /or offered information regarding the provider’s financial counseling services and assistance policies.3.5. Provision of care: Provider organizations will have clear policies on how to interact with patients with prior balances choosing to have elective or non-elective procedures. They will also have clear definitions for elective and non-elective procedures. These policies will be made available to the public.3.5.1. Elective services (As defined by the provider):18.104.22.168. Patient share discussions: Patients have the obligation to make satisfactory payment arrangements before receiving care.22.214.171.124. Prior balance discussions: Patients with prior balances will be informed by the provider organization if the provider’s policies regarding prior balances mean the service will be deferred.3.5.2. Non-elective services (As defined by the provider):126.96.36.199. Patients will be informed that ability to resolve patient share or any prior balances will not affect provision of care.3.6. Patient share and prior balance discussions: Interactions will not interfere with patient care, and will focus on patient education. During patient share and prior balance discussions, the provider representative will:3.6.1. Patient share discussions:188.8.131.52. Provide a list of the types of service providers that typically participate in the service both verbally and if the patient requests, in writing.184.108.40.206. Inform patient that actual costs may vary from estimates depending on actual services performed or timing issues with other payments affecting the patient’s deductible.220.127.116.11. If appropriate, ask the patient if they are interested in receiving information regarding payment options. 18.104.22.168. If appropriate, ask the patient if they are interested in receiving information regarding the provider’s financial assistance programs. 3.6.2. Prior balance interactions discussions: NOTE: Balance resolution discussion occurs on prior balances that are being pursued for collection by provider, collection agency or other organization. There will be many scenarios where patients will not have prior balances.22.214.171.124. Discuss with patient the services that led to the prior balance, including the dates of service and the resulting prior balance. Upon the patient’s request, provide the patient a written list of the services provided, dates of service and the resulting prior balance. 126.96.36.199. If appropriate, ask the patient if they are interested in receiving information regarding payment options. 188.8.131.52. If appropriate, ask the patient if they are interested in receiving information regarding the provider’s supportive financial assistance programs.184.108.40.206. Proactively attempt to resolve prior balances through insurance and financial assistance programs.3.7. Balance resolution: Once the provider organization has fulfilled the best practice steps as outlined above, it is appropriate to inquire about how the patient would like to resolve the balance for the current service and any prior balance the patient may have, as well as informing the patient of the timing of collection activity.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Dale Hockel, senior vice president of operations, and Jim Fanelli, CFO, TriMedx, share strategies for elevating clinical engineering through innovative management programs.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
Scott Schmidt, vice president, Cerner RevWorks, LLC, shares insights on best practices for maximizing a revenue cycle management partnership.
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