Don’t skip the patient conversation when payer coverage for coronavirus is unclear

April 28, 2020 6:49 pm

In a time when more than 17 million Americans are newly unemployed because of a deadly virus infecting hundreds of thousands across the country, it seems as if the clinical and financial stakes in healthcare have never been higher. And according to the experts, the way healthcare organizations talk, or don’t talk to patients about the bills has never been as important.

Conducting conversations with kindness

Luminis Health in Maryland chose to hold certain charges related to coronavirus care, but for previous charges or charges for other care, staff have been instructed to be proactive but gentle when discussing patient responsibility, according to Zubair Ansari, executive director of physician reimbursement.

“We understand that families are going through a lot right now,” Ansari said. [We want to] give the consumer as many options as possible to obtain care and to figure out the financial component post-care.” 

Where previously bills from the organization would arrive with a prompt to pay immediately, they now contain language around payment options and guidance about how to apply for assistance. In general, the health system has relaxed conditions around who is eligible for payment plans and how long they can take to pay it off.

“We have some folks who are on payment plans for more than a year,” Ansari said. “It’s the right thing to do to send a bill to a patient [and provide] options. I’ve instructed my staff to be flexible in general.” 

Keith Gruebele, president of BHG Patient Lending, said organizations must figure out how to continue billing in a humane way.

“We have to make a pronounced effort to overcommunicate,” he said. “We can do that sympathetically, humanely and without being demanding.” 

Organizations that choose to hold charges until payer portions are determined should make sure the patient knows so they’re not caught off guard by a bill that arrives months down the road, Gruebele said. Letting a patient know they will hear from the organization once their share is determined — and that financing options are available when that time comes — will help set the expectation of payment without further immediate stress on a patient who might be facing difficult economic circumstances as well as enduring a deadly illness.

Ignoring the issue completely can be disastrous, Gruebele warned. 

“If we don’t talk about the financial issues and have these difficult conversations as respectfully and humanely as we can, we’re setting ourselves [up] to be in a position where we might not be here tomorrow to have those conversations,”  he said.

Flexibility and kindness will only help the organization in the future, Ansari said. “At the end of the day, do what’s right for the patient,” he said. “That experience that you give now and [the assurance] that things will be fine, they’re the return on investment.” 

Staff education and support

Another crucial piece of clear financial communication is staff direction. Luminis Health sends a daily email to staff with frequently asked questions around coding or issues that might come up with patients. Prior to the onset of the coronavirus crisis, the health system (the product of a 2019 merger between two hospitals) had begun to move toward having one uniform process for billing, so the organization already had been building a culture of communication and collaboration. 

The transition to remote work was fairly seamless for Luminis Health because many employees were used to working from home already, Ansari said.

“We’ve had a generous telecommute policy for years, and we were ready to adapt,” he said. The one task staff can’t do from home is take credit card payments, so people rotate coming into the office to handle that responsibility. 

Because of the dip in elective surgeries (50% to 70% by Ansari’s estimation), the scope of work has changed somewhat as well, he said. Staff members in practices and clinics that are not busy are being sent to those that need extra help so everyone can keep their jobs. This time of relative stillness also presents an opportunity for organizations to catch up on work they can’t always get to.

Gruebele said now is a good time for organizations to reconsider their revenue cycle practices and processes in order to improve in the future. Identifying gaps and considering innovative or disruptive ways to fill those gaps can only help an organization’s performance improve, he said. 

“I know there is a lot of challenge. I know there is a lot more work than ever on our plates. I know there is a huge emotional burden that comes with this,” Gruebele said. “But in every challenge, there’s an opportunity for change and growth.” 

3 steps to review your charity care plan

In a time when it’s harder than ever for patients to pay their medical bills, it’s important for healthcare organizations to revisit their charity care policies to ensure they’re offering the right assistance to the right people. Keith Gruebele, president of BHG Patient Lending, recommended three basic steps. 

  1. Take a patient-centric approach. Offering charity care to the people who need it most is important. 
  2. Review payer contracts. It’s important to understand what negotiated contracts allow the organization to do for patients. 
  3. Screen patients carefully. Giving the patient a questionnaire is quick and inexpensive, but it’s important to verify the information patients are providing. 


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