Improving point-of-service (POS) collection has long been a topic of discussions across healthcare organizations struggling to meet collection goals. But the global pandemic and its aftermath have intensified the need for more effective strategies to meet this challenge while keeping a patient-centered focus. Health systems need to adopt new strategies that will support a positive patient experience and improve collection efforts, all while minimizing the negative impact to patients.
Perhaps the simplest strategy to implement is to ensure patient access professionals are well prepared with the right amount of empathy, compassion and connection to have difficult financial discussions with patients. This strategy requires helping these professionals to overcome their hesitancy so they are better equipped and ready to have a successful financial conversation, called here The Ask.
The Ask process can be broken down into three stages: confidence building, preparation and implementation, and each of those stages can be supported by helping team members understand the importance of goal setting.
Underlying all three stages is a goal-setting process. Having a clearer understanding of the collection goals can help to ease uncertainty. See the sidebar below for more on that.
Confidence building, or overcoming the fear of the ask
Awkwardness, anxiety and apprehensiveness can hinder many collection agents from successfully being able to collect at the POS. To help these collectors overcome their dread of the financial conversation, which can be hard on the two parties, leaders should actively engage with them to equip them with the tools and understanding to have informative and productive discussions that result in a win for both.
Collectors gain confidence when they have the tools and empathy necessary to successfully navigate patient financial conversations. But starting with a patient-centered mindset also is imperative for ensuring patients have a positive experience.
Asking patients for a copay of $50 or more may not seem like a lot of money, but for some it could mean the difference in putting gas in their car or food on their table.
Given that patients present with varied levels of financial need and hardship, it is imperative that collectors develop skills in the areas of active listening and empathy to guide successful patient interaction. Increasing these skills will help collectors determine if the financial discussion should be guided toward payment, financial assistance or other payment options — including, potentially, charity care. It is important for leaders to foster an environment that encourages collectors to show compassion as they grow in confidence to ensure a well-rounded patient experience. Characteristics of such an environment include:
- Allowing employees to tailor the financial discussion based on each patient’s circumstance
- Encouraging employees to ask questions to gain clarity and understanding of the patient’s financial situation
- Ensuring employees are knowledgeable about all the financial assistance options that are available to patients and are considerate when discussing this sensitive topic
Preparing staff to perform the ask
Once employees understand the importance of setting and meeting goals, they should be armed with the tools, tips and techniques to prepare them for performing The Ask.
That involves — in addition to the previously mentioned building of confidence — preparing them to be competent representatives who use consistent practices.
Ensuring competency. Employees can gain competency by continually working to become more proficient in their job and to demonstrate a consistent and high-level of performance.
To prepare for The Ask, collectors need to know how to successfully use the tools, processes and procedures required to determine what to collect at the time of service. Providing educational opportunities is essential and includes:
- Classroom or virtual in-person training
- Enhanced health information systems training, e-learning and job aids
- On-the-job training that utilizes high performers, super-users, etc., in these roles
- Continuing education consisting of 30-60-90-day check-in for new hires, and semi and annual training for existing employees
- Hands-on learning labs and workshops designed to help employees with difficult or common collecting scenarios
Leadership also should adopt systematic strategies for boosting competency, including:
- Ensure collectors have thoroughly reviewed and understand policies and procedures for specific financial conversations. For example, if collectors are unable to verify coverage at the time of service — i.e., the system is down or the patient’s insurance card is not present — having a standard ask policy in place allows collectors to identify what to collect.
- Confirm employees have proper access to insurance verification tools and are able to interpret the information.
- Develop scripting for common financial situations that guides collectors toward a compassionate and productive interaction with patients. Scripting should be used as a guideline and collectors should always personalize it and make it their own.
- Use role playing to create a safe space to practice what to say and how to say it.
Ensuring consistency. Consistency becomes possible once competence and confidence are achieved. Consistency builds trust and is key to repeatable outcomes. It ensures all parties understand that whenever event A occurs, event B will follow. For example:
Event A: Patient Jones is seen in the emergency department and has insurance that has a verified copay due at the time of service of $150.
Event B: The collector communicates and collects Patient Jones’s copay during the visit.
The confusion for patients can occur when Event B does not always follow Event A, because collectors are not consistently asking for the patient’s payment. If there is a valid reason Event B cannot happen, such as the verification system is down during the financial conversation, the reason should be clearly and concisely explained to the patient. This important step helps eliminate patient confusion about why Event B does not always happen.
Implementing the ask
Implementing The Ask entails shaping excellence, generating experience and establishing expectations. The hallmark of The Ask, when it is effectively implemented, is excellent customer service, which is the foundation of many successful organizations and the primary reason for customer loyalty.
By providing excellent customer service throughout the entire visit, collectors will enhance the patient’s overall experience, thereby increasing the likelihood that the financial conversation will be successful and the patient will make a complete or partial payment during the time of service. There are a few ways to quickly improve customer service.
One way is to use what was dubbed the “Take Two” technique as a reminder to take both time and action to build a connection and establish a rapport with patients before completing the registration or having the financial conversation. For example, the collector could chat with the patient briefly about the weather, pets, sports or some topic that is relatable to the patient.
Another approach that can help in engaging the patient is to use the Studer Group’s AIDET Patient Communication tool (i.e., Acknowledge, Introduce, Duration, Explanation and Thank You) to help drive the patient conversation.
The sharing of experience among collectors is important. As collectors consistently engage in the POS collection process with patients, their increased exposure to various patient financial situations will build their experience, giving them the opportunity to share lessons learned.
Having collectors share their collection wins and challenges in a group setting and one-on-one can promote team building by encouraging peer-to-peer support.
This article was adapted from “Wheels Up! A Journey through POS Collections,” which the authors presented at the HFMA Revenue Cycle Conference in New Orleans in 2022.
How to navigate challenging patient financial conversations
Navigating challenging conversations is about changing mindsets, and how collectors handle them will increase their chances for a favorable outcome. The following steps when paired with excellent customer service can help with that.
1. PERFORM THE ASK CONSISTENTLY
Surprisingly, successful collectors hear a lot of “No’s.” Being successful means collectors will consistently attempt to collect, when appropriate, every time. They will be prepared for The Ask, and they should know the following:
- Does the patient have insurance?
- What type of insurance do they have?
- Is the insurance active?
- Do they owe something at the time of service?
- How was the patient’s amount owed determined?
2. SET AN EXPECTATION
Successful collectors will approach the conversation with confidence and set an expectation that both the financial discussion will occur and that the patient will pay their portion due at the time of service. Educating patients when applicable on their insurance and the collection process ensures they know what to expect during the financial discussion.
3. FRAME THE ASK
When it’s time for The Ask, it matters how its framed. Not framing The Ask appropriately can greatly reduce the chances of collecting the patient’s portion due at the time of the service. When asking the patient for their portion due, collectors want to stay away from closed-ended questions such as:
- Can you?
- Will you?
- Do you want to?
It also is important that collectors not immediately take “no” as the final answer. Instead, when asking the patient for their portion due at the time of service, collectors should use open-ended questions and statements such as:
- How would you like to pay?
- I’ll be collecting your $ _ (insert amount) ___ copay/deductible/coinsurance today
- Our payment options are …
Successful collectors set the expectation that payment is expected at the time of service and by framing The Ask with open-ended questions or statements, allowing for follow-up.
4. MASTER THE UNCOMFORTABLE SILENCE
Collectors must learn to stop talking! Learning to master the uncomfortable silence is challenging. Collectors need to give their patients time to think through their options and figure out what, if anything, they will be able pay.
Here is a script that helps level up The Ask and increases the chances for collection.
- Hello. Patient name, based on your insurance, your portion due today is $______.
- You can use debit, credit, check, cash or your flexible spending account.
The collector then should stop talking.
An uncomfortable silence is likely to ensue, but it should only be interrupted by the patient. In these instances, silence really is golden. And how the patient responds will help determine what accommodations should be made, if any, for an inability to pay.
How to set goals for collections staff
To communicate overall goals and work with employees on how best to meet them, leaders should adopt a four-step goal-setting approach:
1. Determine the starting point. Review where the collectors are today in relation to department collection goals and where they should ideally be.
2. Map the goals with employees. Share with the team the organizational financial goals versus the department financial goals; determine the resources needed to reach the department goals; and identify potential barriers in meeting those goals (i.e., staff shortages, collections challenges and availability of tools needed to perform the job).
3. Make goals manageable. Break down bigger picture goals into amounts that employees can easily comprehend, and share the impact of each employee’s goals on the department and organization. For example, seeing how a yearly goal per department employee of $100,000 fits into a total department goal of $1,050,000 can be helpful to the employee.
4. Track and measure the goals. Communicate to the team their progress in achieving the goals. Communication steps should include evaluating in real-time each individual’s progress and accomplishments, as well as those of the team overall, offering regular status updates, rewarding high performers and assisting those who are underperforming.