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Healthcare organizations are depending on the work of financial counselors to help patients understand their insurance coverage and financial obligations. These professionals help patients make the best choices by answering questions regarding the cost of healthcare services, setting up payment plans, or identifying other forms of financial assistance. They also help bridge the gap between successfully collecting patient-responsible balances and bad debt.
Today, these functions are becoming increasingly important as patients face new financial challenges due in part to growth of high deductible health plans (HDHPs). As more payment responsibility falls on the shoulders of patients, healthcare organizations should prioritize financial counseling to help them understand the billing process and meet their obligations—throughout the entire care episode.
Financial counselors have witnessed the evolution of these trends in recent years and are familiar with the dynamic nature of patient financial interactions. Let’s face it, conversations around finances can be complex and unpredictable, and the daily work of financial counselors is not always easy. They must empathetically develop relationships with patients while also protecting hospitals’ bottom lines—a delicate balance.
A typical day generally includes meeting with patients to provide cost estimates for scheduled procedures, reviewing the billing process, and answering any questions prior to admission. Increasingly, patients are seeking support on their own to obtain an estimation of costs as they shop around for the best procedure prices between healthcare providers. And, they expect a timely and accurate response to help them make their decisions. Consider the following patient scenarios.
Patient Scenario No. 1
Out-of-pocket healthcare expenses continue to rise at a steady rate, and patients are increasingly confronted with substantial out-of-pocket costs that are sometimes unexpected. In fact, a Kaiser Family Foundation
study found that 43 percent of insured patients said they delayed or skipped physician-recommended tests or treatments because of cost. Simply put, many patients present without the ability to meet their financial obligations up front.
In these cases, financial counselors meet with patients prior to admission to determine insurance eligibility—a strategy increasingly deployed by hospitals to improve their collections outlook as HDHPs and self-pay revenues increase. Once information is secured, counselors provide estimates of expected patient financial obligations based on the services to be rendered and ask for payments up front. If patients express financial hardship, counselors then determine if discounts can be applied.
If patients have HDHP insurance or are self-pay, financial counselors leverage tools to conduct screenings and identify other potential financial assistance options. Screenings may entail obtaining information regarding patients’ marital and dependent status, citizenship, income, investments, and personal assets. Determinations are also made as to whether procedures are related to crimes committed against the patient, possibly employing motor vehicle insurance or worker’s compensation injury insurance, or COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage if patients are unemployed.
Once the full financial picture has been explored and discounts applied, a final estimation is provided. From there, the financial counselor will work with the patient to set up a payment plan and collect a deposit up front if possible.
Patient Scenario No. 2
Financial counselors often engage with patients who are shopping around for services. Today’s consumers are savvy about their health care and want to take more ownership in the process of choosing a provider. Value is key as patients must balance increasing personal costs against the best care possible.
Financial counselors walk potential patients through expected charges—some of which can be easily estimated while others are more dynamic due to variables that occur in care processes. An infrastructure of eligibility resources and estimation tools is leveraged to conduct a thorough analysis of all factors influencing payments to provide timely estimates that reflect the best prices. As professionals often on the front line of health care hope, one of financial counselors’ main goals is to ensure patients make the most informed choices around their care.
Patient Scenario No. 3
Healthcare billing is complex, so financial counselors spend a lot of time helping patients understand their insurance coverage and medical bills. Patients who historically have relied on insurance to cover the majority of healthcare costs are now trying to decipher billing documents and navigate the challenges of increased financial responsibility.
In one example, a patient inquired about scheduling an MRI (magnetic resonance imaging) before leaving for an international trip. The patient’s insurance required authorization, but the timeframe for approval was five days—a wait that would not accommodate the pending travel schedule. The financial counselor had to explain to the patient in an empathetic manner that he would have to self-pay for the MRI or wait until he returned.
In another instance, a patient with two forms of insurance benefits wanted to access both for the same procedure. One insurer covered 80 percent of the care received, and it seemed logical to use the other to pay for the other 20 percent. Unfortunately, the system did not work that way, and the counselor had to walk the patient through various scenarios to determine the best path.
While these are common situations, there are a multitude of scenarios that create confusion for patients. Many patients have misconceptions about the bills they receive due to the disjointed nature of billing processes across health systems. Multiple invoices from both hospitals, physicians, and other ancillary health services convolute patients’ abilities to understand their obligations, and many end up believing they are being double-billed. To alleviate these confusing encounters, financial counselors walk patients through various charges they will receive up front. On the other end, after patients receive bills, they can also come to the hospital and have a financial counselor walk them through their bills to ensure charges are accurate.
Evolving Skillsets and Resource Needs
Today’s financial counselors must use a variety of resources on the front end of the payment cycle, including screening tools and processes, to secure needed data regarding eligibility and other pre-existing and potential funding sources—as a Kaiser Family Foundation
analysis reveals nearly half of uninsured patients are eligible for Medicaid or other subsidized coverage. When financial counselors are equipped with the right tools and information, they can identify these opportunities, improve patients’ financial outlooks, and ultimately collect more payments.
Forward-looking hospitals and health systems recognize the increasingly significant role financial counselors play in patient access. They leverage this service to strengthen their ability to help patients understand financial responsibilities and improve the outlook on collections and bad debt.
These professionals leverage healthcare organizations’ technological frameworks and unique knowledge and skillsets to address these common patient financial challenges and to improve patients’ financial experiences.
Having the right infrastructure in place sets up financial counselors for success, especially as patients increasingly shop for services and take ownership of the financial aspects of their care. For example, automation that provides eligibility information and cost estimating at the point-of-care can dramatically improve financial conversations and empower patients to make the best decisions in a timely manner.
Effective financial counselors possess a unique skillset of communication skills and knowledge, and patients’ reliance on financial counselors’ advisory roles differentiates them from many other administrative healthcare professionals they encounter.
Communication skills form the foundation of this profession, as does a solid understanding of insurance and claims processing. Financial counselors are not only knowledgeable about healthcare billing processes but also are inherently good listeners who can easily engage with patients. Many patients facing financial difficulties or who have billing questions simply want to be heard. In tandem with listening skills, patience, and a willingness to assess the fine details of a situation, financial counselors go the extra mile to problem solve and find the best options.
Of all the skills that financial counselors need to possess, empathy likely is the most important. When financial difficulties and health intersect, patients often find themselves in highly stressful situations. Counselors who can develop a rapport of understanding and trust with patients while also balancing personal and professional interaction are best positioned for success.
Prioritizing Financial Counseling
The vast majority of patients want to partner with healthcare organizations in their care. They want to receive the best care possible while also meeting their financial obligations. Hospitals and health systems need to empower them to achieve their goals. With the right staffing, communications approach, and resources in place, financial counselors can engage patients throughout their entire financial experience and help them better understand their bills. When it comes to improving patient satisfaction—it’s all in a day’s work.
Thank you to Janet Smelt and the financial counseling team at Change Healthcare for their contributions to this article.