How To | Financial Counseling

Address Patient Financial Risk in Pre-Service to Boost Revenue and Earn Loyalty

How To | Financial Counseling

Address Patient Financial Risk in Pre-Service to Boost Revenue and Earn Loyalty

To improve patient satisfaction and decrease uncompensated care, educate patients on their healthcare expenses, benefit coverage, and payment options.

One way to increase satisfaction is to improve patients’ financial journeys. The first step is focusing on patients’ first encounters with your organization via pre-service and point-of-service initiatives, such as eligibility and enrollment.

As the industry transitions to value-based payment, patients are increasingly financially responsible for their healthcare. Today’s consumers want providers to deliver more retail-like experiences—and they are willing to shop around for the best value. To take charge of patient retention, providers must focus on improving patient satisfaction. 

One way to increase satisfaction is to improve patients’ financial journeys. The first step is focusing on patients’ first encounters with your organization via pre-service and point-of-service initiatives, such as eligibility and enrollment.

Risk of Bad Debt Increases with Shifting Financial Responsibilities 

As high-deductible health plan (HDHP) adoption rises, patients who were accustomed to nominal copayments at the time of service must adjust to hefty up-front costs. The average deductible for consumers with employer coverage rose from $303 to $1,505 between 2006 and 2017, according to the Kaiser Foundation’s 2017 Employer Health Benefits Survey . In addition, a national research study The Engagement Gap: Healthcare Consumer Engagement in 2017, conducted by ORC International and Change Healthcare, found that some patients are saddled with annual deductibles ranging from $2,000 to $10,000.

This increase in financial responsibility arrives at a time when the average American’s finances are already stretched and most are deprioritizing medical expenses. In fact, research indicates consumers at all levels are more likely to pay their mortgage, insurance, loans, utilities, cable TV, internet, lawn care, and newspaper bills than their healthcare invoices, according to Improving Self-Pay at All Points of Service , a white paper by RelayHealth. Providers that fail to address the consumerism trend are likely to experience a rise in bad debt, putting their bottom lines at risk.

Proactive Patient Education, Eligibility, and Enrollment Improves Collections

To offset these risks, hospitals and health systems should implement new strategies to collect from patients prior to care delivery. The Academy of Healthcare Revenue estimates providers have a 70 percent chance of collecting patient responsibility either prior to or at the point of service, compared to a 30 percent chance after discharge.

These three strategic priorities can help your hospital or health system decrease uncompensated care, limit the risk of bad debt, and increase collections—while improving both patient and staff satisfaction.

Uncover funding sources for self-pay patients. If your hospital or health system has a large patient population eligible for government-funded programs, identifying coverage options for your self-pay patients should be a primary focus. Supporting patient enrollment in the right program helps reduce uncompensated care, while preserving your commitment to serve the community.

Facilities can improve eligibility and enrollment services by leveraging a combination of state-of-the-art technology and onsite professionals. By assisting patients with applications and enrollment for Medicaid, Supplemental Security Income (SSI), and Social Security Disability Insurance (SSDI), your organization may reduce patients’ out-of-pocket expenses—and possibly increase patient satisfaction.

Optimize payment for accident-related claims. For many hospitals, a considerable number of ED visits are patients who have sustained work-related injuries or who were involved in automobile accidents. Patients are often responsible for a large percentage of the bill due to deductibles, copayments, and co-insurance requirements. Many don’t know if their automobile insurance or workers’ compensation carrier will cover any portion of their expenses.

Hospitals that employ patient liaisons to gather complete third-party insurance information at the point of service may decrease accounts receivable aging and optimize payment. Proactive education on applicable benefits helps reduce your patients’ out-of-pocket expenses, thereby improving patient satisfaction.

In addition, workers’ compensation claims have a higher payment rate than even commercial health plans. A recent study found two-thirds of workers’ compensation hospital outpatient payments related to common surgeries were higher than those paid by group health. The workers’ compensation and group health difference for a common shoulder surgery exceeded $2,000, according to a report, Comparing Workers’ Compensation and General Healthcare Costs: Compensable Care Incurs Higher Fees .

Educate patients on financial options. As HDHP adoption increases, more hospitals and health systems are prioritizing the need to educate their commercial health plan patients about their benefits, the billing process, and how to best meet their financial obligations.  

Instead of relying on already strained internal resources, many organizations are utilizing highly trained professionals to provide financial counseling both pre-service and at the point of service. These individuals focus exclusively on patient screenings, benefits education, and up-front collections. Performing these functions in a caring, professional way helps patients understand and appreciate all coverage options that can reduce their out-of-pocket expenses.

Although any one of these tactics can improve patient satisfaction and increase revenue, providers reap the most benefits by incorporating them in unison. When performed together, these strategies help providers reduce balance after insurance (BAI) volumes and limit the back-end efforts needed to collect patient responsibilities after discharge. Research shows providers recover only $15.77 of every $100 owed once an account is turned over to collections, according to Study: 31 percent of patient bad debt misclassified, should be charity,” by Healthcare Finance News.

Outsource for Optimization

Addressing patients’ financial needs prior to or at the point-of-service demands significant effort—and requires specific skills. Instead of struggling to perform these services in-house, many facilities are outsourcing eligibility and enrollment services to professionals trained in healthcare compliance, governmental program regulations, and superior customer service.

Healthcare organizations that deliver an exceptional experience at the beginning of patients’ journeys are more likely to decrease their risk of bad debt. By utilizing the right people and technology solutions in the pre-service and point-of-service stages, a facility can maximize its chances of both improving the patient experience and collecting patient payments. Investing in proactive patient education earns the dividends of customer commitment, a positive reputation, and a healthy bottom line.

Kim Williams is senior vice president, eligibility and enrollment advocate, Change Healthcare.

About the Author

Kim Williams

Sign up for a free guest account and get access to five free articles every month.


Related Articles | Financial Counseling

How To | Cost Effectiveness of Health

Cost Effectiveness of Health Report, September 2021

HFMA’s Cost Effectiveness of Health Report, sponsored by Kaufman Hall, is a monthly e-newsletter that will explore ways to ensure healthcare delivery in the United States is not only financially sustainable but also cost effective for all of its stakeholders — including health systems, physicians, health plans and patients. In this inaugural issue of the report, healthcare futurist Jeff Goldsmith shares his perspectives on the need for a focus on improving cost effectiveness of health as a societal imperative.

News | Revenue Cycle

How 3 healthcare organizations are focusing on access and transparency to drive revenue cycle performance

Three winners of HFMA’s 2021 MAP Award share their innovative and effective strategies to build a strong revenue cycle amid uncertainty.

Article | Patient Access

How to engage with patients where they are by balancing automation with the human touch

As provider organizations develop sophisticated automated systems, they should also make sure patients always have an opportunity to talk with a real person in the organization, because patients tend to be drawn to organizations where they feel a personal connection. Providers should address this patient need by having dedicated staff whose role is to personally engage with patients.

How To | Patient Financial Communications

How to ensure a positive patient financial experience

Creating the ideal patient billing experience not only improves revenue cycle performance, but also boosts patient satisfaction and quality scores.