Third-party trainers can be especially beneficial with this type of training, offering real-world scenarios in which an organization’s staff can gain valuable practice and experience.
Not only is training important to increase staff confidence and proficiency with patient financial communications, it is also helpful in establishing consistency between staff members and across departments. Survey respondents from organizations with more than one facility tend to blame lack of training for inconsistencies between locations, which can lead to uneven patient experiences and more back-end rework as staff aim to collect money that should have been gathered up front. Inaccurate pre-payment posts also result in back-end confusion and are possibly the result of poor training as well.
Training methods. Organizations are using a variety of training methods to educate staff. For example, some have found scripting to be a good way to build staff confidence while ensuring uniformity. When staff have multiple script options, they can use what works best depending on the patient and situation.
Survey participants also rely on observation and coaching, as well as team huddles. One organization notes that if a manager sees room for improvement in a way a staff member speaks to a patient, he or she can address it during huddles as a real-world example, being careful not to specifically call out the individual but use the scenario as a teaching moment.
“HFMA also offers comprehensive training resources,” says Nelson. “For example, HFMA’s Patient Financial Communications Training Program can provide guidance in how to bring consistency, clarity and transparency to patient-provider payment interactions.”
Organizations are expanding financial counseling and payment options
To encourage and empower patients regarding their payment responsibilities, hospitals and health systems are enhancing their financial counseling services and diversifying their payment options. One out of three respondents say their organizations provide personal financial counseling to their patients. Although the nature of this work varies by organization, it generally entails discussing how the different treatment options affect the patient financially and working through the available payment options.
The timing of financial counseling is important, and depending on the situation, can cultivate a stronger patient-provider relationship. For instance, one organization has started including financial counseling as part of ED discharge. Before implementing this strategy, patients didn’t realize financial assistance was available and would not attend follow-up appointments or seek follow-up care for fear they couldn’t afford it. By starting financial counseling at ED discharge, the patient can see what financial options are possible and find appropriate ways to pay for continuing care. This can prevent the patient’s condition from recurring or escalating and avoid future unplanned emergency visits.
Although providers would ideally like patients to pay for care, they all acknowledge that their organizations would not refuse to treat a patient who could not or would not pay in advance. That said, 5% did indicate they allow physicians to refuse to perform elective procedures which are not prepaid.
Patient payment options. To ease the payment process, nearly 20% of respondents offer in-house payment plans, which are generally interest-free and range from four months to 24 months. Not surprisingly, organizations find that patients tend to spread large debts (more than $1,500-$2,500) over longer time periods than smaller debts.
Some providers (16%) offer discounts to self-pay patients, ranging from 3% to 77%, with 25% being the most common discount. Sliding scales are in place with 9% of respondents, allowing lower income patients to receive medical services at a reduced cost.
Valuable Training Resources
- Observation and coaching
- Third-party resources
- Online training modules
Collecting money in advance has numerous benefits
Survey respondents are nearly unanimous in appreciating the value of pre-payment and point-of-service collections, and 11% indicate they have either a strong belief or absolute proof that pre-pay and point-of-service payments reduce their days-in-A/R. Respondents’ A/R days range from 37 to 60 with the average being 47.
Pre-pay and point-of service payments are thought to lower bad debt as well. One respondent indicates the organization’s bad debt has declined 4% as a result of pre-payment and point-of-service payment policies and procedures.
About HFMA’s Annual Conference intercept survey:
Analyzing pre-payment and point-of-service collections efforts
HFMA stationed research interviewers throughout common areas at the Annual Conference to speak with attendees about their processes for pre-payment and point-of-service collections. Altogether, 39 providers were interviewed. Interviewers introduced a general topic for response, then probed specific responses as deeply as time and ability allowed. Follow-up interviews were conducted to gather further insight and information.
Consistency is essential
Respondents point out that inconsistent pre-payment and point-of-service policies can result in misalignment between the front- and back-end of the revenue cycle. For example, if there are discrepancies between the patient estimate and what is owed, it can cause patient frustration and the individual may complain to the back-end staff, even though the front-end staff were providing estimates. If there is not transparency between the front- and back-end, and solid policies for how to address irregularities, it can be frustrating to all involved.
Survey participants indicate the following three solutions could potentially mitigate misalignment issues:
- Implementing integrated technology that facilitates consistency between staff and across clinical and financial departments
- Having both the front- and back-end of the business office report to a single person
- Collaborating around solutions and communicating on an ongoing basis
- Conversely, the more siloed the front- and back-office are, the more problems the organization will face in effectively collecting money from patients, fostering a positive financial experience and limiting bad debt.
Remaining focused is key
Having solid and reliable processes for pre-payment and point-of-service collections is critical to advance an organization’s patient collections efforts. Clear policies, multifaceted staff training, timely financial counseling and varied payment options are all critical to helping organizations realize success. Hospitals and health systems looking to make improvements in this area do not need to recreate the wheel. By accessing and employing best practices and technologies, and leveraging the expertise of outside resources, an organization can reimagine its patient payment processes to lay the foundation for long-term financial wellness.
Parallon is a leading provider of healthcare revenue cycle management services. With a long track record of operational excellence, Parallon brings extensive knowledge and a broad portfolio of custom solutions to every partnership, including eligibility and advocacy services, early-out self-pay services, early-out small-dollar insurance resolution, bad debt collections, third-party liability and workers’ compensation services, extended business office and insurance services and physician billing and accounts receivable (A/R) resolution. Parallon enables providers to care for and improve the health of their communities by optimizing financial performance, navigating regulatory challenges, providing operational best practices and leveraging the latest technology. Parallon has more than 16,700 colleagues and serves more than 760 hospitals and 3,000 physician practices. Parallon is headquartered in Nashville, Tennessee, with 19 operational locations across the country.