On Demand Webinar | Basic | Patient Financial Communications
This session will involve first-hand observations about today's consumer financial decision-making trends and explore insights from a recent survey of over 2,000 U.S. adults who visited a doctor or healthcare facility within the past year f...
Save
On Demand Webinar | Overview | Patient Financial Communications
Health care professionals need to understand that the rules governing health information are changing.  Under current final rules, providers and health plans must share data directly with patients, and if a patient requests their data ...
Save
Course | Intermediate | Patient Financial Communications
In this course we will address the Patient Financial Communications Best Practices through concepts of financial counseling. We'll review patient financial care concepts, which include negotiating account resolution, identifying and initiat...
Save
Course | Basic | Patient Financial Communications
HFMA's Patient Financial Communications Training Program is an online toolkit that provides revenue cycle staff with guidance for conducting sensitive financial conversations with patients. It shows patient access professionals how to commu...
Save
Course | Basic | Patient Financial Communications
HFMA's Patient Financial Communications Training Program is an online toolkit that provides revenue cycle staff with guidance for conducting sensitive financial conversations with patients in the emergency department. It shows patient acces...
Save
Policies and Practices | Patient Financial Communications

Communications Best Practices Measurement Criteria

Policies and Practices | Patient Financial Communications

Communications Best Practices Measurement Criteria

These measurement criteria are based on the Patient Financial Communications Best Practices.

Following are criteria for evaluating the effectiveness of patient financial communications in a healthcare organization. These are based on the Patient Financial Communications Best Practices. HFMA offers a recognition program so organizations can demonstrate their implementation of the practices.

1. Training program evaluation
     a. All staff, including Patient Access, Financial Counseling and Customer Service dealing
        with patient financial discussions should go through training on an annual basis.
     b. Evidence that training occurred is presented to the Executive Leadership Team on an
         annual basis.
     c. Training can be provided through a variety of forums (e.g. Web-based or in-person).
     d. Training can be provided by qualified resources (internal or external) as deemed
         appropriate by a designated quality officer (e.g. Compliance, Quality, or Human
         Resources).
     e. Training must cover:
         i. Patient Financial Communications Best Practices specific to the staff role
         ii. Financial assistance policies
         iii. Available patient financing options
         iv. Alternative solutions for the uninsured
         v. Standard language to be used in patient discussions
         vi. Laws and regulations (e.g. EMTALA, FDCPA, TCPA, etc.) specific to the staff role

2. Process compliance evaluation
     a. Ensure provider organization is compliant with the Best Practices through annual
         observation, monitoring and tracking of results.
     b. The evaluation will be comprehensive and cover all relevant parts of the Patient
         Financial Communications Best Practices:
         1. Best Practice Scenario 1 – Patient Financial Communications in the ED
             i. Registration
             ii. Patient Share
             iii. Prior Balance
         2. Best Practice Scenario 2 – Patient Financial  Communications in Advance of Service
             i. Registration
             ii. Patient Share
             iii. Prior Balance
         3. Best Practice Scenario 3 – Patient Financial  Communications at the Time of Service
            (Outside the ED)
             i. Registration
             ii. Patient Share
             iii. Prior Balance
         4. Best Practice Scenario 4 - Best Practices for all Patient Financial  Communications

    c. Process compliance evaluation can be performed by any organization independent of the
        department being audited (e.g. internal audit, compliance, quality or a 3rd party).
    d. A report containing the results of the process evaluation is presented to the Executive
        Leadership Team on an annual basis.

3. Technology evaluation
     a. Ensure technology is in place to support informing the patient of the following:
         i. Verification of insurance eligibility for current services
         ii. Verification of existing prior balance within organizational control
         iii. Estimated cost of the current services and the consumer responsibility portion
     b. A report containing the results of the technology evaluation is presented to the
         Executive Leadership Team on an annual basis.
     c. The technology evaluation can be performed by any qualified individual or organization
         (e.g. technology, compliance, quality or a 3rd party).

4. Feedback process and response evaluation
     a. Ensure process is in place to regularly solicit input and receive feedback from key
         stakeholders in compliance with Patient Financial Communications Best Practices
        (e.g. community, patient surveys, physicians)
     b. Ensure process is in place to measure and respond to input and feedback received
     c. Ensure provider organization has an escalation process for patient complaint resolution
     d. A report detailing the feedback and response process that is in place and a summary of
         the feedback and responses that have been exchanged is presented to the Executive
         Leadership Team on an annual basis.

5. Executive level metrics reporting evaluation
     a. Ensure process is in place to consolidate the reports from the 4 areas listed above into
         an overall Compliance Report and presented to the executive leadership team on an
         annual basis.

Advertisements

Related Articles | Patient Financial Communications

Blog | Self-Payment Collection

Surveys show rates of uninsured increased, underinsured remains significant

HFMA's Chad Mulvany says healthcare organizations should ensure their self-pay revenue cycle process follows best practices as it’s likely with more people uninsured there will be increased scrutiny of these processes.

Trendsetter | Self-Payment Collection

Offering long-term payment plans to meet the financial needs of patients

A forward-thinking bank talks about its accessible patient finance program, which gives patients a way to afford care while ensuring timely payment for healthcare organizations.

News | Revenue Cycle

HFMA’s Digital Revenue Cycle Conference Sept. 30 and Oct. 2 will focus on how healthcare providers can build a consumerism strategy and use consumer-centric KPIs

HFMA's Digital Revenue Cycle Conference features 20 presenters during live sessions, the ability to earn CPE credits and time for networking and peer-engagement.

News | Coronavirus

Why it's imperative for healthcare organizations to review their financial assistance programs during the COVID-19 pandemic

Revenue cycle management services executives discuss why healthcare organizations should review their financial assistance programs amid the COVID-19 pandemic.