Treating patients with respect
during the front end and back
end collection process
David Phelps
Vice President Sales and Marketing
Helvey and Associates
October 31, 2012
Agenda
• Building a Culture
• Training
– It Starts at Day 1
• Quality Assurance
• Being where the patients are
• The Real World
Health Care is Consumer-Driven
• The current trends show an increase shift across the industry for
patients to take more responsibility for Healthcare spending
• Payers shifting financial responsibility to the patient
• Employers are shifting healthcare costs to employees
• Healthcare providers are seeing a shift in payer reimbursement to
patient (self-pay)
• Medicare holding steady at $135 Deductible and 20% Coinsurance
• Government is promoting Consumer-Driven Healthcare as a
means of slowing the growth of national healthcare spending
The Real World
• Trying economic times
• More and more competition
• Not all of the PR is positive
What are you doing to accommodate your patients
changing needs?
Building the culture of respect and
fairness from the top down
• Ways to accomplish
– Guiding Principles
– Open communication from the top
down
• Builds respect
– Employee meetings
– Regular staff meetings
– Make the job fun
– External motivation
Training and Development
• Introduce culture at the onset
– attract more flies with honey
• Emphasis on communications technique
– before process training!
• Assertive not aggressive
– assertive is asking for what you want, refusing
what you don’t want
– The art of negotiation
– Empathy not Sympathy
• Don’t take rejection personally
Motivating patients to pay!
Front Desk Procedures with HDHP
• Difficult for front desk personnel to identify HDHP
patients
– Most of the time, only PPO is stated on the card
• Need to incorporate patient verification procedures
– Identify total plan deductible
– Either % of deductible met or remaining deductible amount
• If not contracted with plan, financial counselors should
negotiate with patient or plan, and try to collect 75% to
100% up front
• If patients are identified with a participating HDHP,
consider collecting 75% of estimated visit costs during
check-out
• Communicate payment expectations with patient upon
verification and again at check-in
New Philosophies in Preregistration and Registration
Processes
• Shift of revenue cycle activities upstream from business
office to front-end/patient access functions
• Patient verification is the key to identifying HDHP patients
• Develop an up front collection policy that is
communicated with patients
• Receptionists need to be prepared to estimate a payment
amount and communicate with patients
• Make use of financial counselors in communicating
payment arrangements with patients
Front-end Collection Components
• Collecting patient responsible payments at time-of-service
can reduce accounts receivable by over 15%.
• Review of payer’s fee schedule of the top payers
• Incorporate fee schedules into information system.
• “Best” opportunity to collection patient’s portion of visit.
The Earlier You Communicate, The
More You Collect
• Estimated Collection Percentage by Front-desk Function
– Check-in
– Check-out
– On month after visit:
90%
70%
<40%
• Prior to visit, healthcare is the greatest priority to
patients
– Psychological advantage for healthcare provider in collecting at
check-in
– Following the visit, healthcare drops to last priority and the
“debt” becomes the high priority
Tips on Improving Front-end
Collections
• Help staff understand what to collect and how to ask
• The more comfortable your staff is on collecting, the
greater your success
• Provide receptionist/financial counselors with the right
tools
– Fee schedule and estimated exam fees
– Practice management system as a guide
– Collection policies and protocols
• Deploy signage and “patient-friendly” collection
campaign within the office
• Share the collection burden
Training Staff to Collect Money
• Practice “Open Book” Management
– Present to staff front desk collection variance
• Remove delineation between clinical, registration and
collection functions
– Obtain buy-in from physicians prior to collection initiative
• Deliver “Kick-Off” meeting to initiate new processes
– Create clear and definitive change of process and policy
• Provide consistent support
– Financial counselor
– Collector “Hot-Line”
Training Staff to Collect Money
• Provide simple training tips and tricks for front desk
collection appeals
– Tap back office collection / customer service staff to assist training
– Collection agencies will often offer to present modified versions of
their own presentations
• Construct role-playing scenarios
• Create desktop laminated “go to” phrases for easy access.
– “We can accept Mastercard, Visa, checks or cash to fulfill your
responsibility of $___ for today”
Training Staff to Collect Money
• Provide multiple “payment avenues”
– All credit cards / debit card alternatives
– Payment plans
– Pre-payments
• Empower registrars to work with patients
– Provide increased lenience for patients during introductory
period
– Create a 3 Strike Rule
• 3 times patient defers payment and does not satisfy balance within 30
days = rescheduled appointment
• Exceptions allowed with justification
Training Staff to Collect Money
• Create Incentives
– Monthly bonuses for registrars based on collection
thresholds
• Co-Payments
• Outstanding balances
– Contests
• Support registrar collection initiatives
– Front desk delays
– Re-scheduled appointments based on financial
issues
– Stress physician patience
QA Programs
• Before you begin
– Justification of cost of program
• Can you afford not to establish?
– Executive buy in!
• Things to think about when developing your program
– Objective measurements
• Difficult as customer service requires on the spot judgment
– Consistency
• Standard audit frequency – weekly / monthly ensures fairness
– Minimize staff responsible for audits
– Tie individual audit results to performance evaluation—so
employees take program seriously
– Thoroughly explain program to staff before implementing
• Get better buy in
QA Programs
• Implementing your program
– Don’t move too fast!
– Trial period before tying to performance
evaluation
• Are you standards too high or low?
– Quality over quantity
• How many calls can be audited conclusively?
– Review and refine—continual
• Add or subtract criteria
• Change weights of criteria
• Re-examine quality standards
Being Where Your Patients Are
• Are you a bank?
– What are your hours of operation?
– What happens to patients before 8am and after
5pm?
• How do you communicate with your patients?
– Electronic vs paper vs phone vs website…
• Responsiveness
The Cleveland Clinic Enterprise Solution
IVR
Online
Registration
Itemized
Statement
Enterprise…
Paper
Statement
MyAccount
Customer
Service
Department
Enterprise Statement
• Created by combining over 140 files from various systems
across the enterprise
• Majority of patients will receive a combined enterprise
statement
• They will continue to send patients separate statements if we
can not verify enough demographic information to create a
combined statement
MyAccount
• Patient friendly tool for online bill payment
• Phased rollout began 2010
MyAccount Features
Phase 1
•
•
•
•
•
•
•
QuickPay
• Credit card/E-Check payment
• Prompt Pay Discount
• Payment plan option
• Email/print receipt
MyProfile
Links to Online Registration, maps and
directions, make an appointment,
MyChart
Historical activity
Pre-enrollment
Link multiple patients to guarantor
FAQs
Phase 2
• Request itemized statement
• Ability to detail post payments
• Ability to complete loan
application online
• Addition of PayPal to MyWallet
Customer Service and IVR
•
•
•
•
•
Single call center for the enterprise
Self service IVR
Ability to make payment arrangements, offer
discounts for prompt pay and provide information
regarding loan program
Employees cross-trained East, West, Main and
Florida systems
Developing a database to request updates to data
in decentralized host systems
But I’m not the Cleveland Clinic!
• Which pieces can you implement?
– Priorities
– Patient Comments
• Partnerships
– The right partners for the right solutions!
• Put your money where your mouth is!
– Are you delivering what you are you telling
your patients?
Thank You!
David Phelps
VP Sales and Marketing
Helvey and Associates
800-735-0730 ext 373
dphelps@hlv.com