Treating patients with respect during the front end and back

end collection process

David PhelpsVice President Sales and Marketing

Helvey and AssociatesOctober 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% Co-insurance

• 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 Pre-registration 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 90%– Check-out 70%– On month after visit: <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

Paper Statement MyAccount

Itemized Statement

Customer Service

Department

Online Registration

Enterprise…

IVR

The Cleveland Clinic Enterprise Solution

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

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

MyAccount FeaturesPhase 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 PhelpsVP Sales and MarketingHelvey and Associates800-735-0730 ext 373dphelps@hlv.com