Proper tools needed for collections work
Some hospitals 'shooting from the hip'
The right combination of people, process, and technology is particularly crucial when it comes to managing collections and charity care procedures, notes Shawn Glinter, RN, MBA, a former access director and revenue cycle consultant who now works for a health care technology company.
Asking for money in a patient-friendly way is the second-hardest job, contends Glinter, who is based in Nashville, TN. The hardest, he says, is being an emergency department (ED) registrar.
"It's hard for those on the front to do their job," Glinter says, "and while there's nothing better than real world experience, they can never be prepared 100% of the time. That's why it's critical to do training and have policies written."
In the designation of charity care and financial aid, for example, "some hospitals have very solid policies and some are shooting from the hip," he says. "Even with policies based on federal poverty guidelines, [at some hospitals] I guarantee you can get two types of discounts from two different financial counselors.
"It's OK to empathize, but you have to have processes in place," Glinter adds. "You don't want staff making decisions based on how they feel that day."
There have been several cases throughout the country in which hospitals were fined for having poorly defined and inconsistent charity policies, he notes. "The answer is not to wipe off somebody's bill every time. You need to be able to show the criteria used in making that decision."
Simply telling financial counselors they can give between a 15% and 40% discount on a bill puts them in a difficult situation, Glinter suggests. "There's got to be training and you have to use technology [to get] good data and something to validate that decision. You give them the ability to make decisions, but you also give them the tools to do so."
There is software, he says, that allows a query to go out — during the course of a registration — on how likely it is that the patient will pay his or her bill. Using the person's name, date of birth, Social Security number, and address, this "prediction of payment" software looks not only at credit scores, but at the complete financial health of the patient, Glinter adds. It then reports, for example, that there is "medium likelihood" of payment from a particular individual.
There are guidelines, he explains, suggesting that this person be asked for an initial payment of $150 and then be set up on a $50-a-month payment plan.
In some cases, he notes, the software may indicate that the person is not likely to ever pay the bill, as well as whether he or she meets charity care guidelines.
At whatever stage the conversation about payment is occurring — on the phone during the scheduling process or in person at the hospital — it's empowering for registrars to talk about fees and deductibles and the possibility of financial aid with this information in front of them, Glinter says.
"One reason we get perceived as providing bad service is that we don't have confidence in asking for money and so we are hesitant," he adds. "If we give [employees] the right tools, they're more secure and have more confidence."
The payment likelihood information also allows providers to use their collections resources more efficiently, Glinter notes. "Hospitals spend a lot of time going after patients with a low likelihood of payment."
On the other hand, he says, "I have witnessed patients who had the ability to pay in cash say they were self-pay and couldn't afford the bill. You can't assume."
[Editor's note: Shawn Glinter can be reached at (615) 491-3270.]
The right combination of people, process, and technology is particularly crucial when it comes to managing collections and charity care procedures.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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