Momentum is critical with point-of-service collections

In 2015, patient access leaders at Peoria, IL-based OSF Healthcare determined that $3 million in cash was going uncollected each year. At the time, patient access collected only copays and didn’t ask for outstanding balances.

“We never audited or looked at numbers or trends. If somebody didn’t collect anything for years, they weren’t questioned,” says patient access service manager Jacqueline Doerman. Even copays were collected inconsistently.

The department set out to revamp its point-of-service collection program by informing patients of their total out-of-pocket costs, including previous balances, and setting patients up with a payment plan if needed. “We believed the opportunity was rather large and that it would be more efficient to collect on the front end versus going through the billing process,” says Doerman.

Patient access staff began giving patients accurate estimates. “We had a lot of quick wins,” recalls Doerman. “Our cash collections soared in the beginning.”

However, collection totals soon leveled off. “We were getting feedback from some staff that they couldn’t increase collections because there wasn’t that much opportunity,” says Doerman.

In response, managers audited the previous month’s collections and compared what potentially could have been collected to actual collection totals. “We found that we were only collecting 2% to 5% of what the opportunity was,” says Doerman. “That was eye-opening for staff! They saw how much opportunity was really out there.”

Collections for Doerman’s department, which consists of six outpatient registration sites, rose from $86,000 in 2014 to $283,000 in 2015. For the first five months of Fiscal Year 2016, $205,000 was collected. “We are keeping a watchful eye,” says Doerman. “Every day, we tell staff how much they collected the day before.”

Most patient access employees were closely following the scripting they’d been given. However, the way in which they were communicating the information needed improvement. “The delivery is what sets the tone and, ultimately, influences the patient’s decision to pay or not,” says Doerman.

If staff members seemed hesitant or gave patients the option to defer payment, patients often declined to pay. “Patients usually pay if asked directly, ‘How would you like to take care of that today?’” says Doerman.

If employees aren’t meeting collection goals, they’re required to write an action plan for how they plan to improve. “That gives us an opportunity to sit down and coach them to help them be successful in the future,” Doerman says.

Some action plans written by employees focused on the need to improve the way in which they used scripting for collections. Other employees admitted that they didn’t really make collections a priority. “When they get busy, it goes by the wayside,” says Doerman. “But that’s when you have your biggest opportunity to collect.”

COLLECTION CHALLENGES

Point-of-service collection totals usually get a boost in the first part of the year. This increase is due to high-deductible plans that have a large amount of initial patient responsibility.

“But this will taper off as the year progresses, moving future amounts over to insurance payments,” says Jamon Rivera, senior director of revenue operations at Yakima Valley Memorial Hospital in Yakima, WA.

Yakima Valley’s patient access staff members manually calculate estimates for patient responsibility. “We are looking to move toward using software that assists with providing a more accurate, less labor-intensive estimate,” says Rivera. This estimate is particularly important for specialty procedures that require a high out-of-pocket cost for patients.

“We have conducted system-wide training with staff on how to collect and provided specific scripting on how to ask for payment,” adds Rivera.

Here are other changes Yakima Valley’s patient access department made to sustain collection gains:

• Patient access managers created a reference tool for staff to use, which identifies patient responsibility for various payers. (See story later in this issue on meeting needs of patients and staff with point-of-service collections.)
• Patient access systems were updated to automate insurance eligibility processing.
• Patient access employees are held accountable for meeting copay collection goals.
• Outpatient registration areas implemented registration pads with the ability to accept payments. “Collections are higher for the entities that use the pads,” reports Rivera.
• Patient access managers review point-of-service collection totals at staff meetings.
• Patient access managers post point-of-service collection goals and current totals on large bulletin boards, so staff can track the department’s progress.
• Patient access employees discuss patient responsibility when they pre-register patients. “This sets an expectation on the front end regarding payment,” says Rivera.

SOURCES

• Jacqueline Doerman, Patient Access Services Manager, OSF Healthcare, Peoria, IL. Phone: (309) 683-6765. Email: [email protected].
• Jamon Rivera, Senior Director of Revenue Operations, Yakima Valley Memorial Hospital, Yakima, WA. Email: [email protected].