Revenue cycle staff have more to worry about than collecting copays and sending “clean” claims. They also have to worry about how it is going to affect the patient.
“Today, more than ever, financial toxicity is a major contributing factor in both the mental and physical health of patients,” says Michelle Vasquez, MHA, CHAM, patient access services director at Banner Casa Grande (AZ) Medical Center.
Over the past two years, Banner’s revenue cycle modernization team has focused on giving staff every possible tool to ease patients’ financial anxiety by making the following changes:
• Staff offer comprehensive financial assistance programs based on federal poverty guidelines. “It is vital that these programs provide support for both uninsured and underinsured patients,” Vasquez stresses.
• Staff go out of their way to explain insurance coverage. Patients misunderstand their benefits. Many still believe their insurance will cover all costs. “Patients are confident because they have insurance. But they are not entirely aware of their coverage plan details,” Vasquez explains.
Staff explain confusing terms, such as deductibles, out-of-pocket maximums, copays, and coinsurance. Recently, the problem was a “limited benefit” plan. The patient was admitted to the hospital with insurance that covered the first $500 of the admission. The remaining balance was the patient’s responsibility, a big problem with no obvious solution.
“Situations like this can be upsetting. An important part of our role is to translate insurance benefits for our customers. We speak a language they may not always understand,” says Paula Huggard, CHAM, patient access services manager at Banner Ogallala (NE) Community Hospital.
• Staff verify coverage in real time. The news is not always bad. “Sometimes, we find coverage that patients are unaware of,” Huggard reports.
Either way, staff can engage in better conversations with patients because they know the actual dollar amounts, using a price estimate tool based on the person’s individual plan.
• Staff offer upfront payment plans at preservice and at point of service, including previous balances. “We recently partnered with a healthcare financing vendor to provide our patients with flexible, low- or no-interest financing options,” Huggard says.
These can be used at hospitals, clinics, and urgent care centers. “This equips patients with peace of mind for future circumstances,” Huggard observes.
One patient was worried about borrowing money from her mother to pay for her surgery. Staff explained the payment plan program to her, she applied, and was relieved to be approved for interest-free payments.
• The department collaborates with Medicaid eligibility vendors. The vendors help uninsured and underinsured patients apply for Medicaid, but also many other programs (unemployment, nutrition assistance, cash assistance, school meal options, childcare assistance, and tax credits, among others).
A patient recently came in to Banner Ogallala specifically to thank registrars. “Because of a visit to our facility that resulted in a screening by our vendor for services, she was approved for food assistance,” Huggard says.
Educate patients about insurance coverage and provide options for financial assistance programs — and do it early.
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