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Treating patients with respect during the front end and back
end collection process
David PhelpsVice President Sales and Marketing
Helvey and AssociatesOctober 31, 2012
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Agenda
• Building a Culture• Training – It Starts at Day 1
• Quality Assurance• Being where the patients are• The Real World
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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
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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?
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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
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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!
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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
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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
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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.
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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
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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
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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”
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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”
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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
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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
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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
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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
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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
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Paper Statement MyAccount
Itemized Statement
Customer Service
Department
Online Registration
Enterprise…
IVR
The Cleveland Clinic Enterprise Solution
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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
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MyAccount
• Patient friendly tool for online bill payment• Phased rollout began 2010
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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
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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
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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?
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Thank You!
David PhelpsVP Sales and MarketingHelvey and Associates800-735-0730 ext [email protected]