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Upfront collections: Pick your battles wisely

Patient Access Weekly Advisor, June 20, 2007

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Your patient access professionals routinely walk the fine line between customer-friendly billing and up-front collections. Trapeze artists they are not, but effective patient resources and cash machines they must be if your organization plans to survive and thrive in the consumerism age.

Clear threats, subtle threats, clever persuasion, or compassion and understanding-which stance should your organization and front-end personnel take when dealing with patients who cannot or refuse to pay their copays or bills? The right answer is complicated and multilayered and depends on a number of variables, such as the relationship that you have with your community and the size of the bills you're dealing with.

The customer is always right

One thing that is clear, according to T.T. "Mitch" Mitchell, president of T.T. Mitchell Consulting, Inc., in Syracuse, NY, is that you should keep the consumer's opinion of your organization in mind.

"Unless you happen to be exclusive, you're going to have some competition. And all it takes is one little thing and people will go elsewhere," Mitchell says. "In today's world, people are not hesitant to drive 15 minutes to a different facility if they feel they aren't being treated right."

You shouldn't take this prospect lightly, he adds. "All it takes is a 5% decrease in patient activity" to take a big bite out of your bottom line. With pricing transparency imminent-and in some states, thriving-you must make and maintain allies in your community. Even if you're located in a rural area, the slightest nick in your public relations image could have long-lasting effects.

Pick and choose your battles

This is not to say that you should forget about the hundreds of outstanding $10 accounts or that you shouldn't consider up-front collections one of your top priorities, Mitchell says. Consider finding a convenient balance between serving the financial needs of your organization and valuing your customer base.

Also consider who your customers are and what kind of relationship you currently have with them. "Larger hospitals might have to look at things differently. They believe cash is king," says Mitchell. "The CEOs of smaller hospitals usually live in the same community. People know who they are, people come up to them in restaurants. Your life can get bad if you treat someone the wrong way."

Simply put, threats and up-front demands don't have a place in the healthcare landscape moving forward. Let people know your policy in advance and that you'll withhold future cases, unless they are emergent, if there's a bill that's delinquent for a specified time. "That way you protect yourself against EMTALA [The Emergency Medical Treatment and Active Labor Act]," says Mitchell.

Communication is always a good idea

Decide on a plan of approach and stick to it. "You have to follow through on what you say, particularly when it comes to messages with threatening undertones, Mitchell says. "You don't want to tell them that this going to affect their credit rating forever. That's not a good approach."

Don Brown, manager of access services at Mercy Hospital of Iowa City, agrees that up-front discussions play a large role in your staff being able to walk that fine line. "Patients should know the consequences of nonpayment," he says. "While language should not be threatening, it should be clear-follow through on collection methods that you outline to the patient."

"Persuasive compassion" is the happy medium that Mitchell professes.

Throw a flag on the play

One proactive approach Mitchell suggests is enabling your registration system to flag registrars when a customer with many outstanding accounts shows up at your hospital. "Your admissions people would have the right to deny them," he says. "Systems flag patients if they need a Medicare Secondary Payer, or if there's no healthcare proxy, so why couldn't they flag that?"

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