Revenue Cycle

Rethink your point-of-service collections strategy

Patient Access Weekly Advisor, July 18, 2007

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H*Works offers its recipe for success

Raking in dollars from point-of-service collections should be every finance manager's top priority. It eases the pressure on all other points of the revenue cycle, jumpstarts revenue, and, perhaps most importantly, helps change the culture in which patients view the obligation of their bills.

But the advent of consumer-directed health plans and health savings accounts (HSA) only further complicates this challenge for managers and their staffs.

No longer can managers address this issue half-heartedly and without rethinking every existing process, says James Green, national practice leader for H*Works, the consulting arm of The Advisory Board in Washington, DC.

Three strikes and you're out-of trouble

H*Works advises its many hospital clients to thoroughly address this problem on the following three levels:

1. Staff education and training

2. Process redesign

3. Using a clinical advisor to determine elective cases

You shouldn't take the handling of staff lightly, Green says. "It's important that they understand their positions and their roles in the revenue cycle. Many do not, and that is a huge problem."

H*Works suggests and offers intensive day-long training of each registrar (see pp. 6-7 of the PDF of this issue for samples of H*Works' training tools).

Don't settle for quick training sessions. H*Works takes the staff with whom it works offline for eighthour sessions.

"Whether it's by authorization denials, eligibility denials, inputting the wrong address, or never sending out the bill, we show them how one of these errors can amount to hundreds of thousands of lost dollars," says Green. "We show them what one night in the hospital costs the hospital, and that shows them the stake in the revenue cycle that they have control over."

This education also illustrates the link to each job down the line of the revenue cycle. The most important lesson is to get the information correct the first time and with every patient. "The registrars must fully understand that they have to be accurate, not only for the organization to get paid but for them to do their job," says Green.

The end of H*Works' staff training is job training. "Most organizations train their staff how to use the system and how to enter the data," Green says. But it's important that you prepare staff for a list of possible customer objections that they will likely encounter and offer strategies to circumvent them.

The final staff training objective that H*Works stands by is the streamlining of workflow. "It's important to remove the items that are not registration specific, such as patient transport and hospitality," says Green. "The registrars should focus on registration and that will eliminate some mistakes."

Extreme makeover

Process redesign means everything from hiring the right staff and shifting resources within the hospital infrastructure, to investing in the right technology.

H*Works believes that maximizing collections in today's consumer-driven healthcare world requires an open mind and a willingness to shake things up.

First, each hospital should ask the following questions of its operation:

  • What is the patient flow to and from the registrar?
  • Is there a hardwire link from registration to our scheduling department?
  • What kind of information do our schedulers get?

    Typically, schedulers get only the patient's name, date of birth, and the date of arrival at the hospital. But according to Green, they should also get the phone and Social Security numbers, chief complaint, diagnosis and procedure, and insurance and plan type. "Blue Cross isn't good enough. You'd need to know everything," he says.

    The schedulers should be able to hardwire that information to the hospital's registration team. If the department has an electronic verification system, the schedulers can access that information instantaneously and use it in the subsequent preregistration call.

    The technology can be pricy, but Green says it's an investment that can pay for itself right away. "Once the first inpatient cardiology case comes through the pipeline and you find out that the patient is ineligible, you'll be happy you have [the electronic verification system] in place."

    Encourage registrars to push scheduling as far in advance as they can. "Ideally, five days gives you a chance to try [to] catch the patient at home and a chance to work the authorization, if need be," says Green.

    If your organization is not set up to receive payments over the phone, set it up now, says Green. "A lot of people think that preregistration is setting up the account electronically so it's easier to register patients on site. But it's actually calling the patient, talking to them, interviewing them, educating them on what they should experience when they arrive, and collecting the copay."

    Working 9 to 5

    Think outside the box when considering other ways to collect copays in advance. That includes changing the hours that your registration team works. "The traditional 8 [a.m.] to 4 [a.m.] hours are only going to catch the Medicare folks, and they don't need your help," Green says. "In some markets, [such as] New York City, you want to extend those hours to 8:30 or 9 p.m. That's when a lot of people are just getting home."

    Your financial counselors should have flexible schedules, as well. Many organizations simply have financial counselors pushing papers. That's a big mistake, Green says. "A financial counselor should do nothing but counsel patients on financial matters. The problem is it's hard to get to the patient if they're not pushed to you," he adds.

    Consider when most of your volume comes in. "If it's between 6 and 8:30 p.m., you need to have financial counselors there to catch them," Green says. "If you can catch them and get the process started, that's golden."

    Staff must be able to recognize whether a patient has an HSA and, if so, determine the deductible for that account. Once they determine the deductible in advance, they can notify the patient. If the patient is unable to pay the deductible, the registrars should hardwire the case directly to a financial counselor, who can run through various options.

    A second opinion

    There are instances in which you can and should refuse service if the patient cannot pay. But rescheduling major elective cases can be tenuous, Green says.

    "I may have to come in for knee surgery. It's not elective. I can walk, but it's certainly life-altering pain," he says.

    For those cases, it's helpful to lean on a clinical advisor to make the tough decisions that a registrar cannot.

    Case in point

    H*Works has employed this strategy at several organizations and has seen tremendous results. At West Virginia University Hospitals, officials saw their ED collections jump from $64,000 to $164,000 since the program went live in November 2005.

    In January 2006, total collections at West Virginia University Hospital were at $204,000. "They started collecting $20,000 a year on point-of-service collections," says Green. "Now they expect to collect a million." n



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