Executive Summary
Patient access employees are being challenged to explain complex coverage and out-of-pocket costs to often-uninformed patients. To have successful financial conversations, North Shore-LIJ Health System’s revenue cycle leaders do the following:
-
Make training a priority.
-
Give patients multiple options.
-
Be sure staff know all the facts beforehand.
When telling patients how much they owe, patient access employees at Manhasset, NY-based North Shore-LIJ Health System work hard to convey the message, “We’re here to help you.”
“The way the message is being delivered, and the person delivering it, is the most important part of this entire process,” says Laura Semlies, MPH, vice president of finance and revenue cycle transformation.
To have successful financial conversations, patient access staff first need a good rapport with the patient. Pattie Froehling, vice president of revenue cycle management for Eden Prairie, MN-based Optum 360 and former director of revenue cycle at North Shore-LIJ, says, “It’s not just about getting money out of patients. We are financial advocates for the patient.”
Something as simple as mispronouncing the patient’s name can start things on the wrong foot. If an employee is unsure, he or she asks the patient, “Am I saying your name correctly?”
“If you’re asking the patient for money but can’t even say their name right, that doesn’t make the patient feel too good,” says Froehling.
The right technology
With the rise of high-deductible health plans and the continued consumerization of healthcare, “patients are increasingly requesting cost estimates up front,” says Doug Fielding, vice president of product strategy at ZirMed, a Louisville, KY-based provider of revenue cycle solutions.
Some patients simply are curious about how much of their deductible is met, which is not always easy information to obtain.
Patient access staff members aren’t always able to get this information without logging onto additional sites or making lengthy phone calls. Fielding says, “This is basic information that, without question, should be accessed in an on-demand electronic format.” He says the two biggest time-savers are electronic eligibility verification and electronic patient financial-obligation estimation software.
North Shore-LIJ already invested in this technology. The next step is tools to help registrars have better financial conversations. “We are looking at how to embed the right training materials at the right point in the work flow, that pop up in real time, of what they should be saying and where to go next,” says Semlies.
Patients are uninformed
Some patients need help with the basics, such as knowing what copayments and deductibles are. Even well-informed patients need some education.
“A coinsurance is what most patients really don’t understand, because it’s based on a contracted amount,” says Froehling.
Complex contractual arrangements between payer and provider “makes preservice financial consults difficult, at times,” says Amber J. Harris, CHAM, administrative director for Patient-Centered Access at Integris Health in Oklahoma City, OK.
Harris has seen patients confused and frustrated by deviations from payment terms by payers and by claims denials, even when the service is authorized. “When the information from the payer is markedly different from the preservice conversation, this causes mistrust between the provider and the patient,” says Harris, who has redoubled her efforts to explain contract terms to her staff.
“Effectively explaining to patients what to expect is critical,” she says. “Retention of trained staff continues to be a challenge.”
New role for access
If the financial conversation goes poorly, this conversation clouds the patient’s perception of the entire healthcare experience.
Semlies says, “More and more people are recognizing that this process has an unbelievable impact on the patient experience.” Because today’s patients have higher expectations, “it’s fundamental for health systems to figure this out and do a better job at it,” she says.
The ability to have good financial conversations is so important to the overall revenue cycle that it justifies a new view of how patient access positions are recruited and compensated, says Semlies. (See related story on improving financial conversations, in this issue.)
“There’s an opportunity, from the HR perspective, to think differently about what a patient access rep looks like,” says Semlies, adding that low, entry-level salaries aimed at an outdated greeter or data entry role should be re-evaluated.
“You need to develop a career path that has your best people landing in the front,” says Siemens. “That certainly is where our organization is going to head over time.”
-
Doug Fielding, Vice President, Product Strategy, ZirMed, Louisville, KY. Phone: (502) 779-4309. Email: [email protected].
-
Pattie Froehling, Vice President of Revenue Cycle Management, Optum 360, Eden Prairie, MN. Phone: (631) 719-2556. Fax: (631) 719-2530. Email: [email protected].
-
Amber J. Harris, CHAM, Administrative Director, Patient-Centered Access, Integris Health, Oklahoma City, OK. Phone: (405) 713-5547. Email: [email protected].
-
Laura Semlies, MPH, Vice President of Finance and Revenue Cycle Transformation, North Shore-LIJ Health System, Manhasset, NY. Email: [email protected].
