Avoid Disastrous Results of Overly Aggressive Collecting

EXECUTIVE SUMMARY

Overzealous upfront collections cause multiple problems for patient access, including dissatisfied patients and noncompliance with regulations.

• Offer additional options for the patient, such as zero-interest payment plans.
• Don’t rush the conversation.
• Give price estimates at the same time pre-service collection calls are made.
• Ensure registrars are comfortable responding to patients’ questions.

One of the first “touch points” a patient experiences is at registration, during which money often is collected upfront.

“A negative experience is what they’ll remember,” warns Holly Lang, a New York-based contractor specializing in healthcare financing, public policy analysis, and nonprofit hospital strategy.

“There are several issues with overzealous collections,” Lang says. “Point-of-service collections is particularly tricky as hospitals increasingly look to get paid at the time of care.”

Not in Compliance

Some hospitals keep patient credit card information on file and charge accordingly, even without the explicit permission of the patient at that time.

“Often buried within the paperwork the patient initially signed, he or she likely agreed for the hospital to maintain this information without realizing how it could be used later,” Lang explains, noting this practice can backfire quickly. “It can create an incredible burden for the patient, who now has to deal with a large credit card bill on top of whatever medical issue brought them to the hospital initially.”

Recent regulations have put into place certain timelines to which revenue departments must adhere, especially regarding lower-income patients at nonprofit hospitals.

“Unfortunately, we still see many hospitals not in compliance,” Lang says.

For example, it is not uncommon for hospital registrars or patient access staff to ask a patient to provide a deposit on their care, or to settle a previous debt, before they’re allowed to be seen.

“Even though hospitals are not allowed to do this in emergent or medically necessary situations, some still do,” Lang says. She recommends a “softer touch” for upfront collections: “Offer additional options for the patient, such as a zero-interest payment plan.” (See related stories in this issue on how to avoid collection complaints, and how an investigation pinpointed the need for additional training.)

Roger Stone, system manager for admission services, patient registration, and central access at CoxHealth in Springfield, MO, says the key is to make patients aware of their financial obligations before they arrive for services.

“This is most certainly a team effort that our pre-registration teams and all other staff are heavily involved in,” he says. “That said, in the past few years, point-of-service collections initiatives have changed tremendously for many healthcare organizations.”

Patient access must help patients understand their financial obligations, Stone says.

“It is best to try to take any surprises out of this process for the patient. Have the financial discussion over the phone during pre-registration, if possible,” he offers.

Driver of Satisfaction

Tanya Powell, CHAM, patient access director for Ochsner Health System North Shore Region in Slidell, LA, received complaints about ED collections some time ago.

“Staff were sometimes showing an open display of aggravation when they were unable to collect,” she recalls.

Patient access managers stepped in immediately to counsel staff that pressure to collect could be perceived as harassment — or worse, an EMTALA violation. Registrars were told that statements such as “Can’t you pay something? It is only $50,” were not appropriate.

“Our team was re-educated that it is primarily our obligation to inform the patient of financial responsibilities,” Powell says. “With increased rounding and coaching, we do not experience this as much.”

If the patient says he or she is unable to pay, registrars offer many options. Sometimes, they get creative in finding ways to assist the patient.

“There is an art to financial counseling,” Powell adds.

Kaylyn Lambert, system director for patient experience at CoxHealth, says point-of-service collections can become a problem if not handled correctly.

“Many systems use this in a competitive format amongst their employees to drive collection dollars,” she explains.

Sometimes, competition becomes too fierce, getting in the way of patient satisfaction. Lambert says the two goals actually are intertwined.

“Point-of-service collection should be utilized more as a resource for patients,” she notes.

Engaging in a quality collection conversation can prevent the patient from receiving an unexpected bill. It alleviates the common worry: “How much will I owe?” However, being too aggressive leaves patients with a lasting negative impression.

“Patients could leave with the idea that the hospital only cares about one thing: money,” Lambert says, adding that overzealous collectors should be coached on customer service techniques. “This behavior causes social media discussions, as well as attorney-seeking, if a patient feels that financial obligations were pushed before their health concerns were taken care of.”

SOURCES

• Kaylyn Lambert, System Director, Patient Experience, CoxHealth, Springfield, MO. Phone: (417) 269-4103. Email: Kaylyn.Lambert@coxhealth.com.
• Holly Lang, Phone: (404) 512-8808. Email: hollylang@gmail.com.
• Tanya Powell, CHAM, Patient Access Director-North Shore Region, Ochsner Health System, Slidell, LA. Phone: (985) 646-5132. Email: tpowell@ochsner.org.
• Roger Stone, System Manager, Admission Services/Patient Registration/Central Access, CoxHealth, Springfield, MO. Email: roger.stone@coxhealth.com.