Collections soar: $4.4 to $8.3 million

Collections soar: $4.4 to $8.3 million

Payment is obtained consistently

When Diane C. Settle, CPA, CHFP, became executive director of revenue cycle at Sarasota (FL) Memorial Health Care System in 2005, no upfront cash collection was done at all.

"The revenue cycle was in really bad shape. The challenge was, 'Can you fix it?'" Settle says.

The patient registration's department's dramatic success in upfront cash collection was a highlight of the last budget presentation given to the hospital board, she says. "We were at $4.4 million annually in 2006, and in 2011 we collected $8.3 million. We have had about a 15% increase each year," Settle reports.

The first step was to convey to staff that they were expected to ask for payment and to convey to patients that the hospital expected to be paid for services, says Settle. "Physicians offices had been doing it forever. You don't go there thinking you won't have to pay your copay," she says.

First, Settle established goals for each site, based on what she thought was achievable for her staff, and these have been met each year.

Registrars must meet their collection goal in order to receive their quarterly bonus, a program that was started in 2008. Though many registrars initially were reluctant to ask for money, competition has become fierce in outpatient clinics, says Settle.

"We did a lot of training and showcased people who were really good at it," she says. "We had people buddy up and shadow them for the day, to see how their coworker went about collecting."

Staff began to realize that patients really wanted to know their out-of-pocket responsibility, Settle adds. "There is nothing worse than waiting 60 or 90 days and then getting that unexpected bill in the mail," she says.

Everyone collects

Settle discovered that the secret to collecting much more cash is to simply ask for it, which wasn't being done previously.

"If you ask, you usually get it," she says. "The biggest obstacle was to get people to ask."

Though a few registrars never became accustomed to the collections role and left the department over time, most have become very good at it, says Settle. "When we interview people now, we are clear that you are going to be collecting money. Everyone collects, except for insurance verifiers," she says. "If that doesn't fit your personality, this is not the job for you."

Financial counseling role

If patients can't pay their out-of-pocket responsibility, they're put in touch with a financial counselor to determine if they can afford a payment plan, if they're eligible for Medicaid or disability, or whether they meet criteria for the hospital's charity and financial assistance guidelines.

Patient registration staff play a much bigger role in financial counseling now, says Settle. "This past fiscal year, we really took control of that piece. We became the ones that steer what path the patient is going down," she says.

One vendor helps patients with disability applications, and one vendor handles more difficult Medicaid applications, but patient registration does the screening. "We brought most of the Medicaid eligibility program in-house this past year, and it has been pretty successful," Settle says. "We have hired a few people that really enjoy it."

This change means that only one person is entering the patient's room to set up a payment plan or do an application for Medicaid, she explains, and only patients who are likely to be eligible for disability or are having problems getting qualified for Medicaid are referred to the outside vendors.

When self-pay patients are found to be eligible for Medicaid after staff members ask some basic screening questions, this means more cash collections for the hospital, says Settle.

"It also helps the patient with every one of their health care bills, because they will have health care claims outside of our walls," she says.

Source

For more information on increasing upfront collections, contact:

Diane C. Settle, CPA, CHFP, Executive Director, Revenue Cycle, Sarasota (FL) Memorial Health Care System. Phone: (941) 917-1479. Email: diane-settle@smh.com.