Bad debt makes for many a sleepless night. Yet, even as the figures continue to rise at an alarming rate, I am surprised that many healthcare organizations have yet to embrace the philosophy of asking for payment prior to services being rendered.
We all know that self-pay continues to be the fastest growing payer class. Over 45 million Americans are uninsured. But did you know that 80 percent of our uninsured patients are employed, and that our fastest growing segment of uninsured is between the ages of 25 and 34 and have an excess income of $70,000? When you add the fact that patient liability after insurance is increasing due to large deductibles and co-pays, we find ourselves in a more desperate situation than we have ever been before as it relates to our collection efforts.
Desperate times call for desperate measures. I challenge you to first look within your organization to determine if your culture, philosophies and practices are contributing to your bad debt dilemma.
Payment Expectations and Myths
Ask any patient access staff member – they've heard the excuses before: "You've never asked me to pay before," or "The nurse told me to leave my wallet and valuables at home."
Could it be that you are your own worst enemy when it comes to setting payment expectations?
In order to implement a successful point of service collection program, you must first think through the issues and formalize your policy decision. First and foremost, senior management buy-in and support are critical. The first time a customer complains to administration and the staff member is reprimanded, all bets are off and you're sure to fail.
The policy must address specifics, such as: Is payment a request or a requirement? In which situations is it OK to establish arrangements? What payment methods are available? Will past due and bad debt balances be collected as well? How will the patient liability be identified? Will services be delayed or canceled without appropriate payment or arrangements? What is the appropriate path of elevation if the staff member is hitting a roadblock? These questions and many more must be considered as you craft your policy.
Now, let's talk about the physician. It is imperative that your policy and expectations be communicated to your physicians. I find that most physicians do not disagree with adopting this approach. Let's face it; they've been practicing this way for years. I can't even see my doctor without making my co-payment first!
Not All People Are Created Equal-Some Need Training
Some are certainly more talented than others when it comes to asking for money. I remember working in a hospital where I had a staff member (we'll call her Susi), who was incredibly successful in her point of service collections. I decided to observe Susie one day to really understand her techniques and see what I might incorporate in the training program for my other staff members.
During my observations, I noted that as Susie went through explaining the paper work and obtaining consents and the like, she ended with "and it's going to be $X.00 today, we take cash, check and credit card" then she promptly got up from her chair to leave the couple alone while making copies. The couple looked at each other and discussed the fact that they hadn't planned on paying, but within a few minutes had pulled out "the wallet." I noted that Susi had been monitoring what the couple was doing from the copy machine and when the wallet came out she promptly returned to her desk to take the money.
Now, this technique may not work in all situations, but what I learned from Susi is that she did not give the couple an option NOT to pay. Too many times we talk too much instead of just allowing our customer to respond to our request.
A solid training program with defined competencies and expectations is imperative to a successful point of service program. It is important to remember as well, that a single training session is not sufficient. With turn over, new employees and new techniques, training sessions should be repeated on a monthly basis. It is also recommended to develop scripts. One organization put together a number of rejection statements and the appropriate responses in a color-coded laminated tool for the staff to reference. Role-playing is also a great method to ensure your staff is comfortable in asking for money.
Customer Satisfaction
We assume that when asking for money that somehow customers will be dissatisfied or offended. The fact is that the customer wants to know. By separating the financial aspect of the visit from the clinical aspects of the visit we improve overall satisfaction. One particular health system in Ohio contacts the patient or guarantor up to 30 days in advance of the scheduled treatment to discuss benefits, patient liability and payment options. In 70 percent of the cases, the organization is successful in collecting the patient portion prior to services being rendered. This accomplishes several things: First, it puts the customer's mind to rest in that the anxiety related to the financial aspect of the visit is resolved before the visit occurs, and it avoids "post-treatment" sticker shock after services have been rendered.
Incentives and Celebrations
Consider implementing some type of incentive program or celebratory events to recognize and acknowledge staff members. I am a firm believer in establishing goals, both departmental and individual. I am also a firm believer in health competition. Post results for all to see. Rewards may be monetary, a special privilege, food or just about anything.
Another large hospital system has implemented a program in which the staff is incentivized with a bonus based on a percent of their specific point of service collections. Regardless of what incentive program you choose, you'll find the results of implementing such a program the icing on the cake!
I challenge you! We can all continue to sit around and complain about the bad debts continuing to grow, or we can do something about it. Go forth, conquer your bad debt. The tools are within your grasp. Foster a culture that supports your policy decisions. Give your staff tools and training to assist them in being successful and achieving their goals. Implement training programs and offer incentives. By embracing these techniques you too will be collecting with confidence!
Julie Waddell, CarePricer® Owner
To learn more about collecting with confidence, visit Accuro CarePricer.
