Explore the ‘big questions’ to increase patient collections

By Amanda Macmanus, Director of Sales Strategy, Patient Access Solutions | Posted: 06/15/2018

Don't know how to collect money from patients? Is your health care system struggling to collect patient out-of-pocket costs, which today are estimated at approximately 30 percent of hospital revenue? Is the “old way” of attempting to collect patient responsibility at the back end proving ineffective and increasing your cost-to-collect?

If so, you are not alone. The shift to high deductible health plans (HDHPs) has turned patient billing and collections on its proverbial head, with patients pushing back on payment of higher out-of-pocket costs if they haven’t been informed in advance and provided with multiple payment options.

To better inform patients and improve your chances to collect, the responsibility now squarely resides with Patient Access to create buy-in upfront, calling for a whole new way to approach the problem. However, before applying a band aid to the RCM process or throwing Patient Access technology at the problem, it is important to ask yourself three big questions to assess how well positioned you are to make it happen:

How much are you collecting today?

Beginning with where you are is a great place to start as it enables you to establish a baseline on your current status. Once you’ve run the numbers, the next step is to set goals on where you want to be. While the industry gold standard set by the Healthcare Financial Management Association (HFMA) suggests that POS health care collections should average around 3-5 percent of your Net Patient Revenue, you’ll want to consider your specific circumstance to determine what is realistic (read more about customizing your revenye cycle metric in our blog, “Find your par: Focus on being your personal best”).

What is your ultimate goal for improving patient collections?

In some cases you’ll want to shoot higher, or, depending on legislation in your state, 3-5 percent may be too optimistic, at least initially. Establishing an “ultimate” goal should be based on capabilities and constraints to achieve and sustain success.

Once you’ve determined where you want to be, the next step is to create milestone goals in manageable increments of time, such as 30/60/90-day intervals. Creating these milestones is important both to generate hospital revenue and as way to celebrate incremental achievements with your team. These measures could be based on a certain dollar amount or percentage.

Once you know your baseline, collection goal and timeline of milestones to achieve your “ultimate” goal, the next key question is:

How are you going to meet your revenue management goals?

To determine the path that is right for your health care organization you’ll need to allow a discovery period, asking a series of additional questions to determine your approach.

Here are some additional questions to consider:

  • Do you have buy-in from the clinical team?
  • Does your staff know which coding services (working diagnosis codes and Current Procedural Terminology codes or CPTs) your scheduled patients are going to have?
  • Do you have trained staff who are able to ask for money in an effective way?
  • What is your process to financially clear patients and prevent medical billing denials on the back-end?
  • Do you have a quality assurance tracking program for your patient registration or Patient Access staff to limit the number of errors entered upfront?
  • Is your technology integrated and robust enough to support your team?

Additionally:

  1. Does it verify that the information given by the patient is truly accurate?
  2. Can it run auto Eligibility & Benefits (E&B) for timely and accurate review of the patient’s benefits?
  3. Does it check codes to see if prior authorizations are needed?
  4. Can it produce an accurate estimate of medical recovery services the patient is expected to receive?
  5. Does it check propensity to pay to better understand the patient’s ability to pay?

Effectively redesigning your Patient Access operation to assist with patient education and capture more of the patient’s financial responsibility is a BIG job, however the good news is that it is entirely achievable if your clinical operation is optimized to better reflect today’s patient journey. To learn more about how nThrive can help your health care organization improve the POS collections process read our eBook, “Five ways to turn Patient Access into a revenue generator.