Michelle Moore Manager, OutPatient Registration Services Angelica DelVillar Registration Lead Representative, OutPatient Services PIH Health Whittier, California
PIH Health is the dominant hospital provider in its area 444 beds (and growing ) 57 Bed Emergency Care Center Average ED Census: 70,000 patients per year 190 patients a day Payer mix: Medicare 24.5% Medi-Cal (Medicaid) 10.3% HMO-Commercial 18.4% HMO - Medicare 24.2% PPO 13.4% Other 9.2%
Quick Registration at check in point Triage: To Bed or Lobby Rooms are divided by a team based workflow (6 teams): ED Physician (or PA), RN, Unit Clerk and Registration Representative per team Approx 10 rooms per team Bedside registration: after medical screening /EMTALA The Registration Representative is responsible for all aspects of the registration process for each patient they register from start to finish: registration, financial counseling, POS collections ect.
POS collection improvements in the ED Tools can be used in any front end registration department How we got to where we are today Steps we used to become successful in our POS collections Scripts Reward and Recognition
Insurance Verification and Up-Front Collections Indicator Collection of elective service deposits prior to service Collection of inpatient patient-pay balances before discharge Collection of outpatient patient-pay balances before service Collection of emergency room patient-pay balances before departure Screening of uninsured inpatients and high-dollar outpatients for financial assistance Best Practice 100% 65% 75% 50% 95% IMA Consulting: IMA Insights, Revenue Cycle Self-Assessment: Mapping a Course to Nationally Recognized Revenue Cycle Performance, Vol 9 Issue 11 November, 2011.
Review a 6 year time frame of ED POS collections and points of success and improvement. 2006 2008: ED POS collections increased by 25% 2008 2009: ED POS collections increased by 32% 2009 2011: ED POS collections increased by 20% Overall, from 2006 2011 our ED POS collections increased by more than 55%
2006 in the beginning 1 st Step: Help the ED Registration staff understand the purpose of POS collections: It is a service to our patients so that they are aware of their liability right away and can take care of payment or arrangements so they can focus on their care and recovery and do not need to worry about a bill later on. Reduce overall bad debt for the organization Saves time and money from billing on the back end Secures money that otherwise might not be paid. Upon billing after insurance payment, only 40% of patients pay their bill. In Aug, 2011 we looked at all the insurance accounts that went to collections that originated in the ED; representing over $167k for just one month. Since we know only 40% will pay when we wait to bill them after insurance pays, we can figure that in one month the $100k the ED is collecting prevented another $60K from going to collections.
2 nd Step: Change our expectations : Managers, Registration staff also, we needed to begin to change our patients expectations. Begin with asking. #1 Way to improve your POS collections *** Expect your staff to ASK EVERY PATIENT who has a liability to pay*** (seems simple but I guarantee, this is missing) Before 2006, staff just asked sometimes or would take the payment only if offered. Low performers when asked by Supervisor would always say, well no, I don t ask every patient. Patients knew we would not ask, that was their expectation, so they did not come prepared. At one point in 2008 our Short Stay Surgery department had almost $1 million in bad debt with Self Pay accounts. Last year it was down to $325K. What a difference asking for money makes!
Your organizational culture will take some time to change; for staff and patients. Expect that the patient will pay: A mindset the staff needs to adopt and will over time. A perception the patient should feel from staff when they ask for the payment. How is the question/conversation being approached? Caring, Compassionate, Respectful, Knowledgeable and Confident. Take a pause after you ask for payment. Let the patient speak and answer. Biggest hurdle You have never asked before? That is probably true, so just apologize and say I m really sorry about that, we realized we may not have done a great job with this in the past and I understand this may be unexpected. However, we have now modified our process and are required to ask for payment at the time of service. This way you can focus on healing after your services today and not worry about getting a bill in the mail or having to deal with sending a payment later. How would you like to take care of your payment today, cash, check or credit card?
Training At staff meetings: Understanding why and purpose Expectations Basic skills Scripts Collection Buddies One on one training with Leads using role play examples or shadowing. Random customer survey with our patients by a Lead: 6 patients a day: 2 patients per shift (lower acuity) 3 questions: 1-5 (5 being a great experience) 1. How would you rate your registration experience today? 2. How satisfied were you with your questions being answered regarding registration and your insurance benefits? 3. Upon collection of your liability today for services, how would you rate the customer service that was provided to you? **Have a place for the Lead to write additional comments for you to review** Thank the patient for their time and ask.. Is there anything else I can do for you before I leave?
2006 2008: Started with asking Changed our expectations Training Rewarded staff End of 2008, we increased our department monthly goal to the highest amount we had collected in the past 2 years. ($42,807 - new goal $72,645) Staff knew they could do it! Step 3: implemented some automated tools to assist staff with POS Collections: 2009 was our biggest success with increasing POS Collections. We increased by 32% in the ED Registration Department this year! (from $666,821 to $968,747) By 2009, we started to see a real change in personal expectations ; from our staff and patients.
We implemented a online payment process program Provide a print out of patient payment estimate Use best practice collection steps: ***Do not stop at the first No *** Focused on scripting more Sending Dear Patient letters on the day of service if POS collection was not paid Implemented employee individual collection expectations Post all employee collection stats monthly. Post quarterly collection averages and place employee in the category where they fell Daily Productivity Report: staff calculates their own collection percentage daily so they are aware and accountable of where they are on a daily basis. Keeps them actively tuned in. Increased the reward and recognition for staff efforts to keep them motivated and excited to continue to do well.
What we did to continue our POS collection success: Implemented an online payment program that enabled us to provided more payment options for our patients: Postponed payment Payment plans Implemented employee payroll deduction program in ED Registration Patient Payment Estimator: One page print out that shows the patients estimated liability. Provide to patient when asking for liability. Professional and shows the patient we retrieved information directly from their insurance company. Breaks down their liability total. Improved our PPO collections as we never asked for these liabilities in the ED before. Changed the way were handling the No s.
Do not stop at the first No! Start with a general statement/question: You have a $xxx co-pay/$xxx co-insurance for PPO/estimated amount for Self Pay for today, how would you like to take care of that? We take checks, credit cards and cash. *Pause If NO #1 Rule: Always ask an open ended question. Never use questions that may end in a yes or no answer 1. I understand. We can take a payment/deposit of half of the amount today? 2. I know this may be difficult and unexpected. What CAN you pay today? 3. Thank you, I understand. I d be happy to help you. Let s see if there is something we can do to take care of the balance. Let s work something out together that will work for you. a. I can offer you a postponed payment? Maybe for the date of your next payday? Next month? What date would be good for you? *Pause b. I understand, no problem. Let s figure out something that will work for you. I can offer you a payment plan? How many months do you think you would need to pay off this balance? Always end with thank you! Is there anything else I can do for you?
Scripting. Just send me a bill: We have checked directly with your insurance and fortunately your coverage is active. The estimated amount due listed on your insurance contract is $xxx. We have options for you to take care of this amount today if you are unable to make the full payment right now. How would you like to take care of your payment today, cash, check, credit card or if you prefer we can discuss a postponed payment or payment plan? Which one would work best for you? I didn t bring my wallet: I understand this may be unexpected. If you would like to use our telephone to call someone who can access your credit card, we are happy to take your payment over the phone. If still no, give them a business card for the dept and say, Please go ahead and give us a call as soon as you get home and are feeling better. We can take your payment over the phone so that you don t have to worry about getting a bill later on. I d rather wait to see what my insurance covers before I pay: For your benefit, we ve confirmed directly with your insurance which portion of your services are covered. The estimated amount you owe is $xxx. How would you like to take care of that today, cash, check or credit card?
If after requesting full payment, half, what CAN you pay today and all options and the patient still says no thank them and send a Dear Patient Letter. ***Note: we also provide a Self Pay Packet and encourage an Uncompensated Care application be filled out in appropriate circumstances; in any part of the steps. 12401 Washington Blvd. Whittier, CA 90602-1099 (562) 698-0811 Ext. 12575 Hearing Impaired and TDD (562) 696-9267 Patient Notification of Estimated Financial Responsibility Patient Name Account number Dear, Thank you for choosing Presbyterian Intercommunity Hospital s Emergency Room for your healthcare needs. I contacted your insurance company for you. Based on the information provided; We ESTIMATE you have a financial responsibility of $. This includes a co-pay or co-insurance amount based on the hospital contract with your insurance and estimated charges.
Request payment from all patients that have a liability. Consider a minimum of 50% POS Collections in the ED. 50% represents: 50% of all patients the employee registered who had a liability. Post stats monthly (at least quarterly) so staff is aware of where they are. Daily Productivity Report
.005% of what ever is collected goes to those who collected 70% or above for the month. (they must meet accuracy requirements as well) - $100,000 - $500 Incentive The more they collect, the bigger piece of pie the top collectors will share. Other fun rewards.. Raffle tickets: give a raffle ticket for each time they collect 100% for the day, full Self Pay payment, any other idea you are trying to promote. Pick a name out of the raffle at the end of the month for a prize. Pizza parties Lunch or Coffee Tickets Thank you cards: in their work mailbox or send to their home Post their name and the day prior success story in the office board for all to see. Congratulation email recognizing a staff member (send to all staff) Or
100% Collections for the day Full Self Pay collection No registration errors for the day Or to promote anything else you are implementing ***10 Reg Bucks: buy back an error 25 Reg Bucks: Lunch or Coffee Ticket 50 Reg Bucks: 2 Movie Tickets 100 Reg Bucks: $25 Gift Card of your choice
Teach the purpose of POS collections to Registration staff Change our expectations: Managers, employees and patients Understand this will take time Begin with asking every patient for their liability Ask in a caring, compassionate, respectful, knowledgeable and confident manner *Pause*, let patient speak and answer You have never asked before.admit, apologize and ASK Train staff on a continued basis scripting Set obtainable goals Provide patients with payment options Do not stop at the first No : pay half, what CAN you pay today, options and then. Send Dear Patient letters the same day for those who do not pay at time of service Post collection stats, ensure staff always knows where they are at with performance Increase your reward and recognition for staff to keep motivated
Questions??? Michelle Moore Michelle.Moore@pihhealth.org Angelica DelVillar Angelica.DelVillar@pihhealth.org