Creating a Patient-Centric Revenue Cycle Experience

One of the most stressful situations a patient can encounter is navigating through a hospital stay.  Throughout the process, the patient and family are trying to wrap their heads around the entire experience but forget the financial impact.

After weeks of recuperation and the patient is on their way to recovery does the financial effects of their hospitalization become fully visible.

Bills start to trickle in and the family starts their journey into the revenue cycle world.

Throughout a patient’s journey, the physician and clinical team did a fantastic job explaining the cause of symptoms, procedures, and the anatomical implications. The fallout is explaining the costs associated with this journey. 

Health care systems have realized the importance of adding financial counselors into all aspects of a patient’s health care experience, therefore creating a patient-centric revenue cycle experience.

Patient-centric revenue cycle experience

 “A patient-centric revenue cycle is vital to both patient satisfaction and organizational financial health,” Healthcare Financial Management Association (HFMA) President and CEO Joseph J. Fifer, FHFMA, CPA said in advance of the HFMA Revenue Cycle Conference.

The way it works is that hospitals traditionally deny a claim and then bill the patient. The patient’s confused (and angry); he picks up the phone and calls customer service, is put on-hold for 15 minutes (or longer). Then, the patient talks with someone in customer service, who says she can’t see what the patient is talking about on their bill.

Should we really be putting patients through this? And, how do these interactions affect the patient’s experience?

Wouldn’t it be a better experience for the patient, if before the procedure and prior to discharge, a financial counselor met with the patient, explaining what their deductible is and how much they owe? And, if the patient owes money, wouldn’t it be a better experience for the counselor to assist the patient in setting-up a payment plan?

If the patient’s surgical procedure isn’t scheduled for a few months from now, the patient could even start paying the future charges.

This gets to healthcare’s Triple Aim, outlined by Dr. Don Berwick, which encourages:

  • Better care for individuals, described by six dimensions of health care performance listed in the Institute of Medicine’s 2001 report, “Crossing the Quality Chasm;” safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.
  • Better health for populations, by tackling “the upstream causes of so much of our ill health,” such as poor nutrition, physical inactivity, and substance abuse.
  • Reducing the per-capita cost of care.

Providing financial assistance

A financial counselor could explain to the patient who has a $3,000 deductible, and has met $2,500 of their deductible obligation, that they owe $500, and how would the patient like to pay?

That way the patient is not surprised by their financial obligation. They’d know how much they’re responsible for upfront and can establish a payment plan. The hospital financial counselor could also proactively establish charity care, when appropriate.

By being proactive, the patient becomes an engaged member of the care team. By engaging the patient in their financial responsibility, we make the patient part of the revenue cycle solution, and therefore create an environment where the patient is more receptive to understanding their financial responsibilities and the hospital’s revenue cycle.

The financial counselor is best positioned to educate the patient on what they’re responsible for, as well as not over-reacting when they receive a bill. For example, a patient has a procedure and receives two separate bills, one for a CT scan and the other for an ultrasound. Because the patient has already established a payment plan for what they owe, the patient knows what their insurance will cover and what is their financial responsibility.

Collection at the time of service

A recent report about telehealth services improving billing and payment practices, says that the best time to collect patient co-pays is while they’re at the facility. For example, a patient presents in the emergency department, and either at the time of registration or immediately after they are treated, the hospital should ask for the copay.

Callout: Things hospitals can do to assist patients

  • Be proactive with patients around finances
  • Listen to the patient’s concerns about finances
  • Tell patients upfront what their financial responsibilities will be
  • Help establish a payment plan for the patient
  • Dedicated phone number for financial questions
  • Ease of online payments
  • Additional call center hours

Financial education

While everyone should have a financial understanding, the majority of people do not. Hospitals can educate patients on their health care finances.

Payment plans can be established with the patient prior to services being provided, though payment plans — if offered at all today — are usually established after the patient receives care. Hospitals can also provide patient education on what their financial responsibility is prior to a procedure. Patient education should explain the different costs associated with the procedure.

To have a better understanding of health care costs to the patient, some hospitals are offering estimated pricing charts. The chart shows the average cost for common inpatient admissions, surgical procedures, and diagnostic treatments. The prices show the average cost for self-pay, insured, underinsured, or uninsured patients.

Proposed transparency rule

Price charts only show the hospital bill. They do not include specialists, anesthesiologists, pathologists, or radiologists. Personal physician or other doctor charges are billed separately to the patient, so they should know that beforehand.

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) proposed new regulations requiring hospitals to be more transparent. The CMS proposal would require hospitals to make their standard charges available online.

A positive patient-centric revenue cycle experience will not only benefit the patient and their active involvement in care, but will benefit the hospital, too.