Transcript MAHAP Presentation

2011
JAMES J. DEFRANCISCO, MBA
Lakeland HealthCare, St. Joseph, Mich., provides this collections and customer service
training course to its revenue cycle staff. The course educates staff on such topics as
insurance verification, types of insurance plans, and how to effectively communicate with
patients.
Source: James DeFrancisco. Reprinted with permission.
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Champions for the cause
Unlearning as well as Learning
Participative (Active Engagement)
The Mantra: “Your amount payable
today is $____ May I put that on a
charge card for you, M ________?”
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Deductible and co-pay increases
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Self-pay increasing
Managed Care Contract limitations
Commercial Insurance Payment slowdowns
Outpatient Services increasing
Economic changes
Uncollectable Accounts increasing
Automation challenges (installing new
systems, conversions, limitations, interfaces,
etc.)
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Higher deductibles
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Percentage of workers enrolled with annual
deductibles exceeding $1,000 increased from 16% to
40% for small firms from 2006 to 2009 and 23%
more since current recession began
Higher out-of-pocket maximums
Higher premiums
Higher employee contributions
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Employer > Employee cost shifting
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Patient focused
Employee professionalism
Integration throughout the system
Accurate and complete data
Financial accountability
Rapid cycle time
Results oriented
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One key strategy hospitals employ is to
improve efforts to differentiate between
patients who are able but unwilling to pay
and those who truly are unable to pay.
Stronger efforts should then be undertaken for
those patients without payment ability not only to
assist in determining eligibility for financial
assistance or charity care but also to aid in the
enrollment process.
 Individuals with an ability to pay can be best
served with efforts that help them understand the
obligation and processes that help facilitate
payment.
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 HFMA
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Greeting the Patient
Sizing up the Situation
Communications
Registration Process
Patient Financial Counseling
Process
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Greeting the Patient in a friendly
and professional manner
Smiles
 Make and maintain eye contact
 Assess for special needs
 Use a caring tone with an appropriate
volume
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Sizing up the Situation
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Observe for balance and gait deficits or
other discomforts
Offers the patient a chair while
completing paperwork
Offers a wheelchair if needed
Identifies special financial needs or
stressors
Uses Service Recovery if needed
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Registration Process
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Ensure the customer is comfortable
Maintain periodic eye contact
Adjust questioning to the customer’s pace
Ensures the customer has no further needs
Thanks the customer for their patience
Shows compassion with a comment of gesture
Preserves the patient’s dignity
Determines appropriate hand-off and whether the hand-off
needs to be direct or indirect
Clarifies that the customer knows their next steps
Requests payment in a friendly, courteous, and professional
manner
Alerts the next care giver of any special needs
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Greet patient’s formally.
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i.e. Mr. Smith, or Ms. Smith
Call children by their first names
Enter each room with a smile & introduce
yourself by name & title.
Know when it is appropriate to joke with
patient’s & when it is disrespectful
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Matching patient’s vocabulary is a great
technique to put patient’s at ease & increase
understanding.
Interact with family members in the room –
their comfort level is important too.
Compliment the physicians and nurses to the
patient; if we don’t have faith in them why
should we expect our patient’s to?
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When completing a registration thank the
patient for choosing Lakeland for their health
care needs.
Also when finishing a registration inform the
patient of the next step in the process
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i.e. “Please stop by the discharge office when you
leave to speak with one of our financial
counselors”
In the end, just looking at our ER from
our patient’s point of view, and going
out of our way to ensure their comfort,
makes a huge impact. We have a
chance to be the friendly, welcoming,
reassuring face of our hospital.
Patient’s will notice the difference.
Identifying
Urgent Needs
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Chest pain, pressure, tightness, or heaviness
Pain that radiates to neck, jaw, shoulders, back,
or arms
Indigestion or “heartburn”
Nausea/Vomiting associated with chest
discomfort
Persistent shortness of breath
Weakness
Lightheadedness
Loss of Consciousness
Patients presenting with these symptoms need
IMMEDIATE attention by a triage nurse
Difficulty in
Breathing
Severe
Abdominal
Pain
Trauma or Large
Amounts of Blood
Loss
We never know who or what
issue may walk through our
doors at any given time - if
you don't feel safe sending
the patient to the waiting
room then notify the triage
nurse.
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Mature, collaborative Team Player
Ability to emphasize compassion and
sensitivity in working with people
Understanding of role and how it effects
the information and revenue cycle
Independent judgment and decision
making skills
Adapts to change and is a catalyst for
change
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Understands and meets work priorities:
Patient satisfaction is number 1 priority.
 Independently manages multiple tasks
 Controls work inventories
 Results oriented - completes tasks appropriately
and on time
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Understands regulatory compliance,
insurance, and managed care
Understands clinical/financial process
relationships
Effective Collections Will:
 Increase Cash Flow
 Lower Bad Debt Expense
 Lower Costs
 Will Increase Patient Satisfaction
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IMPORTANT: Be familiar with EMTALA
regulations and be sure to follow them.
After the patient has been treated and is
ready for discharge from ER, collect amount
due – or - send the patient back to the
Patient Financial Counselor.
For patients with insurance, focus on
collection of co-payment amounts.
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For patients with insurance, focus on
collection of co-payment amounts:
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If the patient has an insurance card that has
a specific ER co- pay on it then the
Registrar will ask for that amount. Ask the
patient, “Your insurance plan has a copayment amount of $_______ for today’s
services. Do you want to pay that by cash,
check, or may I put that on a charge card for
you?”
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If the patient has Commercial Insurance but
does not have a specific co pay listed on the
insurance card then the Registrar will ask
for $50.
Ask, “We estimate co-payment amounts
based on our experience with insurance
companies to be $ 50 for today’s services.
Do you want to pay that by cash, check, or
may I put that on a charge card for you?”
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Private Pay patients will be asked to make a
payment of $200.00 which is the charge for a
Level I ER room and physician.
Ask, “Our charge for a basic level one ER
room and physician is $200.00. Since you
do not have insurance we request that you
pay this amount today. We will bill you later
for any balance remaining for today’s care
after we have all the specific charges totaled
up. Do you want to pay the basic $200.00
today by cash, check, or may I put that on a
charge card for you?”
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Patient Financial Counseling Process
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Ensure the customer is comfortable
Maintain periodic eye contact
Adjust questioning to the customer’s pace
Ensures the customer has no further needs
Thanks the customer for their patience
Shows compassion with a comment or gesture
Requests payment in a friendly, courteous, and
professional manner
Counsels and assists the patient relative to patient access
financial issues and needs
Preserves the patient’s dignity
Determines appropriate hand-off and whether the hand-off
needs to be direct or indirect
Clarifies that the customer knows their next steps
Alerts the next care giver of any special needs
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Financial Aid Programs
Health Services & Clinics
Dentists
Emergency Shelters
Food Pantries
Counseling Services
Etc.
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Friendly greeting
Call person by name (how do you want me to
address you?)
Avoid demands, jargon, and arguments
Recommend and request
Provide alternatives and options
Be objective and flexible
Know your job well
Respect privacy
Goal = Obtain payment in full while enhancing
patient relations
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Benefits
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Makes patients comfortable
Increases patient convenience and privacy
Gives Registrars flexibility
Keys to success:
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Be respectful of patients and clinical team
 Mutual respect
 Interruptions
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Maintain PMA (Positive Mental Attitude)
Be accurate
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Trauma situations
Patients complaining of Chest Pain
Patients in Active Labor
Crime victims
Patients with Mental Health issues
Patients who are violent or in restraints
Verified Worker’s Compensation cases
Email: [email protected]