THR Practices for Improving Point of Service Revenue ...



Scripting for Improving

Patient Financial Communication and Revenue Efficiency

It is the responsibility of the Patient Access Leadership team at each facility to ensure all staff interacting with patients during the intake and collection process are thoroughly trained in all aspects of the financial counseling/collection process. When a patient is scheduled or presents for services, it is imperative that staff are able to help educate the patient on their financial responsibility and their options.

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Effectively Handling Point of Service Collections

During the Pre-registration Process:

Telephone Call – Prior to Service - Beginning and End of Call

|Beginning of Call |End of Call |

|Insured |Thank you for your payment of ($) Is there anything else I can help you |

|“Based upon the information provided today by your physician and according|with today? |

|to your benefits, the deposit amount due for this service is ($). Please | |

|understand that this is only a deposit calculation and that once the |Thank you for choosing xx Hospital for your healthcare needs. |

|insurance company processes the claim, you will be billed for any | |

|additional amounts that you may owe. Please keep in mind that your policy| |

|is a contract between you and your insurance company. They may not pay | |

|for all of part of your services if you did not follow the plan’s terms. | |

| | |

|I must also advise you that this deposit calculation includes the hospital| |

|bill only. You will be billed separately for other physician services. | |

| | |

|We accept all major credit cards and can process checks electronically. | |

|Which payment method would you prefer to use today?” | |

| | |

|Uninsured/Self Pay | |

|“Based upon the information provided today by your physician the deposit | |

|amount due for this service is ($). This amount includes a 45% discount | |

|that the hospital offers self pay patients. | |

| | |

|I must also advise you that this deposit calculation includes the hospital| |

|bill only and is only a deposit amount. You will be billed separately for| |

|other physician services. | |

| | |

|We accept all major credit cards and can process checks electronically. | |

|Which payment method would you prefer to use today?” | |

Sample dialog with patients during the registration process:

|Patient Excuse |Registrar Response |

|“I can’t pay that balance.” |“I understand and can work with you on a deposit amount. I am able to |

| |accept 50% of the deposit amount today, which equals $xxx.xx. The |

| |remaining balance will be billed to you once services have been rendered. |

| |At that time, you will be able to make payment arrangements on the |

| |remaining balance. How would you like to take care of that today?” |

|“I can’t pay the minimum amount” | “Similar to your physicians’ office, payment is due at or before services|

| |are rendered. I can accept a minimum deposit with the understanding that |

| |you will be agreeing to payment arrangements once you receive your bill? |

| |As mentioned previously, I can accept all major credit cards and checks |

| |electronically. Which payment method would you prefer to use today? |

|“I can’t pay that either” |Will you be able to make payment arrangements on your balance once a bill |

| |has been received? If so, we can go ahead and provide services today with|

| |the understanding that you will be billed and will be responsible for |

| |completing your payment arrangements with the CBO. |

|“I have no insurance” |“I understand. We are pleased to offer you an uninsured discount of 45% |

| |and that will bring your deposit due to $________”. How would you like to|

| |take care of that today?” |

|“So is this all I am going to owe”? |“What I am providing you is a deposit calculation based on the information|

| |that I have today. Once your insurance company processes and pays your |

| |claims, we will inform you of any amount you may still owe.” |

|“My Ex-spouse is responsible for paying these bills” |“I understand. Unfortunately we cannot become involved in divorce |

| |decrees. As the presenting parent you are the responsible party for this |

| |account. You, in turn, can seek reimbursement form your ex-spouse. How |

| |would you like to take care of that today? |

|“Send the bill to my attorney” |“Unfortunately, attorneys cannot guarantee the outcome of a case and |

| |therefore cannot guarantee payment for your claims. We’ve found that it |

| |works best for all parties involved if payment is made at the time of |

| |service. Once a settlement is reached, you will be reimbursed from those |

| |proceeds. I’d be glad to put this on your credit card or I can process an|

| |electronic check. Which payment option would work best for you?” |

|Patient Excuse |Registrar Response |

|“Why do I have to pay my outstanding balance?” |“I understand that this may be something new for you. However, health |

| |care financial responsibility is a mutual relationship between the |

| |hospital and those who utilize its services. We provided those services |

| |for you on _____ and your outstanding balance is $________ . How would you|

| |like to take care of that today?” |

|“Is all you care about money?” |“I know that talking about the patient’s portion due is sometimes a |

|“Are you afraid I’m not going to pay after I leave?” |difficult subject. We have, however, found that it is best to talk about |

| |it up front so that there are no surprises for anyone later on. By doing |

| |this, I’m able to offer you to pay now and then be billed for the |

| |remaining balance. May I process this on your credit card today or we can|

| |process your check electronically.” |

|“I’m always overcharged and it takes forever to get your money back.” |“I understand how frustrating that can be, We’ve done our very best to |

| |make sure we have provided your deposit amount correctly. If you find |

| |that you are due a refund, please call our business office directly at |

| |xxx-xxx-xxxx and they will follow up and ensure your credit balance is |

| |promptly refunded. Now… how would you like to take care of this today?”|

|“I’ll have to discuss this with my spouse.” |“Sure, I understand. I can give you my direct line so that you do not |

| |have to be routed back through the queue. You may call me at xxx-xxx-xxxx|

| |and I can take care of the payment at that time.” |

|“It’s not right to pay for a service before you have it done!” |“I understand this may be something new for you. We have, however, found |

|“I’ll pay after my insurance pays.” |that it is best to talk about it up front so that there are no surprises |

| |for anyone later on. Also, once you’re finished with your test/ |

| |procedure, you’ll be ready to go home and won’t have to worry about |

| |stopping back by patient admissions/registration. How would you like to |

| |take care of your balance?” |

|“Show me the bill?” |“Sure! I’d be glad to discuss with you how we arrived at your estimate |

| |today….” |

|“That’s why I have insurance” |“Unfortunately insurance rarely covers all costs. As a service to you, we|

| |have already verified your coverage benefits and your deposit amount due |

| |today is $______. How would you like to take care of that?” |

|Patient Excuse |Registrar Response |

|“I don’t get paid until next week” |“For your convenience I would be glad to post date the transaction on your|

| |credit card or a check for the date of your paycheck or the date of your |

| |service.” |

|“My insurance company said I do not have to pay up front.” |“According to our contractual relationship with the payer, we are |

|“My employer told me not to pay because my insurance is contracted with |permitted to collect deductibles, co-pays, and the estimated patient cost |

|your hospital.” |share at the time of service. How would you like to take care of your |

| |deposit today? “ |

|“My doctor said I did not have to pay” |“Keep in mind that the payment for hospital rendered services is separate |

|“I’ve already paid the doctor.” |from physician charges. I know receiving a bill from different providers |

|“My doctor just said to come on over…” |can become confusing. That’s why it’s important for us to let you know |

| |what your deposit amount due to the hospital will be before you have the |

| |service performed. Perhaps you doctor was referring to your account at |

| |their office.” |

|“I don’t have any money.” |“I understand. Why don’t I have you talk with our Financial Counselor? |

|“I can’t afford it right now.” |This will help us determine how we can assist you in resolving your |

|“I am not working. How can I pay if I don’t work?” |account balance.” |

|“I’m going to file bankruptcy.” | |

|“I’ve never been asked to pay before.” |“Depending on what service you had last time, you may not have had to pay |

| |a co-pay/co-insurance at that time. If the service was in a previous |

| |benefit year, maybe you had already met your deductible and or OOP max. |

| |Perhaps you had a different insurance last time you were here or maybe you|

| |also had a secondary policy that picked up where the primary left off. As|

| |you can see, there could be several reasons why you were not asked to pay |

| |at the time of service. How would you like to take care of your balance |

| |for this visit?” |

|“I was in a car accident that wasn’t my fault!” |“I understand. We’d be happy to bill your medical insurance. They will |

| |pay the claim according to the terms of your policy. After a final |

| |determination of fault is made by your insurance company, they will direct|

| |you to your next steps. As a service to you, we’ve verified your coverage|

| |and your deposit due today is $_____. How would you like to take care of |

| |that?” |

What to say?

|Bad Phrases |Better Phrases |

|“I want you to… |“Here are some options for you…” |

|“I need you to…” |“Did you know you can…” |

|“We require…” |“May I suggest …” |

|“Our policy states…” |“As a service to you…” |

|“Would you like to pay today…” | |

Patients treated through the Emergency Department will be triaged first to determine their medical condition. Collection of the advance deposit, co-payment and/or deductible will not take place before completion of:

• The Medical screening exam and

• Initiation of any necessary stabilizing treatment for an emergency medical condition. Stabilizing treatment does not have to be completed before the financial discussion begins, but the treatment must have been started and cannot be hindered or delayed by the discussions.

Basic demographic information will be obtained and once patient is screened and stabilized in accordance with EMTALA, financial conversations can take place. Insurance information will be electronically verified to determine patient co-share or patient card / template will be used for deposit information.

If appropriate, patient may be referred for financial assistance options

|What if the patient wants to know how much services will cost before the |“Your health is the most important thing to us right now. You will be |

|medical screening evaluation and stabilizing treatment? |provided with a medical screening examination and stabilizing treatment |

| |for an emergency medical condition, regardless of your ability to pay. |

| |However, after your examination and emergency treatment, you will be given|

| |the opportunity to provide insurance information or to make arrangements |

| |for the payment of services today.” |

|What if the patient insists on obtaining the information regarding |“We understand that you would like to know in advance how much you would |

|payment? |be charged for the services we provide to you today. However, we are |

| |restricted by law from discussing financial arrangements with you prior to|

| |your medical screening condition.” |

|What if the patient states they will leave if the information is not |“I will call the charge nurse on duty so that she can more fully explain |

|provided? |the hospital’s policy to you and some of the risks of leaving prior to |

| |being seen by a qualified medical person.” |

Sample Script for ED Patient Service Representatives

 

Patient/guarantor arrives in emergency department check-out area:

 

Patient Service Representative: Good morning/afternoon (applicable title and name). Thank you (name of care professional if patient was escorted). My name is _______, and I am a patient service representative here at (name of hospital). I'm sorry an emergency brought you here today, and I hope things are better now.

 

Let me explain quickly what we will be doing. Is that OK?

 

If patient answers no:

 

Patient Service Representative: What may I help with before we go on?

 

Based on the response, it may be necessary to reconnect with the care professional or allow the patient some time to take care of some immediate need, e.g., go to the restroom, get a beverage, hand off a child.

 

If patient answers yes:

 

Patient Service Representative: I just need to review some of the information you have provided. We want to be sure we have complete and accurate information to file a claim with your insurance company. Let's go over this quickly, and please feel free to interrupt me if you don't understand something or if we have recorded something incorrectly. Does all of that sound OK to you?

 

1. If patient is insured, patient service representative reviews guarantor information and insurance information.

 

Patient Service Representative: Great. Then let's move on. We will file an insurance claim with your insurance plan within the next 72 hours. You will receive a statement from us if your insurance company delays payment; thus, you will be aware of our progress with your insurance company. If there is an excessive delay, you may trust that we will contact you to assist us in getting your claim resolved to your satisfaction.

 

Your insurance has a $____ co-payment for emergency department services. Will you be paying by check, cash, or credit card today?

 

1a. If patient wishes to pay at this time:

 

Patient Service Representative: Thank you. I will prepare your receipt.

 

There is an exchange of the payment and the receipt.

 

Patient Service Representative: Thank you again, and if you have any questions, please feel free to contact our billing department at (phone number). They will be happy to assist you.

 

Always close with:

 

Is there anything else I may help you with at this time?

 

1b. If patient does not wish to pay at this time:

 

Patient Service Representative: I understand. In that case, let's discuss what payment options are available to you.

 

At this point, the patient service representative refers to the financial assistance policy and offers the following options in this order:

 

Patient Service Representative: I can offer payment in full within the next 30 days?

 

 If the patient expresses a financial hardship, the patient service representative offers the following options in the following order:

 A.  I can take a deposit at the time and provide you with a contact number for our central business office so that you may set up a payment arrangemnent? 

B. I can refer you to our Medicaid eligibility firm – ECI, to see if you may qualify for Medicaid assistance.

 C. I can give you our financial assistance (charity) application, explain the requirements, and give you an envelope to mail it back to us after you complete it.

 

 Always close with:

 

Is there anything else I may help you with at this time?

 

2. If the patient is not insured, the patient service representative estimates charges and requests payment in full by check, cash, or credit card. Please refer to the Co-payment Schedule to determine the appropriate level deposit to request payment by check, cash, or credit card.

 

Patient Service Representative: Great. Then let's move on. Since there is no insurance coverage, The deposit requirement for your visit today is $_____ (refer to Co-payment Schedule) Will you be paying by check, cash, or credit card?

 

Patient: I will pay by _____ (check, cash, or credit card).

 

Patient Service Representative: Thank you. I will prepare your receipt.

 

There is an exchange of the payment and the receipt.

 

Patient Service Representative: Thank you again, and if you have any questions, please feel free to contact our billing department at (phone number). They will be happy to assist you.

 

Always close with:

 

Is there anything else I may help you with at this time?  

Source: Texas Health Resources. Used with permission.[pic]

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