Patient Collections: How I.T. Helps Sort Out the Mess

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In the era of high-deductible plans, managing patient collections is sure to become one of the biggest revenue cycle challenges. Now, providers must do far more than establish insurance eligibility or qualify patients for charity care. Below, two providers describe their use of niche revenue cycle applications and how they plan to address these challenges.


Hospital: Nebraska Orthopedic, Omaha

Tools: Payment Portal, Reminder Calls

The Omaha-based hospital has a number of systems in play across the revenue cycle. At the front end, it uses an eligibility checking package, from Passport, which offers insurance information such as co-pays and deductibles. The hospital tries to collect as much as possible in advance for inpatient services, usually at least 50 percent of any anticipated patient obligations, says Lisa Wiley, patient financial services manager. The hospital is learning to cope in the new era of high-deductible plans, adds Anna McCaslin, CFO. “In years past, we were not aggressive to ask,” she says. “Now we will look for the deductible in advance.”

Of course, many patients lack the resources to pay their entire bill upfront. With these patients, the hospital’s financial counselors set up payment plans. Patients have the option of setting up online payment plans, via a portal the hospital launched in 2009. Provided by ePay Healthcare, the portal offers a secure environment in which patients can review their statements and make payments via credit cards or checking account deductions. The software enforces perameters around payments, such as requiring minimum payments and not letting payment plans exceed certain time limits, notes Wiley.

The portal has proven popular with patients. Nebraska Orthopedic collects a little over one-third of self-pay patient revenue via the portal, says McCaslin. It streamlines collections management and also generates analytics around collections. Nebraska pays a transactions fee each time money is collected. But payments post automatically to the hospital’s core revenue cycle system (the hospital is now gravitating to a Cerner system, which will replace its legacy system). That’s a workflow efficiency that makes the investment worthwhile, the CFO says. ‘This makes collections easier to administer,” she says.

A second system in play at Nebraska Orthopedic is an automated payment reminder set-up, from TeleVox. The vendor also provides automatic appointment reminders via an interface with the hospital’s legacy revenue cycle system. When balances come due after treatment, the system will prompt the patient with a call, although the recorded message does not mention the amount due. “Some patients pay no matter what, and some won’t pay, but there is middle ground of patients who just need prodding,” says Wiley. “This system prods them.” Usually after the second call, most patients pay up or set up a payment plan.


Hospital: Atlantic General Hospital, Berlin, Maryland

Tool: Patient-facing Systems for Documentation Gathering

The 62-bed hospital sees annual revenue of about $110 million, equally split between inpatient and outpatient services, says Cheryl Nottingham, vice president of finance. It’s an industry dichotomy that confuses many patients—who are in line sometimes for a flood of bills from the facility and the physicians. That’s one reason the hospital embarked on a move to “patient friendly billing” nearly 10 years ago, notes Jean Marx, financial analyst. The goal is simple: make any and all patient communications around financial issues clear and easy to understand.

Atlantic General has just added a patient portal, from its EHR vendor Allscripts. Initially, the portal will enable patients to review their health record. But in a later iteration, the portal will enable online bill payment and financial statement access, says Mickey Griffin, director of patient financial services.

In addition, the hospital is adding electronic signatures for various patient forms, include consents, release of information and financial responsibility acknowledgements. “We want to be paperless,” Griffin says. “Right now, we print a form, the patient signs it, we scan it and append it to their file. When they electronically sign, the form will automatically go into the system.” The electronic signature capacity is from NTT Data, the hospital’s revenue cycle system vendor for registration, billing and collections.

Atlantic General also hopes to include electronic patient kiosks in its registration and scheduling areas. These kiosks would enable patients to enter various demographic and insurance data, and also pay any upfront co-pays before service, Griffin says. A vendor search committee is just getting underway.

Despite such advances, there are still gaps in the revenue cycle that make patient billing and collections difficult. Griffin’s biggest I.T. wish list item is a better interface between its hospital and physician billing systems. Ironically, the two platforms are from the same vendor, Allscripts. “We have issues transferring data back and forth,” she says.  “We’re looking at how to integrate them.”

As a result, patients have to call two places with hospital or physician billing questions. “If we had an integrated system, we could have just one place to call,” Griffin sighs. Allscripts is offering a patch, an additional piece of software that would facilitate the transfer of demographic and insurance information between the two systems, thus streamlining collections. “Patients won’t have to provide the same information twice,” Griffin says. “But on the back end that won’t help much with statements. We’ll still have to send out separate statements.”


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