Treating patients with respect during the front end and back end collection process
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Treating patients with respect during the front end and back end collection process. David Phelps Vice President Sales and Marketing Helvey and Associates October 31, 2012. Building a Culture Training It Starts at Day 1 Quality Assurance Being where the patients are The Real World.

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Treating patients with respect during the front end and back end collection process

Treating patients with respect during the front end and back end collection process

David Phelps

Vice President Sales and Marketing

Helvey and Associates

October 31, 2012


Building a Culture


It Starts at Day 1

Quality Assurance

Being where the patients are

The Real World


Health care is consumer driven

Health Care is Consumer-Driven

The current trends show an increase shift across the industry for patients to take more responsibility for Healthcare spending

Payers shifting financial responsibility to the patient

Employers are shifting healthcare costs to employees

Healthcare providers are seeing a shift in payer reimbursement to patient (self-pay)

Medicare holding steady at $135 Deductible and 20% Co-insurance

Government is promoting Consumer-Driven Healthcare as a means of slowing the growth of national healthcare spending

The real world

The Real World

  • Trying economic times

  • More and more competition

  • Not all of the PR is positive

    What are you doing to accommodate your patients changing needs?

Building the culture of respect and fairness from the top down

Building the culture of respect and fairness from the top down

  • Ways to accomplish

    • Guiding Principles

    • Open communication from the top down

      • Builds respect

    • Employee meetings

    • Regular staff meetings

    • Make the job fun

    • External motivation

Training and development

Training and Development

  • Introduce culture at the onset

    • attract more flies with honey

  • Emphasis on communications technique

    • before process training!

  • Assertive not aggressive

    • assertive is asking for what you want, refusing what you don’t want

    • The art of negotiation

    • Empathy not Sympathy

  • Don’t take rejection personally

Motivating patients to pay!

Front desk procedures with hdhp

Front Desk Procedures with HDHP

Difficult for front desk personnel to identify HDHP patients

Most of the time, only PPO is stated on the card

Need to incorporate patient verification procedures

Identify total plan deductible

Either % of deductible met or remaining deductible amount

If not contracted with plan, financial counselors should negotiate with patient or plan, and try to collect 75% to 100% up front

If patients are identified with a participating HDHP, consider collecting 75% of estimated visit costs during check-out

Communicate payment expectations with patient upon verification and again at check-in

New philosophies in pre registration and registration processes

New Philosophies in Pre-registration and Registration Processes

Shift of revenue cycle activities upstream from business office to front-end/patient access functions

Patient verification is the key to identifying HDHP patients

Develop an up front collection policy that is communicated with patients

Receptionists need to be prepared to estimate a payment amount and communicate with patients

Make use of financial counselors in communicating payment arrangements with patients

Front end collection components

Front-end Collection Components

Collecting patient responsible payments at time-of-service can reduce accounts receivable by over 15%.

Review of payer’s fee schedule of the top payers

Incorporate fee schedules into information system.

“Best” opportunity to collection patient’s portion of visit.

The earlier you communicate the more you collect

The Earlier You Communicate, The More You Collect

Estimated Collection Percentage by Front-desk Function



On month after visit:<40%

Prior to visit, healthcare is the greatest priority to patients

Psychological advantage for healthcare provider in collecting at check-in

Following the visit, healthcare drops to last priority and the “debt” becomes the high priority

Tips on improving front end collections

Tips on Improving Front-end Collections

Help staff understand what to collect and how to ask

The more comfortable your staff is on collecting, the greater your success

Provide receptionist/financial counselors with the right tools

Fee schedule and estimated exam fees

Practice management system as a guide

Collection policies and protocols

Deploy signage and “patient-friendly” collection campaign within the office

Share the collection burden

Training staff to collect money

Training Staff to Collect Money

Practice “Open Book” Management

Present to staff front desk collection variance

Remove delineation between clinical, registration and collection functions

Obtain buy-in from physicians prior to collection initiative

Deliver “Kick-Off” meeting to initiate new processes

Create clear and definitive change of process and policy

Provide consistent support

Financial counselor

Collector “Hot-Line”

Training staff to collect money1

Training Staff to Collect Money

Provide simple training tips and tricks for front desk collection appeals

Tap back office collection / customer service staff to assist training

Collection agencies will often offer to present modified versions of their own presentations

Construct role-playing scenarios

Create desktop laminated “go to” phrases for easy access.

“We can accept Mastercard, Visa, checks or cash to fulfill your responsibility of $___ for today”

Training staff to collect money2

Training Staff to Collect Money

Provide multiple “payment avenues”

All credit cards / debit card alternatives

Payment plans


Empower registrars to work with patients

Provide increased lenience for patients during introductory period

Create a 3 Strike Rule

3 times patient defers payment and does not satisfy balance within 30 days = rescheduled appointment

Exceptions allowed with justification

Training staff to collect money3

Training Staff to Collect Money

Create Incentives

Monthly bonuses for registrars based on collection thresholds


Outstanding balances


Support registrar collection initiatives

Front desk delays

Re-scheduled appointments based on financial issues

Stress physician patience

Qa programs

QA Programs

  • Before you begin

    • Justification of cost of program

      • Can you afford not to establish?

    • Executive buy in!

  • Things to think about when developing your program

    • Objective measurements

      • Difficult as customer service requires on the spot judgment

    • Consistency

      • Standard audit frequency – weekly / monthly ensures fairness

    • Minimize staff responsible for audits

    • Tie individual audit results to performance evaluation—so employees take program seriously

    • Thoroughly explain program to staff before implementing

      • Get better buy in

Qa programs1

QA Programs

  • Implementing your program

    • Don’t move too fast!

    • Trial period before tying to performance evaluation

      • Are you standards too high or low?

    • Quality over quantity

      • How many calls can be audited conclusively?

    • Review and refine—continual

      • Add or subtract criteria

      • Change weights of criteria

      • Re-examine quality standards

Being where your patients are

Being Where Your Patients Are

  • Are you a bank?

    • What are your hours of operation?

    • What happens to patients before 8am and after 5pm?

  • How do you communicate with your patients?

    • Electronic vs paper vs phone vs website…

  • Responsiveness

The cleveland clinic enterprise solution

The Cleveland Clinic Enterprise Solution


Itemized Statement

Online Registration


Paper Statement


Customer Service Department

Enterprise statement

Enterprise Statement

  • Created by combining over 140 files from various systems across the enterprise

  • Majority of patients will receive a combined enterprise statement

    • They will continue to send patients separate statements if we can not verify enough demographic information to create a combined statement



  • Patient friendly tool for online bill payment

  • Phased rollout began 2010

Myaccount features

MyAccount Features

  • Phase 1

  • QuickPay

    • Credit card/E-Check payment

    • Prompt Pay Discount

    • Payment plan option

    • Email/print receipt

  • MyProfile

  • Links to Online Registration, maps and directions, make an appointment, MyChart

  • Historical activity

  • Pre-enrollment

  • Link multiple patients to guarantor

  • FAQs

  • Phase 2

  • Request itemized statement

  • Ability to detail post payments

  • Ability to complete loan application online

  • Addition of PayPal to MyWallet

Customer service and ivr

Customer Service and IVR

Single call center for the enterprise

Self service IVR

Ability to make payment arrangements, offer discounts for prompt pay and provide information regarding loan program

Employees cross-trained East, West, Main and Florida systems

Developing a database to request updates to data in decentralized host systems

But i m not the cleveland clinic

But I’m not the Cleveland Clinic!

  • Which pieces can you implement?

    • Priorities

    • Patient Comments

  • Partnerships

    • The right partners for the right solutions!

  • Put your money where your mouth is!

    • Are you delivering what you are you telling your patients?

Thank you

Thank You!

David Phelps

VP Sales and Marketing

Helvey and Associates

800-735-0730 ext 373

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