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Transforming Point of Service Collections. AAHAM Rocky Mountain Chapter and HFMA Colorado Conference 2011. Introductions. Leslie Richard – Centura Health Corporate Director of Revenue Management (Patient Access) Darcy Kochevar- Porter and Littleton Adventist Hospitals

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Transforming Point of Service Collections

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transforming point of service collections

Transforming Point of Service Collections

AAHAM Rocky Mountain Chapter and HFMA Colorado

Conference 2011


Leslie Richard – Centura Health

Corporate Director of Revenue Management (Patient Access)

Darcy Kochevar-Porter and Littleton Adventist Hospitals

Director of Patient Access

Keri Karl-Parker Adventist Hospital

Director of Revenue Management


We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities.


Centura Health

  • Largest Colorado health care provider
    • $1.8B in revenues
    • 13,000 employees
    • Nearly 6,000 affiliated MD’s
  • Services
    • 13 hospitals
    • Clinics with ~ 200 providers
    • 7 senior living communities
    • Home care
    • Hospice
key success factors
Key Success Factors

Set Realistic Goals by defining POS

Centura POS is 5 days post dc

High Pre-Registration Rate

Payment Estimator Tool


Executive Support

Collection Incentives

project background drivers for change
Project Background – Drivers for Change
  • Healthcare costs are shifting more to consumer
  • Centura lacked a robust tool for estimating service costs and patient balances
  • Processes for estimating balances and costs were not standardized across departments and facilities
    • Used a combination of spreadsheets, files, and past accounts to provide these amounts
  • Monthly point-of-service collections were under $500,000
    • Analysis indicated Centura had the opportunity to improve collections by more than $1M per month
pos collections opportunity
POS Collections- Opportunity

The opportunity to collect is greatest at Time of Service

Institute for Health Care Revenue Cycle Research - A Division of Zimmerman, LLC. National Pledge to Reform Uncompensated Care Reform Underway: Adopting Best Practices to Reduce Uncompensated Care and Improve the Patient Experience. a special supplement to PATIENT PAYMENT BLUEPRINT™

project background creating a team
Project Background – Creating a Team
  • POS project management team was comprised of leaders and staff from across the Centura system
    • Included patient access, charge audit, IT, managed care
  • Key deliverables from the POS project management team’s efforts
    • Securing of buy-in from leadership, staff, and the community
    • Selection of a price estimator
    • Revised policies and procedures
    • Implementation and training for staff
    • Challenges faced—and results achieved
project background goals
Project Background – Goals
  • Improve POS collections as a % of net revenue by 1% or more
  • Specific goals for each Centura facility varied, depending on factors like their volume and patient mix
    • FY 2010 target: 1.0% improvement
      • Range for individual facilities: 0.8% – 1.5% of NPR
    • FY 2011 target: 1.3% improvement
      • Range for individual facilities: 1.0% – 2.2% of NPR
  • Collect at least 50% of patient responsibility before service is a goal, but is not mandated and is facility specific
  • Leverage upfront collections and standardized Patient Access processes to “get things done sooner and faster within the revenue cycle”
identifying an out of pocket cost estimator
Identifying an Out-of-Pocket Cost Estimator
  • One important step in achieving POS collection goals and providing transparency to patients was developing a consistent, standard process for estimating balances
  • Selection team met with several vendors to evaluate different programs
  • Chose system that incorporates charges along with contracts
    • Produces allowable amount
    • Lists patient benefits
    • Reasonable cost to organization
securing buy in for pos process improvement
Securing Buy-In for POS Process Improvement




  • Staff were initially hesitant to focus on obtaining patient payment
    • Thought this practice conflicted with their mission to provide care and had a difficult time asking for financial contributions
  • Provided education and soft-skills training to emphasize importance of collecting at time of service
  • Held leadership and departmental meetings at each facility to explain new processes and demonstrate financial benefits of improving collections
  • Held individual department meetings with clinical units to gain understanding and partnership. This is still a challenge depending on the facility and the nursing unit.
  • Started to request payment from scheduled patients at time of pre-registration using verbal cues
    • “Based on the plan you have with your insurance company, that leaves patient portion of $X for your procedure”
  • Most receptive to the idea when staff connected payment amount back to insurance plan
  • Best results occur when the patient is notified 5-7 days prior to service of their financial obligation
establishing standard policies and procedures
Establishing Standard Policies and Procedures
  • Not only did our efforts to improve POS collections need to include price estimation—we also had to standardize policies and procedures to ensure all facilities and staff were on the same page
  • Strive to collect patient portion based on estimate
    • If estimate for scheduled procedure can be determined, attempt to collect at least half of patient responsibility.
  • If estimate cannot be determined (primarily non-scheduled), ask for set amounts by patient type:
    • Outpatient: $50
    • Same-day surgery: $250
    • Emergency room: $25
    • Inpatient: $200
  • Some groups are excluded from the target calculation listed above:
    • Patient types: observation, recurring, newborns
    • Financial classes: auto, charity, Medicare, Medicaid, Worker’s Comp
    • Locations: mammography, lab, Flight for Life

Establishing Standard Policies and Procedures (cont.)

  • During pre-registration, staff notify patients that health benefit advisors (insurance verification representatives) will contact them regarding expected financial responsibility
    • “We’ll be verifying your benefits and determining your patient portion, and you’re going to be hearing back from one of our health benefit advisors.”
  • When balance estimate is determined, health benefit advisor contacts patient
    • “I was able to verify your benefits and determine your patient portion. Based on the insurance plan you’ve selected, your patient portion for the MRI comes to $X.”
  • Centura offers payment plan for patients requiring financial assistance
    • Reduce by x% of total patient responsibility based financial need
    • Can break payments out in “x” number of months or dollars
    • Account Balance Plan Duration▪ < $500 No more than 12 months▪ $500 - $1499 No more than 18 months▪ $1500 - $4999 No more than 24 months▪ > $5000 No more than 36 months
    • Discounts for self-pay patients
      • General discount
      • Prompt-pay discount

Assisting and Motivating Staff – Scripting

If patient says, ““You have never asked me for payment before; you have always billed me.”

Response – Prior to Date of Service“I apologize if there were previous inconsistencies in our processes, but we are now required to request payment on or before the time of service when the insurance carrier indicates there is a patient liability. We will be happy to process the appropriate payment for you upon arrival on your day of service.”

Response – Date of Service“I apologize if there were previous inconsistencies in our processes, but we are now required to request payment at the time of service when the insurance carrier indicates there is a patient liability. How would you like to pay for this service today?”

At registration, use the following script to ask the patient or appropriate family member how they will pay for their portion due:

“Mr./Ms. (Patient Name), per your insurance carrier/plan you have an estimated amount due of $(Dollar Amount). How would you like to pay for that today?

“This is an estimate of your liability based on the information available from your insurance company. Additional amounts due may be billed to you after your insurance company receives and processes the claim.”

assisting and motivating staff documentation patient notified of financial responsibility
Assisting and Motivating Staff- Documentation-Patient Notified of Financial Responsibility
assisting and motivating staff incentive program
Assisting and Motivating Staff – Incentive Program
  • Implemented an incentive program for POS collection staff based on facility goal
  • Working to find a balance in progressive improvement to keep staff motivated


Parameter (facility goal): 100 – 124%

Total possible payout: 10%

PROCEDURE: The following guidelines are to be applied when applying the Patient Access At-Risk Plan:

  • Associates in positions where there is a direct ability or responsibility to collect POS collection and who collect $0 for the month will not be eligible for payment for that respective month.
  • Associates who do not participate in the overall process of POS collections are not eligible to participate in this plan.
  • Payments will be paid to the eligible associates based on Facility attainment of targets as previously established.
  • Plan pays on POS collections only. POS is defined as collections posted 0 through 5 days after discharge or registration.
  • Daily tracking of associate collections and metrics will be the responsibility of the Patient Access department.
  • Payments will be paid out monthly for each calendar month, on the pay period following the end of the previous month.
  • Payments will be based off of productive hours worked in the previous month and paid as a % of those hours times the midpoint of the grade for which the associate is based.
  • Facilities can choose to opt in or opt out of the at-risk program.

Payment Eligible and Parameters:

  • The associate forfeits the total amount of payment award if they voluntarily or involuntarily leave Centura for any reason prior to the pay out for that respective month.
  • There is a maximum per/person payout of $12,500 annually.
  • Minimum payout will be $25.
  • Payments will be paid and taxed according to IRS regulations.
  • Evaluation of the goals and targets will be done at least twice per fiscal year and may change/delete or modify eligibilities as necessary. If changes are made, advanced communication will be completed prior to implementation.


Parameter (facility goal): 125 – 149%

Total possible payout: 15%


Parameter (facility goal): >=150%

Total possible payout: 20%

challenges and results achieved
Challenges and Results Achieved
  • While overall efforts to implement technology and engage staff in POS improvements have been successful, Centura encountered several challenges to this process
  • Secured compliance from employers in smaller communities to collect balances at point of service (initially, employers resisted hospitals’ efforts to collect from employees)
    • CFOs met with company leaders and explained how collections are used to mitigate bad debt, patients don’t always pay after service, etc.
    • Have seen improvement in willingness to pay
  • Used positive project results achieved at top-performing facilities to encourage CFO and Director support for POS improvement efforts
    • Reported improvement results by hospital to show disparity between hospitals with more buy-in and those without
    • CFOs intensified governance over staff roles and activities supporting POS collections to achieve similar results
tips and lessons learned
Tips and Lessons Learned
  • Establish accountability and goals
    • Clearly define collection goals by patient type and establish performance expectations across facilities
  • Provide comprehensive and interactive/engaging training for staff
    • Develop relevant training at all sites and explore option of online training to centralize resources
  • Communicate with patients regarding their financial responsibility 5-7 days prior
    • Determine patient portion prior to scheduled service and work to determine appropriate payment arrangements as needed
  • Choose external partners and tools that best support project objectives
    • Select a business partner that provides defensible estimates and meets other identified organizational needs

Leslie Richard-leslierichard@centura.orgDarcy Kochevar-darcykochevar@centura.orgKeri