Improving Revenue Cycle Performance and Patient Financial Experience in Emergency Care

By Tyler Williams, President, ZOLL AR Boost
Twitter: @zoll_rescuenet

Healthcare consumerism is changing the way patients and healthcare teams interact. As patients shoulder greater financial responsibility for rising out-of-pocket healthcare costs, their needs and expectations are evolving. Greater transparency and simplicity in medical billing rank high on the list of new consumer demands.

Conversations about healthcare expenses can be challenging. Many patients are uninsured or under-insured and struggle to cover medical costs or high health plan deductibles. This puts financial pressure on both consumers and the healthcare providers delivering services to them. The stress is perhaps greatest during emergency medical encounters, where the need for treatment is unanticipated, emotions are running high and financial planning is often an afterthought.

Although tending to the clinical needs of the patient is the first priority, EMS teams and emergency departments must also collect patient demographic and insurance information to support billing. This can be particularly challenging in the ambulance business, where patient identification and insurance information may not be readily available. To overcome these challenges, many EMS and ED billing teams are implementing new tactics and technologies to better support and streamline revenue capture.

Software support for patient payment processing
Quickly identifying patients and their medical coverage during emergency encounters is step one for emergency billing teams. In situations where patients may not be able to communicate and family members may not be present to fill in gaps, patient demographic and insurance verification can be difficult. Revenue cycle teams are increasingly relying on patient data validation software to ensure that accurate information is collected to support billing. These tools improve staff efficiency by eliminating manual data discovery tasks and reduce inaccuracies in patient data that can lead to claim denials downstream.

Insurance validation and discovery software is another resource billing teams are using to improve revenue cycle efficiency and reimbursement. These tools allow billers to quickly identify primary, secondary and tertiary insurance coverage for more patients. This helps billing teams avoid the misclassification of patients as self-pay when insurance coverage exists, mitigating the chances of a negative patient experience down the road when unexpected bills arrive. Automated updates related to payer coverage and requirement changes further support claim accuracy and reduce processing time.

By automating these workflows, billing teams save time and money and are able to process more claims per biller. These software resources also help billing teams migrate key payment processes to the front-end of the revenue cycle, greatly reducing the risk of returned claims and the overall time it takes to collect.

A third way emergency billing teams are leveraging technology to improve payment performance is through patient propensity to pay assessment. With self-pay patient populations swelling to include those working towards meeting high deductible thresholds, these resources can be especially valuable. Self-pay analytics tools allow billers to pre-determine which patients can pay, as well as those who qualify for charitable coverage or a hardship discount. This insight enables billers to focus efforts on patients who are most likely to meet payment requirements, reducing the time and money spent pursing payment from patients that simply cannot cover expenses.

Reapproaching patient payment conversations
One way emergency billing teams can improve payment capture is by offering zero interest payment plans to self-pay patients with a higher propensity to pay. Another tactic is to simply have a productive conversation with the patient that remains sensitive to their needs. When the time comes to have a conversation with a patient about medical payment remittance, implementing best practices is key.

Set up a program that coaches in-office bill collectors to speak to every patient as if it were the first, last and only time they were going to interact with the patient, because it may truly be a singular experience. Often times, once a patient identifies the number of the collection caller, they will block or avoid future calls. Billers may have one opportunity to engage the patient in a fruitful conversation.

All too often, collections calls can feel confrontational. To ensure a productive conversation, billers should keep the conversation positive. Use positive terms with the patient and work with them to achieve a positive outcome. Instead of saying: “We have a payment plan and you must pay $50 a month until payment is met in full,” articulate to the patient that an interest-free payment plan is available and offer the patient varying payment amounts that will help them cover expenses. Tell the patient: “We could set you up to start paying $20 a month and maybe in four or five months, when you have more money, we can move to $50 a month. Would that work for you?”

Remember that you are there to set the patient up to successfully meet payment obligations, not to get into an antagonistic conversation. If the patient raises concerns related to care quality issues, enlist the support of a clinical point-person to address any concerns. Collections calls should avoid clinical discussions entirely, directing any clinical complaints the patient may have to a supervisor. Failure to have a fruitful conversation about payment can lead to patient dissatisfaction that may, in turn, lead to loss of future business for the provider organization.

Successfully navigating the revenue cycle as patient payment responsibilities and consumer expectations evolve can be arduous for emergency billing teams. By reimagining revenue cycle processes and introducing new best practices for patient clinical communications, EMS and ED billing teams can improve the patient financial experience as well as reimbursement performance.