Key strategies to better manage your self-pay accounts

Wednesday, February 17, 2021

A study published late last year by the Urban Institute forecasted that over 10 million families would lose their employer-sponsored health insurance during the novel coronavirus (COVID-19) pandemic. As a result, healthcare organizations have observed a growing number of uninsured patients and a rise in out-of-pocket responsibility.

On the latest episode of The Revenue Integrity Show: A NAHRI Podcast, NAHRI Director Jaclyn Fitzgerald, CHRI, was joined by Juli Forde, director of strategic partnerships, AR optimization, ZOLL Data Systems in Broomfield, Colorado, for a wide-ranging discussion on how healthcare organizations should approach the new reality of escalating self-pay patient responsibility.

Forde offered several strategies to help organizations maximize reimbursement in these times.

The first step, she said, is to ensure empathy and understanding toward the patient.

“I think one of the things we do really well is we get a great H&P (history and physical examination) clinically for patients before we move into a treatment plan,” Forde said. “We make sure we really understand them. We need to be doing the same thing financially. So, a wonderful best practice is to obtain one of the solutions available that will partner with you and give you the financial information around the patient. That allows you to come alongside them in a way where they feel heard and they feel understood.”

Organizations can obtain a financial profile of an individual without asking invasive questions that make the patient uncomfortable, Forde said. One of the keys is for organizations to harness the new technologies that are available that help organizations understand the patient as a financial individual in addition to knowing them clinically.

“If you’re still doing revenue cycle the way you did it five years ago, 10 years ago, there’s wonderful technology that you’re missing out on that really helps you deal with this profoundly difficult reality of a greater patient responsibility, a higher denial rate from the payers, an additional regulatory burden being placed on healthcare,” Forde said. “There are tools available that really make those lifts a lot easier and help you to maximize your reimbursement while giving the patients a wonderful experience.”

In addition, Forde stressed the importance of charity care. She said healthcare providers must put in place policies based on objective criteria to establish a successful charity care program, which should benefit both the patient and the organization. When organizations ask patients for the amount that they can truly afford based on their own financial characteristics, they see the average patient collection increase significantly, according to Forde.

“So it’s very interesting that by appropriately and compassionately discounting the final charge within a compliant charitable discounting program, we actually recoup more of the patient’s self-pay responsibility,” she said.

To listen to the full podcast episode, search Revenue Integrity Show on iTunes, SoundCloud, Spotify, or Google Play. The episode is also available to stream on the NAHRI website.

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