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To Improve Hospital Collections, Move Revenue Cycle Up Front

Rene Letourneau, for HealthLeaders Media, April 15, 2013

"The reason I am so passionate about the pre-service center is it is part of the front end of the revenue cycle. The focus has always been on the back end. If we can get it right on the front, it mitigates any surprises on the back. If you can minimize the rework, you are able to reduce costs," he adds.

The pre-service center's 12 full-time employees have also been trained to call patients who are scheduled for an appointment for which there will be a substantial out-of-pocket responsibility.

"If they do have a responsibility for a high amount out of pocket, we do outbound calls to inform them. There is an opportunity here to educate patients so they don't get the sticker shock on the back end. It's also to engage with them. If they don't feel they can pay, we'd rather have that discussion up front than after they have received care," Richmond says.

During the call, patients are also offered the opportunity to prepay their bill.

"As we are telling the patient about their out-of-pocket responsibility, we ask if they would like to make a payment up front. Some do, and some want to wait until the time of service. It's not about collecting payment at this point. The main thing is about educating them about their responsibility," Richmond says, noting that so far, MetroHealth is collecting about 15% of patient balances up front.

"Right out of the gate, we started seeing some success. … We've even seen some collecting of dollars right from the start. It's a small amount, but it is still a success," he says.

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3 comments on "To Improve Hospital Collections, Move Revenue Cycle Up Front"


stefani daniels (5/27/2013 at 12:43 PM)
The concept of front end revenue cycle activities for elective or outpatient services should also be applied to the hospital's ED. Attention to Medical necessity determinations and compliance issues is just as important. Too often patients are admitted as inpatients only to find out after the fact that they do not qualify for inpatient services. Then its all about catch-up and back end fixes. And then there are the physicians who insist upon an inpatient admission and the hospital's compliance with issuing ABN or HINN notices. And of course, the issue of inpatient vs outpatient, which if not clearly discussed with the patient from the outset, leads to patient dissatisfaction and sticker shock when they receive an unexpected bil.

Tom Kincheloe (4/19/2013 at 3:34 PM)
I own a private outpatient rehab facility that provides both OT and PT as well as lymphedema therapy. This concept of front-end servicing is not new to us; my staff have been pre-screening insurance coverage for payment type, co-pays and to ensure that each plan allows for therapy coverage. We've seen cases where a particular insurance plan would cover one therapy but not the other. We've also used this concept to screen out problem insurance payers so that we can tell patients that we do not cover or are not in network with a particular plan. This method has saved us tens of thousands of dollars in loss revenues. It's also saved many of our patients from unexpected out-of-pocket costs. It's an excellent concept and one I endorse wholeheartedly.

Joan McCarthy (4/16/2013 at 11:54 AM)
This seems like an easy process to develop but it takes good systems and knowledgable people to actually complete. Very good article. What appears so intuitive at first glance has not been the practice across the healthcare settings.