Starting the financial-engagement process with patients as early as possible is a top priority for the St. Francis revenue cycle team because timeliness benefits both the patients and the hospital, Glass says. "A lot of patients want to hear what they might owe and are willing to work with us. Our best practice is to meet with all patients who have a financial responsibility, so that we can take a payment or establish a financial assistance plan as early as possible. If not, we will be months down the road before this is set up and payments start coming in."
At Gundersen, the best practices of financial counselors are focused on informing patients about the resources that are available to help pay for medical bills, Hurwitz says. "We do not provide financial advice to patients. We help explain insurance benefits to patients because most people do not understand them—we see that as our responsibility to educate them. We provide patients with information about resources that can help them with their financial obligations. We provide them with estimates, both the total charges and their out-of-pocket responsibility. So, we're providing them with resources and information; we are not providing them with advice."
The Gundersen financial counselors are expected to possess or develop a relatively advanced skill set, says Shannon Carey, manager of revenue cycle at the health system, which is centered on 325-licensed-bed Gundersen Lutheran Medical Center in La Crosse. "One of the most important things I look for is outstanding communication skills, verbally and in writing. I also look for good deescalation skills. ... After patients get their bills, the financial counselors need to be able to deescalate situations and give information to the patients to make sure they understand. We try to do more behavioral interviewing to get people with these kinds of exceptional skills."
The financial counselors also need specialized business skills to function effectively, Carey says. "They have to have good computer skills, too. We have multiple systems that they have to be fluent in for giving good service here. Mostly, they're in an office without a group around them, so they need to have a strong independent work ethic and be able to be independent thinkers. There's a lot of attention to detail and follow-up work. We can't always give answers to questions at the time the patient is present—we may have to wait for information from an insurance company or the county. They have to have a basic knowledge of coding and medical terminology; especially when they are trying to give patients estimates, they need to understand if there are missing codes or what might be entailed in a procedure that a patient could be billed for. When patients run into denials, the financial counselors have to have an understanding of insurance rules and coding rules. We don't require them to be coders, but they have to have a general understanding. And they have to be able to handle money and balance cash drawers because they are taking payments."
Convincing a health system's leadership team to embrace creating a financial counselor job title and finding suitable candidates to fill the role can be daunting, some financial leaders say.
Christopher Cheney is the senior clinical care editor at HealthLeaders.