by Phil C. Solomon on July 15, 2013

in Collecting self pay deductibles and co pays,Revenue Cycle Management,Self Pay Collections

revenue cycle news


Hospitals are facing a rising challenge of collecting cash from patients who are responsible for paying their own hospital bills. Solving an increasingly difficult Patient Self-pay dilemma is one of the newest focal points for CFO’s to address, as they strive to keep their hospital’s on solid financial footing.

In 2013, CFO’s and revenue cycle executives have many challenges to occupy their time and attention. Aside from Patient Self-pay, healthcare reform, ICD-10 conversion and the challenge of leveraging big data analytics are initiatives that also deserve CFO’s and revenue cycle executive’s time and attention. In order to keep pace with the myriad of changes in healthcare today, hospital CFO’s and revenue cycle executives must become change agents who drive innovation within their organization. Change agent’s are initiator’s of new ideas and creative approaches to help solve the most pressing issues.

Collecting Patient Self-pay balances is a vexing problem that is creating an impact so significant that hospitals cannot afford to ignore it. Just a few years ago, as little as 3 to 5 percent of a typical hospital’s revenue came from Patient Self-pay. Today, it is as much as 20 to 30 percent, and it’s growing. In 2013, CFO’s and revenue cycle executives must find new imaginative approaches for collecting more Patient Self-pay unpaid balances.

This ascending problem is forcing executives to UNTH!NK the status quo and the way things have been done in the past. Developing creative solutions requires applying a fresh new set of ideas and beliefs so existing problems can be solved. The first step in creating change is to shift one’s mindset and assume the responsibility as an organizational change agent. Becoming a change agent isn’t for the faint of heart. True innovators and successful change agents are those who are willing to take calculative risks, and become visionaries in their own right.

UNTHINK Patient Self-paySince the recent rise in Patient Self-pay unpaid delinquent accounts has accelerated at an epic pace. Revenue cycle stakeholders don’t have time to follow old methods in an attempt to solve today’s current problems. There is no time to employ old re-engineering processes or initiate long-term studies to change outcomes. Executives must UNTH!NK the Patient Self-pay problem quickly, by wiping away all current and perceived notions as new solutions are considered.

As change agents, CFO’s and revenue cycle executives must be open to change and be willing to keep all ideas and options on the table for consideration.

What are some of the solutions available to hospital executives for improving the collection of Patient Self-pay accounts? Here are 25 individual strategies that can immediately improve  Patient Self-pay collections:

  1. Implement an overarching strategy which clearly measures collection goals, workflow benchmarks, policy adherence and KPI milestone attainment
  2. Clearly post and communicate to patients the hospital’s financial assistance, discount and prompt payment policy
  3. Remind patient’s of their payment obligation and attempt to collect the patient portion when performing appointment confirmation calls
  4. Educate patients to be prepared to pay for services upon arrival at the hospital
  5. Utilized integrated scheduling and registration quality tools to seamlessly handle the flow of patient visits and accurately move patient’s through the billing process
  6. Use a registration quality technology to accurately classify self-pay patients at point of service and improve payer claims outcomes
  7. Leverage a real-time technology that notifies registration staff of Red Flag inconsistencies and fraud alerts
  8. Help patients understand what they will owe at pre-registration, registration and patient check out with a robust bill estimator
  9. Partner with a vendor who offers a fixed fee, unlimited-use, real-time insurance eligibility verifying program to check eligibility of patient accounts throughout the entire revenue cycle collection process
  10. Introduce a comprehensive and accelerated program to help patients apply and qualify for various state and federal programs
  11. Install a web-based revenue cycle patient-intelligence platform to analyze real-time workflow performance
  12. Add a new call center work flow management technology to manage call volume, improve customer service and increase first call resolutions
  13. Post PFS staff in the Emergency Department to collect co-pays, deductibles and pure self-pay balances
  14. Collect a pre-determined deposit from ER patients during quick registration and reconcile total estimated payment due through a bill pay estimator
  15. Preauthorize credit cards and checks at the time of scheduling, registration or any other collection check point
  16. Apply a self-pay point of service collection strategy for collecting previous and current balances
  17. Utilize a self-pay collection scoring technology that builds score-based workflows and offers algorithms that estimate the ability and propensity of payment
  18. Implement a self-pay charity scoring workflow. Leverage presumptive charity write-offs prior to bad debt placement
  19. Use an integrated scanning technology to maintain accuracy while improving the identification and proper storage of patient records
  20. Implement an advanced technology to collect credit card, debit card, eCheck & ACH payments
  21. Offer a web-based payment portal for patient bill pay
  22. Implement e-cashiering and kiosk solutions to give patients more options to pay
  23. Insource or outsource self-pay account processing. Utilize a predictive-blended dialer for inbound and outbound calls, closely monitor right time calling analytics, send out-patient friendly statements/invoices and most importantly, ensure that all self-pay patients are treated with respect, dignity and professionalism.
  24. Provide on-going face to face and web-based collection and customer service training. Offer a continuous training program, which is designed to educate staff on the use of technology, workflow procedures, corporate philosophy and staff adherence of departmental policies and procedures
  25. Send out-patient satisfaction surveys to help identify issues and educate self-pay patients

Hospital CFO’s and revenue cycle executives have several options to choose as they decide which strategy is the best fit for their organization. They could choose to utilize internal resources to roll out new Patient Self-pay solutions, or consideration could be given to contracting with a healthcare outsourcing partner who offers a single source, proven Patient Self-pay solution.

It’s a daunting decision – to internally “build” or externally “buy” a solution that will mitigate the rise in self-pay write off’s. “Building” a solution, takes time to source, price and contract with multiple vendors, then retrain existing staff to operate in a newly structured environment. Deciding on a “buy” solution offers some roadblocks, however the upside net back revenue gain and the potential expense reduction offers a very attractive value proposition.

Contracting with a qualified, technology driven, patient centered provider who offers a single source solution’s is an attractive option. There are outsource providers who offer tested “buy” solutions, however they are few and far between.

Regardless of the decision to in-source or outsource, it’s important to employ the best and brightest leaders who have deep domain knowledge and a tested, successful track record.

There are no easy solutions to solve the Patient Self-pay cash collection issue. Making the decision to initiate forklift technology upgrades and systemic holistic changes to an existing revenue cycle operation vs. contracting with an end to end technology and services outsourcing firm is not an easy one. It takes a CFO or revenue cycle executive who has vision and determination and who is steadfast against following the status quo. Those who UNTH!NK traditional methods typically are the type of change agents who aren’t afraid to initiate large-scale, game changing solutions.

Those who are responsible for revenue cycle performance can learn valuable lessons from other famous change agents, like Guy Kawasaki, the former Chief Evangelist of Apple Computers. His goal was to create change while serving his customer at the highest level. Similarly, healthcare finance and revenue cycle change agents must be UNTH!NKERS, so they can positively change the way Patient Self-pay is processed and collected.

UNTH!NK your way to becoming a change agent for your organization. Let’s all challenge ourselves everyday to UNTH!NK our way to personal and professional success!

Phil C. Solomon is a healthcare finance and revenue cycle sales consultant and marketing strategist with experience spanning two decades. Phil has expertise in the areas of healthcare technology and business process outsourcing (BPO). He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.





{ 4 comments… read them below or add one }

James McNiff July 19, 2013 at 8:54 PM

I hope Revenue cycle leaders take your advice to heart and push these initiatives in their organizations. They will get push back from clinical staff such as in the emergency room. But that is the difference between a good revenue cycle manager or a great one…Leadership when fighting the good fight…


Phil C. Solomon Phil C. Solomon July 21, 2013 at 1:34 PM

I totally agree James!


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