Straight Talk with Patients about Billing

A partner guest blog by Marie Bass, Director of Education Strategy, HFMA

It’s not always easy to talk about money with patients. Having the right conversation, at the right time, in the right way, can better serve patients’ needs, increase compliance, and reduce problems throughout the revenue cycle.

Healthcare providers are finding that they need to be more consultative than ever in regards to financial options and payer responsibilities. So how do we have this conversation with patients, and, more importantly, why does it matter?

First, it matters because of permanent changes in the healthcare landscape which have changed the conversation about payments, including:

• The focus on patients’ financial responsibilities
• Newly insured patients served by Health Care Exchanges
• Patient satisfaction scores
• A rise in denials as a result of ICD-10

Prepare Staff to Communicate Better

Healthcare organizations need to create a consistent, shared set of recommendations that staff can use to help patients understand the cost of the services they receive, their insurance coverage, and the individual responsibility portion of their bill. We are our patients’ best advocates when it comes to financial responsibility. If we do not perform this role, who will?

The Healthcare Financial Management Association (HFMA) has created a set of best-practice guidelines on patient financial communication. The guidelines were formed to bring consistency, clarity, and transparency to healthcare billing—something that in most cases has not been a priority.

For ideal patient financial communication, WHEN is the first question. Obviously, the earliest opportunity possible to begin the discussion is best. An exception is the Emergency Department; there is never a time before a patient is stable and safely recovering that is appropriate to discuss insurance issues. However, at all other times, discussions in advance of services are best.

For these discussions, don’t wait for the patient to bring it up. You must proactively start the conversation as quickly and clearly as possible. Your organization will want to determine the topics to cover in a conversation about patient billing and the tone in which it is discussed. Do you want to talk with them about prior balances that they have? Do you want to discuss balance resolution? Each department should have the same conversation based on consistent policies which should be clear and consultative.

The parameters for the conversation are compassion, advocacy, and education. Patients might need assistance with filing for other forms of insurance, information about their options, or they may need you to explain the basics of their coverage. At least 70% of the new health care exchange policies have $10,000 deductibles, and some patients may not understand what this means in terms of paying for services prior to reaching their deductible. They may also be shocked to find that they owe $10,000 after a hospital event.

The Commitment to Clear Financial Communication with Patients

To help standardize these financial discussions, HFMA has created the Adopter Recognition Program.  All hospitals and healthcare systems are eligible to join the HFMA Adopter Recognition Program which demonstrates an organization’s commitment to clear financial communication at no cost to the facility.

Patient Financial Communications Adopter Recognition is based on HFMA's review of an application and supporting documents that describe an organization's financial policies and procedures. Organizations achieving this status are allowed to use the phrase "Supporter of the Patient Financial Communications Best Practices" in their marketing materials. Adopter organizations will also receive a certificate, listing on HFMA's website, and listing quarterly in HFMA's magazine, HFM. For more information, visit HFMA.org

HealthStream has partnered with (HFMA) to provide education, resources, and certifications to support all aspects of the revenue cycle and in this case, specifically, patient financial communication.  The online training program consists of three modules and is practical and realistic. The toolkit offers beneficial content like user guides for staff coaching, customizable training materials, sample financial policies, and a competency development action plan to help get staff up to speed.

There is no downside to improved communication about financial responsibility. When providers are proactive, the patient benefits from:

• Better understanding of liability and costs
• Better understanding of who to call with billing issues
• More confidence knowing when and how the account will be paid

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