3 Ways to Improve Front-End Collections

A pre-access center and three-tiered arrivals process is transforming point-of-service collections at Northeast Alabama Regional Medical Center.

This article appears in the January/February 2019 edition of HealthLeaders magazine.

Three years ago, the scheduling, registration, and arrivals process for patients at Northeast Alabama Regional Medical Center, headquartered in Anniston, Alabama, wasn’t bringing in sufficient front-end collections.

In 2015, they were collecting less than $5,000 a month at point-of-service collections, and during a "big month" they might have collected $10,000, says Bruce Turner, director of the business office and admissions.

"We were a little bit lax in terms of our front-end collections compared to our peers that are nearby in Birmingham or Atlanta, and we knew we needed to do a better job," he says.

Although they'd made attempts in the past to improve front-end collections—mostly by asking unprepared patients for their co-pays or deductibles on the day they arrived and were met with resistance—those efforts quickly fizzled out.

It was time for a change, and over the past three years, the organization has transformed its traditional scheduling functions into a pre-access department that has increased patient satisfaction and has seen a 2,400% increase in point-of-service collections that went from less than $5,000 per month to more than $120,000 per month.

Here are the 3 things they did to change their front-end collections process and get paid:

1. Create a pre-access department
 

"We had to take the schedulers and train them on how to register patients like an admitting clerk," Turner says.

Instead of simply scheduling patients, representatives from the pre-access department also pre-register patients and call them ahead of their appointments with tailored estimates based on their insurance and the physician who's providing the service.

During these pre-access phone calls, patients are asked for the estimated patient balance that is due. If they are not able to pay in full, they are asked what type of deposit they can make that day.

Sometimes the patient pays the entire balance in full on the phone; others might ask to pay on the day of service or set up a payment plan, which the pre-access rep can also calculate and arrange using technology tools from PatientMatters, a patient financial management and experience system. 

Rather than being scared away from treatment or being surprised by a huge bill after receiving their service, patients are usually grateful for the heads up.

"It's been very beneficial," Turner says. "We have seen comments on our patient satisfaction surveys where they appreciated knowing upfront what they owed and what options we had available for them to take care of that balance."

Because of that additional call volume and length of time on the phone, the organization added additional scheduling staff and also extended the department's hours to 6:00 pm. Eventually they may extend the hours to 7:00 pm.

2. Implement technology for front-end collection efficiency

Northeast Alabama Regional Medical Center invested in technology that provided the functionality to schedule patient services, run patient estimates, generate patient-specific payment options, and obtain financial clearance before patients arrive.

3. Use a three-tiered patient arrival system

The organization is in the final stretch of completing a transformation that will culminate in a patient arrivals process that's tailored to their pre-registration and financial status.

"Our goal is to have the patients know what they owe beforehand," Turner says. "Eventually what we're moving toward is a three-tiered approach to when patients present at the facility: We would have a no-stop, a quick-stop, or a full-stop" approach.  

The three tiers will function like this:

No-Stop: No-stop patients have been scheduled, pre-registered, financially cleared, and can proceed directly to the department where they're having their service, without first stopping at the admitting area. They have either paid in full or agreed to a payment plan for their outstanding balance prior to their arrival at the hospital. 

Although the organization is still working out logistical issues for no-stop patients, such as electronic signature forms, their eventual goal is for 70%–80% of patients to be a "no-stop."

Quick-Stop: Quick-stop patients have completed everything except their payment. For example, they've been scheduled, pre-registered and notified of their balance, but may not want to pay over the phone or online ahead of the appointment.

When they arrive, they make a "quick-stop" at the admitting area to make their payment and then get directed to the appropriate department for their service.

The pre-access center aims to be flexible with patients and understands that different patients have different preferences, Turner says. For instance, younger patients like to use the online portal to pay their bills online (which they can do through the PatientMatters tool), whereas older patients often like to pay in person, rather than on the phone or online, Turner says.

Others may not have the ability to pay large balances all at once.

"We are flexible with how they pay and when they pay," Turner says. "Being community-based like we are, we work with all of our patients to do what we can. We do just ask that you make some type of payment on the day of your service."

Full-Stop: Patients whom the pre-access department can't get in touch with or ones who don't feel comfortable sharing personal information over the phone will require a "full-stop" when they arrive.

These patients will need to go through a more traditional hospital arrival process: Walking in the door and completing a full registration at the admitting desk.

Occasionally, being notified of a balance has prompted patients to reconsider when or whether they need the service or whether a lower-cost option is available. But Turner emphasizes that no patient is ever denied treatment because they're unable to pay. That was an early fear of physicians.

"We just reassure our medical staff that under no circumstances are we going to deny care or treatment to anyone," he says.

"We would just be asking that a good-faith effort be made to make a deposit for the services that are being rendered and that we would be working with the patient as best we could on those payment plans."