Bolster the Patient Billing Experience for Overall Rev Cycle Success

The patient financial experience is just as important to a hospital as a patient's clinical experience. Healthcare leaders share their thoughts on current billing challenges and solutions.

Editor's note:This article appears in the March 2023 edition of HealthLeaders magazine.

Revenue cycle leaders must pay attention to each aspect of an organization's revenue cycle to have a prospering organization. Although there is an individual argument for streamlining each segment of the cycle, when it comes to improving the patient financial experience, it's imperative to put the microscope on an organization's current billing process.

Chris Johnson, vice president of revenue cycle at Atrium Health, and Chris Cox, senior vice president of product, strategy, and operations at iVitaFi, recently spoke at the HealthLeaders Patient Financial Experience NOW Summit about challenges they are seeing in the industry when it comes to the billing process and proactive ways to solve these challenges.

"We often hear in the industry that the patient experience was great and everything was phenomenal, then the patient gets the bill and all of the sudden the perception of the services received can change which impacts the patient financial experience," Johnson said.

As Johnson said, this shows that improving the billing experience can drive up satisfaction scores and an overall positive patient experience for an organization. Cox added that the patient billing experience affects how the patient ultimately feels about their experience at that organization, regardless of how the clinical care went—so it's important to remedy when it comes to patient leakage.

"Providers lose, on average, between 10%–30% of revenue as a result of patient leakage, and that's hundreds of millions of dollars in losses per year," said Cox.

Examining the challenges

So where should organizations start when looking to improve this patient experience?

"There are quite a few challenges in the market today when it comes to a patient's billing experience," said Johnson. Narrowing down those challenges and working on perfecting them will ensure a positive patient financial experience.

When it comes to a patient's bill, it's common for certain populations to find the amount of information presented overwhelming.

"Healthcare billing continues to be a complex process especially since you have the provider, patient, and payer all involved," said Johnson. "Quite frankly, when some patients see an insurer's use of CPT and ICD-10-CM codes, it can be like a foreign language, and it can cause real confusion."

Another added component seen across the healthcare industry is that patient bills still tend to show gross charges for the service or services provided to a patient.

"While gross charges are not the actual amount paid by insurers or patients, we continue to use them for billing purposes across our industry. Providers often assume patients are not concerned about gross charges, but this may not be the case." Johnson said.

"When we send a patient an itemized bill and they see their gross charges for $100,000—all of the sudden they are interested in those gross charges, not just what their actual financial responsibility is. So again, I think billing continues to be more complex than it needs to be as an industry," he said.

Price transparency has come a long way in the industry, but certain populations may need more education on what they are seeing in that final bill and breaking down this overload of information is an important step in achieving a positive patient financial experience.

"I see it time and time again where throughout the continuum of care, the billing aspect of service is just not discussed. And even when a patient would proactively ask, 'How much does this cost?' that discussion goes 'Oh no, we'll just send you a bill,' " said Cox.

Bringing that conversation forward and setting the expectation that a patient may see a gross charge or mentioning to a patient that they haven't met a deductible will help remove that surprise element from the patient's bill, Cox said.

On top of this surplus of coding and pricing information, it's not unusual for patients to receive multiple bills from different providers for one episode of care.

"That can be confusing for patients. And again, it's not a problem that we have successfully fixed at this point," said Johnson.

Also, it's common for a patient's statement to not completely align with the explanation of benefits that the patient receives from their insurance company. Receiving multiple bills for one encounter as well as receiving mismatched facility and payer statements can greatly affect the patient's financial experience.

"While we are continuing to improve and provide better information to our patients, we have a more ground to cover in making this industry and process truly patient-friendly," Johnson said.

Potential solutions

So, what can organizations focus on to improve the patient financial experience?

Being able to articulate to patients how much they owe in a clear and concise manner is critical and has been brought to the forefront by the No Surprises Act. An opportunity to improve a disconnect in communication can start as early as patient scheduling, check in, or check out.

"Providing this information to patients at all of those different touch points, having that discussion with the patient, and just setting the right expectations can improve that patient financial experience," Cox said.

Another solution to improve on the billing and collection process is simply having those back-end staff be more friendly and understanding, said Cox.

"I've never received a phone call where I pick up the phone and I'm like, 'Hey, you caught me at a great time. I'm so happy you called me,'" said Cox.

"All times are equally inconvenient for patients, and finding a better medium to contact patients or even giving them the ability to schedule a call through text and say, 'Would you like to schedule a call with us to discuss your bill?' Those are some areas where I think we could make it a little bit more friendly and ultimately improve the financial results of this process," he said.

Johnson agreed and added that although burdensome to some hospitals, the move toward price transparency is only going to help improve that patient financial experience, especially when patients are educated on the information they are being presented.

"I know it's been a difficult journey for a lot of us, and the rules that require us to do some of this don't always line up with reality of either what we can do or what needs to be done. But I still believe that it should be considered a positive thing because, ultimately, it's going to give patients more information about what they will ultimately owe out of pocket and options for resolving the out-of-pocket expense," Johnson said.

The revenue cycle space is seeing a boom in automation and technology, giving patients better access to patient portals, digital front doors, and payment options.

While patients may be getting an information overload through their bills and statements, once this information is paired down and streamlined, the advancement of technology can make the patient financial experience easier and more transparent.

Johnson echoed this point by saying that "healthcare has been providing more and more information to the patients through online portals. We are moving down multiple payment paths, trying to make that a component of the patient experience as easy as it can be."

"The ultimate goal is to give the patient the information they want, when they want it, where they want it, and how they want it, including the ability to make payments and to interact with us on their financial issues in any manner that they see fit," he said.

The growth of more payment plan options have also been a key solution in bettering the patient financial experience. Most organizations are dealing with patients who have higher out-of-pocket expenses, and it's becoming more likely that patients are routinely unprepared to pay the out-of-pocket expenses.

"When you carry $3,000, $5,000, or $10,000 out-of-pocket maxes, most patients aren't walking around with either that kind of money or the ability to write a check at one point in time. And I think the industry is responding to that, and providers are responding to that to try to make the payment mechanism for those out-of-pocket expenses easier for patients to navigate," Johnson said.

Finding solutions to these common patient billing pitfalls is imperative for organizations.

"The mindset should be that the patient financial experience needs to follow the same path as the clinical experience," Johnson said. "They both need to be phenomenal in order for our patients to be satisfied with the organization providing the service."

"It's important that we're setting the right expectations so that way when patients get a bill, they're not surprised. We want patients to not only pay their bill, but we want them to come back. That patient leakage is incredibly important to track and monitor, and organizations need to have a plan on how to minimize it moving forward," Cox said.