Knowledge Center

A Tale of Two Early Outs

Nick McLaughlin,
Ridiculously Nice Sales and Business Development

It was the best of plans, it was the worst of plans, it was the age of rising deductibles, it was the age of shrinking budgets, it was the epoch… I had to look up what the word “epoch” meant, so I’ll stop there! Shout out to Charles Dickens for letting me play on his epic opening of A Tale of Two Cities to begin this article on how I’ve seen Early Out Collection Services work brilliantly to improve the patient experience for hospitals and health systems, reduce A/R Days, and accelerate cash flow, and how I’ve seen it turn into a total nightmare if the program is not set up properly, or the wrong partner is hired. If you’d like to skip the rest of this article, here’s the best advice I have to give: do everything you can to simplify your patients’ experience with your billing process. That focus will send you down a successful path.

The Story

Hospitals and health systems have been going down the path of “do more with less” for a long time now, and one result of that is that resources have been focused on higher yield activities like insurance claim follow up, rather than collecting self-pay balances. Now that the average annual deductible for a family health insurance plan is over $8,000, patients are paying much closer attention to their medical bills. This results in many more patient calls with questions on their bills, financial assistance availability, and options for payment. When this increased demand for customer service attention meets a shortage of in-house talent able to answer patient questions, hold times and call abandonment rates increase to unacceptable levels, patients get frustrated, and the experience the patient just had with your facility can get spoiled no matter how wonderful their care. Not to mention that with growing deductibles comes an increased risk of revenue leakage. We know that the longer an account goes unpaid, the less likely we are to collect it, so adequate follow up is more important now than ever.

That’s where an Early Out partner can come in and be a big help in handling those inbound call questions, keeping hold times low, following up on unpaid accounts in a timely manner, and streamlining communication and account resolution for patients. That said, there is a lot at stake with an Early Out partnership, especially since the company you hire represents your hospital(s) directly, so be careful to avoid these pitfalls we have run into that compromise the patient experience, and result in way too much time spent with unhappy patients.

Early Out Pitfall #1 – “Day 45”

One way to set up an Early Out partnership is to place accounts with that company 45 days after the first bill goes out. The first bill has the phone number of the hospital’s business office on it, but the subsequent bills sent out by the Early Out partner often look very different and have the phone number for their office, not the hospital. The biggest problem with this arrangement is that a patient can have an account with the Early Out company, and another bill still at the hospital, and would have to speak with two different business offices to resolve both balances, even though both places said they were the business office of the same hospital.

To avoid this issue, place all self-pay balances with your early out partner the day the accounts drop to self-pay. We also highly recommend that all statements sent to patients come from the same statement vendor, whether that’s the one you currently have in place, or the one the Early Out partner uses. That way they look like bills the patient has received before and they don’t think they may be receiving a scam attempt.

Early Out Pitfall #2 – Multiple Early Out Partners

Most hospitals across the country use multiple partners for bad debt collections in order to compare performance and have a backup plan if one of the agencies starts falling behind. When it comes to Early Out, those benefits need to be weighed against the benefits of presenting a unified business office experience to your patients. Many households these days have multiple last names due to an increased number of blended families and changes in societal norms. If you have two partners for early out, and accounts are alpha split by last name, a good number of your patients could have to talk with one Early Out partner for one family member’s accounts, and another Early Out partner for another family member’s accounts; a huge source of patient dissatisfaction.

We highly recommend only using one Early Out partner. In order to manage performance, I encourage you to hold them to call center customer service metrics such as call abandonment rate (under 5%) and percentage of calls that wait less than 30 seconds before being answered (70% or higher), as well as monitoring a monthly activity report of inbound calls received, outbound calls made, statements sent (if applicable), and of course, dollars collected.

The moral of the story is this, avoid these two common pitfalls by simplifying the patient experience with your business office, and you’ll be rewarded by happy patients, higher collections, and higher patient loyalty for years to come. Make it as easy as possible for them to get answers to their questions and resolve their self-pay balances, and good things happen. From the patient’s perspective, paying for healthcare services is already a very stressful experience. Help them help you strengthen your bottom line by devoting the thought and resources required to offer an awesome patient experience!



Americollect Announced as Large Business of the Year by Chamber of Manitowoc County

Americollect was named the Large Business of the Year on Tuesday night at the 101st Annual Dinner and Meeting of The Chamber of Manitowoc County; which was held at the Holiday Inn in Manitowoc.

Americollect has experienced continued growth under Kenlyn T. Gretz’s leadership and has grown from 12 employees in 1999 to more than 250 employees today. “Our consistent growth over the years can be directly contributed to our hardworking team members at Americollect. Our team really shows passion for what they do. Team members work closely with patients to help them resolve their medical debt. They show compassion and understanding and are truly living out our Ridiculously Nice commitment,” stated Kenlyn T. Gretz, President and CEO of Americollect.

The culture at Americollect is another aspect of the company that plays a crucial role in their growth. “Our culture is very unique and it means a great deal to us. We put time and effort into the culture to ensure it is always being strengthened. We have a culture of passion. Passion for our work, and passion for the team that we work with,” stated Gretz. “Our culture is the glue of what keeps our company moving towards one common goal, helping others reach their goals of paying off their medical debt. Our culture is one of family and love.”

Americollect is currently on a mission to change the way collection agencies are viewed. Gretz stated, “By using our Ridiculously Nice approach we are demonstrating to patients, clients and others that we are here to help. It brings us joy to see patients reach their goals of making that last payment.”

Question and Answers

We have created a new section in our newsletter to share our questions and answers from our clients or questions we ask of our peer-network for our clients. We hope you find these as helpful! These questions have been shortened and removed de-identified.

Question 1: “I have a question in regards to 501r and the requirement of not asking for payment of prior balances at the time of registration and advice”

Answer 1: The trick comes down to determining “emergency or medically necessary”.

Here are the three ways that I know people are asking for money:

1. Some registration areas you may be able to classify as “non-emergency or medically necessary” with a policy to allow them to request money on past balance.
2. I have heard some facilities are asking the question “is this appointment an emergency, medically necessary, preventive, or just an illness” and if the patient answers is “no” they document, then they ask for the past due balances.
3. Finally, you can ask for money on past due balances if you immediately offer financial assistance application and offer to help them fill it out.

Question 2:
“I have a question on returned mail as it relates to the 501r requirements for ECAs. It has come up recently that a statement was returned. Currently we have Epic workflow to immediately send to bad debt approval Work-queue.

Per our policy, we have language regarding the guarantor’s responsibility of providing the correct mailing address but don’t specifically refer to it as returned mail as the indicator that we don’t have a correct mailing address. Do you think we are ok to send the accounts to collections upon the first returned mail (per our policy) assuming it is past the 120 days from the first post-discharge statement?”

Background: Americollect has recommended adding, (It is the patient’s obligation to provide a correct mailing address at the time of service or upon moving. If an account does not have a valid address, the determination for “Reasonable Effort” will have been made.) to the billing and collection policy to address statements and final notices that are mail returns.

Answer 2: Yes.
1. You are following your policy.
2. Americollect has built controls in place to ensure that we wouldn’t do ECA (specifically credit bureau reporting) until 120 days after the first statement. We do this by using the Epic data file and extracting the date of patient responsibility, date of last payment, or date of service and correctly add the additional number of days to each one of those accordingly.

Question 3: XYZ Health is also looking at using our collection prediction score to cancel accounts off as presumptively eligible for financial assistance. The question is when to presumptively qualify. Their controller is having issue with writing off the account as bad debt (accounting wise) and then reversing from bad debt and then applying financial assistance to rebuckets for accounting.

Would you mind sharing if you actually reverse the bad debt accounting bucket and then reapply as financial assistance accounting wise. And then a follow-up, what do you do when the “books” have closed for a year?

Answer 3:
Yes, we do just that! The account is originally written off to bad debt. Upon reclassification (per policy definition), the account has a negative transaction posts to bad debt and the balance is moved to charity care on the general ledger. These are not prior period adjustments. They are run through current period as the change is based on current information that was not known at the time of the write off (and in some cases, circumstances have changed, such as the guarantor is deceased).

Here was the background provided as part of a memo/documentation to our controller for our change in policy in 2013. Whether the accounts are processed through the revenue cycle system or just as a general ledger transfer would depend on the age of the accounts.

HFMA Guidance:
Bad debt results from the unwillingness of a patient to pay, whereas charity service is provided to a patient with demonstrated inability to pay. HFMA’s P&P Board Statement 15, Section 4.1 advises that “in some cases, [charity] eligibility is readily apparent, while in other cases, investigation is required to determine eligibility, particularly when the patient has limited ability or willingness to provide needed information.” [Emphasis added]

In cases where the patient never requests financial assistance, or is unwilling/unable to provide the needed financial information, the account defaults to bad debt. However, section 4.3 of the P&P Board Statement states, “Commencement of collection efforts does not alter the patient’s financial status. A provider’s collection efforts, including the use of outside collection agencies, are part of the information collection process and can appropriately result in identification of eligibility for charity care.” [Emphasis added]

Do you need advice or have advice on these topics? Write us at and we will share.

Least Sophisticated Consumer

Shawn Gretz,
VP of Ridiculously Nice Sales

I love TED talks. A recent one by Rutger Bregman titled, “Poverty Isn’t a Lack of Character; It’s a Lack of Cash,” had us at Americollect thinking about the “poor” in a different light. Go ahead, stop reading this article and watch the first five minutes or so.

Click Here To View

If you watched the full TED talk, this article is not taking a stance on agreeing or disagreeing with Rutger’s proposal of instituting a guaranteed income. I do, however, agree with much of what he says in the first five minutes. So, why do poor people make so many bad decisions? Why is it that statistically poor people:

  • borrow more
  • save less
  • smoke more
  • exercise less
  • drink more
  • eat less healthfully

A common argument, that Mr. Bregman himeslef self-proclaimed, is that “there’s something wrong with them. If we could just change them, if we could just teach them how to live their lives, if they would only listen.” Them being “the poor”. But something changed Mr. Bregman mind. That something was a study published Eldar Shafir, a Princeton Professor, who learned that when a person is “poor” they have a corresponding loss of IQ. Mr. Bregman compared it to the loss of a night’s sleep or being drunk. Now, most of us know the feeling of both and I’d like to think my IQ remains the same when I had a few drinks, but let’s take lack of sleep for a day. I remember the haze I was in after my son Trevor was born.  We had a rough first year where Trevor loved to sleep 2 hours at a time and then stay up an hour until his next “nap”. There were some days when I would go to work on a total of 3 hours of sleep. I know my IQ wasn’t anywhere close to where it is with a full-night’s sleep. It goes on to say that a person who is “poor” has a “scarcity mentality”. Your IQ decreases when you are searching for what is scare as in “time, money, or food” and let me add health or worried about the health of a loved one or child.

The mind of someone who is struggling isn’t making bad decisions because of who they are but more so because of “where” they are in life. The mind is being overloaded on where the next meal will come from, how to pay the rent, and how to get themselves or family healthy again. Think of it like a computer that has a bunch of programs opened at the same time and running very slow. The computer is overloaded because of all the items you are asking it to do at once. How does this relate to the “Least Sophisticated Consumer”?

The Fair Debt Collection Practices Act (FDCPA) is a regulation that collection agencies are required to follow. In the FDCPA, the “Least Sophisticated Consumer” is the regulation standard for which communications can occur with patients. It ensures that we don’t overload the patient when discussing bills.  That is exactly why Americollect works on being Ridiculously Nice in early out and collections. Patients prefer to communicate with an agency that understands that a person struggling today could be overloaded. Americollect helps patients understand by explaining away the complexities of healthcare with well trained healthcare collectors on items such as preventative vs. diagnostic treatments or facility vs. physician charges. This creates a relationship of trust with the patient and helps Americollect recover more money while satisfying patients and clients. Remember the next time you are on the phone with a struggling patient, their brains could be overloaded with many, many more important scarcity items.



No More Hospital-Based Imaging Says Anthem

Nick McLaughlin, Ridiculously Nice Sales

The Patient Experience is #1 on our list of priorities. It seems that may not be the case for Indianapolis-based Blues giant, Anthem, who implemented a new policy this summer saying that they will no longer pay for MRIs or CT scans delivered at hospitals, unless a review finds it was medically necessary to perform the scan at a hospital. The states effected are Indiana, Kentucky, Missouri, Wisconsin, Colorado, Georgia, Nevada, New York, and Ohio.

Anthem’s hope is that the policy allows them to keep premiums low, and give patients with High Deductible Health Plans an opportunity to save hundreds of dollars to go to a free-standing imaging center. The trouble with that explanation is that patients already have that option. Those who want to take advantage of it can seek lower-cost imaging services, but Anthem’s broad brush solution of not paying for hospital-based imaging at best limits patients from seeking the services they want, where they want, and at worst sticks their patients who are not familiar with this policy with even larger, unexpected bills.

What does this mean for Americollect clients?

Some patients with the resources and ability to deal with the hassle of this policy will likely seek outpatient-imaging services outside of the hospital setting. This will likely deal a significant blow to an often profitable service line, and hurt hospitals’ ability to offer other important services that operate at a loss. Additionally, there will be patients who go to the hospital for care, receive their normal service there, and wind up with a surprise bill that is not covered by Anthem because of this policy. Many of these accounts will wind up in bad debt, the patients will be furious that Anthem did not pay them, and many will refuse to pay the balances themselves. This is a lose-lose situation all the way around.

What can you do?

As if you didn’t have enough hoops to jump through already, here’s another one: figuring out how to prove medical necessity for Anthem’s imaging patients. There is a lot on the line with this one, so figuring out what qualifies as “medically necessary to perform the scans at a hospital” would be my greatest recommendation. Next, for yours and the patients’ sake, try to run all out-patient services through an eligibility check prior to providing the service. I hate that this now has to be done down the services that are provided, but it seems like that is the requirement at this point.

I have a dream that one day getting paid for providing awesome healthcare services won’t be such a contentious, convoluted mess.

To view our recorded webinars, click here.

What AR “Legacy” will you leave behind?

Shawn Gretz,
VP of Ridiculously Nice Sales

“Can you work my old AR to clean up my legacy system?” It is common for Americollect to receive this call from health systems throughout the nation. The answer is always, “Yes, but“. This article is about that but, the what to consider, and the how to put the patient experience at the center of the legacy AR decision.

System conversions can be a stressful time when your entire operations is about to be put in flux. For a majority of conversions it is not the operations that is the problem because the operation can be tested. It is the people that a system change can affect more. Your team will become frustrated, slower, and all together less productive. Have you ever called your spouse when they are frustrated about something? It normally ends with some sort of transference of that frustration to you. Not intentionally, but it happens. Now let’s put the patient in the middle of that frustration and you have a recipe for lower customer satisfaction scores and loss of revenue do to patients going elsewhere for services.

So, how do you put the patient in the middle of the decision on what to do with legacy AR. Let’s diagnose the problems that I have seen.

 1. Multiple Statements – While system conversions is a great time to make changes to partnerships, it is not the right time to add a level of complexity to your patient experience. I have seen it time and time again on health systems websites:

  •   If your date of service is before X you will receive this statement.
  •   If your date of service is after X you will receive this statement

Multiple statements are the death of patient experience. Imagine getting two statements from your credit card provider because they decided to change systems. It would never happen. It will be easier for your team, easier decision to make, and some statement providers (who will make more money by sending more statements) will even want you to make this decision because it will be easier for them, but you know who it will not be easier for right? Yes, I am talking about the patient. The patient doesn’t want two statements, with two payment plans and two sources of confusion. It is hard enough for patients to understand deductibles, co-pays, co-insurance, and out-of-pocket maximums so how does adding another statement make for a better experience?

Solution –  I would highly suggest that you work with your statement provider to find a way to combine both systems into one statement. The “good” partners know how to get this done with the data you provide. It may cost more money in programming for these companies, but it will be well worth the money to keep your patients happy!

2. Multiple Payment Portals – If you are working with separate online portal from your statements or moving toward your new systems portal such as My Chart this can be tricky conversion. I will give you a few suggestions ranked by what I believe provides the best experience to worst.

Solution – My first recommendation would be to pay the extra-money for adding the legacy systems API data to the new portal but this isn’t always possible. My second recommendation would be look external for a partner that can combine both charges for the first year. After one year, legacy systems will be almost completely worked down. There are many services who offer such in a payment portal. It will cost more money for one year, but the patient experience will be there.

3. Live Agents or IVR“Press 1 if your date of service was before X, Press 2 if your date of service was after X.” As mentioned before, this isn’t the best approach to patient experience. Many of your patients will have dates of service before and after, so where do they go? What if they press 0 or what if they have questions about both? This is where the patient experience dies. The patient doesn’t care that you just changed systems; they just want answers for all their accounts in one place.

Solution – Maybe to create a better patient experience, it may make sense to outsource your revenue cycle call center at least three months before go live and maintain that outsource agreement for 9 months afterward. This will allow your team to focus on the system conversion and less on call center operations. You could even repurpose some of your team to help patients understand the changes, upfront collections, financial assistance, learn the system, and/or improve the patient flow. The other solution would be to add staff ahead of the conversion to cover longer call times.

4. Legacy System Shutdown“We are going live 04/01/2017 and we plan on shutting down within six months”. “Ouch” says the patient experience. Patients call in every tax season to request an itemized statement for tax purposes. Medicare bad debt audits will require data in the legacy system. 501r audits may require access to all patients that have received financial assistance.

Solution –  My solution maybe a little late, but maybe the next contract should plan for the next separation with an agreement to host the legacy system and data for seven years. Finally, if all fails, then hire a third party company that specializes in hosting legacy systems.

Conversions are done to create a better patient experience. Don’t let the legacy system start that conversion off on the wrong foot with patients. Oh, and call Americollect if you are open to discussing the “Yes, but” on legacy systems.




Transition from Patient Billing To Guarantor Billing

Nick McLaughlin,
Ridiculously Nice Sales and Business Development

Most healthcare billing systems are great at combining bills from different encounters on a patient or account basis. However, a higher level of customer service can be achieved with guarantor, or household billing.

Allow me to set the scene. Greg and Stacy have three children and the whole family is under Greg’s employer’s health plan. Greg will be the guarantor no matter which child is the patient. In most billing systems, if Stacy brings a child in for an office visit, Greg has a knee replacement, and another child has to visit the Emergency Department, Greg would receive a separate bill for each patient, with none of them reflecting Greg’s total balance with ABC Healthcare. In our experience at Americollect, guarantors like Greg would much prefer to have one, guarantor-level statement with ABC Healthcare. Meaning each statement would include self-pay balances for all members he is the guarantor for in the household. Not only does aggregating the accounts under one guarantor improve the patient experience with billing statements, it improves the patient experience working with your Patient Financial Services Department. Greg no longer needs to bring up each account number with your Customer Service Representative, one-by-one, and add them up to get a total balance.

How To – Guarantor Number Creation

For starters, defining terminology is the first step to take when discussing guarantor billing. Below are common healthcare system terms:

  • Medical Record Number – unique set of digits associated with the patient
  • Guarantor Number – unique set of digits associated with the guarantor
  • Account Number – unique set of digits associated with the date of service

The system you use today may already be using this type of combination. If not, we may be able to help you improve the patient experience through guarantor billing.

The guarantor number in this case is critical to successfully executing this flow. However, at Americollect we understand some healthcare information systems are more challenging to use, and may need more attention to develop. Americollect has designed programming to take common data elements such as name, DOB, and address to assign guarantors and created custom programming to manage, organize, and create a guarantor-based statement. The guarantor then receives a statement once per month on all balances currently in self-pay. If an account is paid in full, we manage their statement cycle, and as the guarantor balance increases with successive services, we work with our clients to customize the best statement workflow for them. Greg and his children will be on one statement. Greg’s wife, since she is her own guarantor, would be on her own. Some organizations manage their guarantors by whomever brings the child in, and not whomever holds the insurance policy. We have seen that process work just as well. Greg receives his proper statements for all his self-pay responsibility and Stacy receives hers.

Result – Improved Patient Experience

The best part is that we have integrated our phone systems and calling workflows to ensure Greg or Stacy have received at least one statement reflecting their current total balance before calling their accounts. We always want to discuss their total guarantor account balance, and create a full-scope conversation to shape the patient experience from the back-end to the front-end. This saves your customers and your team time on the phone discussing multiple accounts at different times, and time is money!



Emergency Room for Non-Emergent Problem

Shawn Gretz, 
Ridiculously Nice Vice President of Sales

Blue Cross and Blue Shield (BCBS) is no longer paying for the boy who cried wolf in four states. You know the old wives’ tale – A bored boy tending sheep cried “Wolf!” to get attention. He did it a second time, and again the village people came to help him. The third time the boy cried “Wolf!” and the boy was ignored but this time the wolf was real and his flock of sheep was eaten. The moral of the story… BCBS doesn’t want patients utilizing the emergency room when a primary care doctor will do!

BCBS in New York, Georgia, Kentucky, and Missouri will be no longer paying for non-emergent use of emergency departments. It is an interesting stick that BCBS is using to try to drive the patient to cheaper options for healthcare.

What does that mean for Americollect clients? I am afraid to say that it is going to mean more bad debts and confusion for patients if you work in those four states. I also feel that this provision is one that could potentially spread to other insurance companies and divisions of BCBS before long.

What can you do? I believe now is the time to start training all registration staff in the emergency department to have the discussion with patients that have non-emergent problems as they leave the ED. Educate them on the options they have for service that would be in their best interest, or they risk paying the charges themselves if the service isn’t covered in the future.

TCPA Language – Are your contracts updated?

Joelle Mark, 
Ridiculously Nice Compliance Officer

The Telephone Consumer Protection Act puts restrictions on how we are able to contact consumers to collect on your accounts.  Some general provisions of the TCPA include but are not limited to; prohibiting calls made to a cell phone with an automatic dialing system without prior express consent and prohibiting faxing, e-mailing and texting unsolicited advertisement without prior express consent.

The TCPA not only affects Americollect, but you as medical providers if you are using an automatic dialing system for appointment reminders, notifications of prescriptions, or anything else.  There are a few ways that you can help protect both your collection agency, as well as yourself, from litigation under the TCPA.  Do not skip trace for phone numbers. Make sure that if a phone number is for “next of kin”, it is labeled correctly, document that the phone number was given to you by the patient or guarantor, and update your admission agreements, online login agreements, and yearly HIPAA sign offs with the following language:

You agree to receive pre-recorded/ artificial voice messages calls and/or use of an automatic dialing device, text messages and/or emails from CLIENT NAME, our partners, subcontractors, or any and all other companies that we may have to transfer your account to at any telephone number or email address that you have provided us or that we have otherwise obtained, which could result in charges to you.  We may place such calls, texts or emails to (i) notify you regarding upcoming appointments; (ii) notify you of results; (iii) troubleshoot problems with your account (iv) resolve a dispute; (v) collect a debt ; or (vI) as otherwise necessary to service your account or enforce this admissions agreement, our policies, applicable law, or any other agreement we may have with you.

 The ways in which you may provide us a telephone number or email address include, but are not limited to, providing the information at account opening, adding the information to your account at a later time, providing it to one of our employees, providing it to our partners, subcontractors, or any and all other companies that we may have to transfer your account to, or by contacting us or our partners, subcontractors, or any and all other companies that we may have to transfer your account to from that phone number or email address. If a telephone number provided to us is a mobile telephone number, you consent to receive SMS or text messages at that number. Standard telephone minute and text charges may apply if we contact you. You may revoke this express consent at any time by calling us at: XXX-XXX-XXXX.

By adding the above language to your admissions agreements, you are taking huge steps help Americollect remain compliant with the TCPA which means an ability to collect more money on your accounts.

For questions, please contact our Compliance Team at 800-838-0100 or



“Why Are Medical Bills So Confusing?”

Shawn Gretz,
Ridiculously Nice Vice President of Sales

This is a question that the US Department of Health and Human Services (HHS) decided to tackle when they released a design contest titled “A Bill You Can Understand.” To view the report and winners visit: The report from the study does a great job of describing the problems patients have with the largest post-service touchpoint, the medical bill. The contest had two prizes: 1. Easiest Bill to Understand, and 2. Process -Transformational Approach to Medical Billing. This article is a synopsis of the problem areas the report found, along with solutions that the contest winners brought forth that we believe have true potential. We will also address what you can do right now to provide “a better patient experience.” (Besides hiring the Ridiculously Nice Early Out and Collection agency if you haven’t already!)

Problem-“Complexity Kills the Payment”

The first problem identified in the report was the complexity of charging for healthcare services. Issues raised in the report include:

  1. Patients are confused by the fragmented care provided by multiple doctors and facilities who all bill independently;
  2. Patients rarely know what they are going to have to pay before a procedure;
  3. Patients do not know where to turn for answers to their billing questions; and
  4. Patients do not understand the denial, appeal, and insurance resubmitting process.

Let me also include that studies show (including one done by that on average patients do not understand deductibles, co-insurance, co-pays, and out-of-pocket maximums.

Problem-“Volume of Communications”

Consider from a patient perspective all the written and verbal communications that a patient receives from one visit. The complexity is mind-boggling to the point that it creates a barrier to payment. The communications include:

  1. Pre-Service – Price comparison, registration, pre-authorization, and appointment reminder – Oh my! Each one of these touch-points have a potential for patient dis-satisfaction. The biggest medical service that has removed the complexity is the one we would prefer to steer patients away from, emergency care. There, a patient can skip this step and just come on in.
  2. Appointment – At the appointment, the volume of communication continues. At the registration desk the annual HIPAA authorization, pre-service paperwork including authorization to bill along with Telephone Consumer Protection Act express consent. Then there is the verbal nurse’s instructions, verbal doctor’s instructions, pamphlets, prescriptions, and written instructions for after service.
  3. Billing – Even after the service, the volume of communication continues.
    1. Explanation of Benefits (EOB) – First come the EOBs with their confusing language of deductible and co-insurance. Add in the coding for the procedures and doctor names that the patient doesn’t even recognize for service. Multiply this by the multiple EOBs for facility, ER, anesthesiology, radiology, or pathology bills.
    2. Statements – Next comes the patient statements that may be come 30-45 days later and not just from the facility but again from ED physicians, anesthesiology, radiology, and pathology. Each of these statements may or may not match the EOB. Let’s take the patient paperless. Great now you need multiple logins from each of the different services to pay for the service. Most emails that I have seen sent to patients do a poor job of describing the services because of HIPAA’s requirements to send a clear communication of who the patient was and what the services were for.
    3. Verbal – Next come the communications with a call center that hopefully is staffed correctly to handle the incoming volume.

    Each and every one of these communications leaves space for the patient to be dissatisfied or choose to seek services somewhere else. Combine with this that the article points out that patient understanding, terminology, timing, and trust plays a role in patient payments.

    Solutions Offered:

    1. Patient Journey Mapping – A solution can only be solved when you state the full problem. In this contest one of the requirements was to create a patient journey map of all the touch points from the patient revenue cycle, and qualify them as either producing a positive or negative experience; thereby stating the problem. I would suggest you try this process yourself. Bring together your team to follow a patient’s journey through the experience you are creating for the patient. Search for those positive and negative touch points and remove the negative when possible.
    1. Deductible and Out-of-Pocket Maximium – The organization RadNet revealed a statement design that included a pie chart with the deductible and out-of-pocket maximum information. Patients who receive a statement such as this may stop looking at the EOB, and wait for your statements to make it less confusing. This information would be available through most clearing houses at the time the statement is generated.
    1. Doctors – Another design change by RadNet was to show images of the doctors next to each itemized charge. This refreshes the memory of the patient making it easier for payment. Along with the images is a QR code that could quickly take the patient to a FAQ spot to describe the service or facility being charged for to explain away the complexity.
    1. All Physicians – A submission by St. Luke’s in Boise, ID brought together all physicians, regardless if they operate independently, onto the statement sent to the patient. Imagine if you could differentiate yourself by making it easier for the patient to pay by sending one statement for the entire service. Many groups and their billing companies struggle to find a way to continue to collect self-pay balances. By combining these charges with your self-pay charges, significant cost savings could occur from statements and phone calls for the physicians.
    1. Terminology – The simplest way to generate a statement is to use the already provided terminology on the charge master. This may also be adding unneeded complexity to the bill. Consider providing the statement company a different table to simplify the language of the charge master into what the patient can understand. Also consider viewing the EOB from time to time of patients to see if the insurance companies terminology matches your terminology.

    These five solutions can all create a better patient experience as does choosing the right partner to implement these. I suggest you look to implement these in the future or journey map your own solutions to the complexity.

    Americollect is looking for partners to build a “Patient Journey Mapping” case study with, including providing early out services for a hospital or health system and their contracted physician groups. The overarching goal being to improve your patient experience.  Let Americollect come on site with our team to map out the current patient experience and redefine the future with you. If you would like to explore this opportunity with us, reach out to Shawn at or 920-420-3420.