Are You Ready to Send Consolidated Statements?
Solution Director, Communication and Payment Services
Bryce has spent the last 12 years in healthcare and financial services optimizing consumer behavior and helping to enhance healthcare financial literacy. Over the past four years, he has been enhancing and launching new solutions for Change Healthcare.
Senior Manager, Performance Improvement – Advisory Services,
Ernst & Young LLP
Hardik has spent more than 12 years in health provider revenue cycle and health IT consulting, primarily focusing on optimizing processes to improve consumer experience, increase revenues, and reduce the cost to collect.
Principal, Performance Improvement – Advisory Services,
Ernst & Young LLP
Andy has more than 19 years of experience advising hospitals, health systems, academic medical centers, physician practices and health IT companies on strategic decision-making and supporting large transformational projects that positively impact healthcare providers’ financial and operational performance.
How many bills are too many?
Following a single hospital encounter, patients often receive multiple bills from a variety of providers—sometimes as many as 20 or 30—depending on the services provided and specialists involved. This barrage can be overwhelming, but there are other issues as well. One bill may arrive significantly later than the others, frustrating patients who believed they’d already met their financial obligations. When they find the volume or timing of bills confusing, they may want to call the billing or customer service department for help—but which one, the hospital, provider or payer's office?
The consequences are predictable: delayed payments and dissatisfaction. In a 2015 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey (HCAHPS), patient satisfaction ratings fell by an average of more than 30% from post-discharge through the billing process. The survey also found that poor patient satisfaction not only reduces repeat business, it also diminishes the likelihood that patients will recommend the hospital or provider to others.1
The increasing prevalence of high-deductible health plans and rising patient-financial responsibility makes the patient billing experience a critical component of your business strategy. Consumer expectations have been shaped by the communication and billing options offered in other industries, and singlestatement billing offers you the opportunity to address consumer needs, meet expectations and improve patient satisfaction.
Consolidated Statements: A Giant Leap Forward in Patient Communications
Consider a patient who has a complex hospital encounter that results in charges from the surgeon, facility, radiologist, and anesthesiologist. Rather than receiving multiple bills, the patient gets a single statement that clearly indicates the charge applicable to each provider or service. If there are concerns about the bill, the patient can call a single customer service phone number for answers to questions about any aspect of the encounter. Because the patient understands the total bill, the likelihood of timely payment is increased, the need for follow-up communication is decreased and patient satisfaction is higher. Providers can also benefit from cost savings achieved through economies of scale and staffing efficiencies associated with reduced mailings.
From a patient’s point of view, single-statement billing is simpler—everything’s all in one place with one check to write and one-stop shopping for customer service.
Proceed with Caution
For providers, however, making the transition to single-statement billing will require remapping processes related to customer service and payment allocation. The logistics of combining data, billing cycles, and patient services can be complex and takes time to complete.
Nor is the transition without risks. If executed poorly, single-statement billing could potentially alienate patients. It would be better to send three or four statements with easy-to-understand language and charges than a single statement with an unfamiliar, nonintuitive format and cumbersome payment instructions. Disrupting current processes without a strong vision, a detailed plan of action and a purposeful rollout could also decrease collections and frustrate or demoralize staff.
The benefits of sending consolidated statements are significant, but you’ll only have one chance to get it right. Working with a vendor who has already navigated the challenges and discovered solutions will get advantageous results. As you embark on this journey, you’ll want to make sure that your organization is ready, and you’ve taken the steps that have already proven to be essential to success.
Preparing for Single-Statement Billing: A 4-Step Readiness Plan
Realizing the benefits of single-statement billing requires preparation. Whether or not you adopt new vendors or technology, you will be changing your organization’s culture. Allow time for the preliminary work of information-gathering, investigation, and analysis. Taking the following steps will help you move toward readiness:
Step 1: Engage Stakeholders
Any change requires buy-in from stakeholders. Single-statement billing is not just a change in the bill, it is an organizational change that affects several areas of your business. As you begin the process, work to make sure all parties are aligned and build a steering committee that includes all those affected by the change. Ownership may belong with the CFO and revenue cycle leadership, but depending on your organizational structure, you may also want to involve representation from the billing department, customer service and call centers, the patient experience office, IT, general counsel, or others responsible for making changes to technology. Be sure to include patient voices from the beginning so that the changes you are making address the needs of your customers.
Step 2: Assess Technology and Data Sources
The complexity of drawing data from multiple systems will depend on the compatibility of those systems. If all entities are working on the same electronic health record (EHR) system that directs charges to a single billing office, the process will be simpler. Commonly, however, parties will use different EHR vendors or will have disparate solutions with data stored in different systems. In that case, successfully combining the data will depend on having a unique patient identifier or common data element, such as a medical record number (MRN), in each of the data sources. Even then, you will need to consider several questions, such as:
- Are the systems account-based or event-based?
- Does each data source contain the same types of data, or are different details communicated? (Common header titles will need to be chosen to include data from each source.)
- If each entity has a different address in its system for the same patient, which should be used for the consolidated statement?
- How long do you wait to aggregate the data, especially if some parties currently have different billing cycles (e.g., daily vs. monthly)? Billing cycles will need to be coordinated so the data to be consolidated is received at the same time.
You will also want to conduct a thorough assessment of technology and vendors used in other parts of the patient billing process and look for ways to align them with single-statement billing.
Step 3: Identify Opportunities to Standardize Policies and Processes
Many processes will have to be adjusted when implementing single-statement billing. Payment tracking, cash reconciliation, payment plans, dunning cycles, and bad-debt processes should be evaluated and redesigned to enable coordination among the participating entities. Policies around self-pay discounts, small balance write-offs, and defining bad debt will need to be standardized.
Determining how to handle partial payments will be a significant decision point that involves multiple stakeholders. Options include allocating payments by the first in, first out (FIFO) method, allowing patients to direct payments, and distributing the funds proportionally. Participating organizations should conduct a thorough analysis of how each option under consideration would affect each party to choose the most appropriate method.
Step 4: Determine Where Third-Party Support Will Be Needed
In addition to having a strong partner to assist with the decisions and realignment outlined above, you will likely need to evaluate the role of vendors and systems for other aspects of the process. For example, if there are disparate patient account systems and applications used across facilities and providers, you will need to implement thirdparty technology to pull in data feeds from all systems and provide a single view, workflow and reporting method for the organization. You will also want a statement vendor with the data and design capabilities to produce a compelling consolidated statement.
Keys to Success
Include Consumer Preferences in Statement Design
Preparing a single statement has many technical and logistical elements, but they should not overshadow the importance of design. The final appearance of the bill will largely determine the patient experience. The most effective statements draw on research, experimentation and understanding of adult learning and behavioral psychology. Patients need statements that reflect their own experience of events to find them understandable and trustworthy. Trust and clarity are also key factors in motivating patient payments.
Update and Unify Customer Service
A single statement should be supported by a onestop customer service solution, so patients don’t need to call multiple offices to get their questions answered. New phone numbers and other means of contact should be implemented, and ideally, customer service team members should be working in the same office. Consolidating customer service functions will go more smoothly with appropriate policies and thorough training. Staff will need crosstraining on hospital and physician billing so they can answer questions on both topics.
While the reorganization may eventually lead to a reduction in staff, keep in mind that the transition period will be demanding, with staff potentially learning new information, workflows, and technology while still fulfilling customer service needs. Downsizing staff at the start of the process could diminish gains in positive patient experience and increase confusion internally.
Educate Stakeholders on the Benefits of Change
Well before rolling out new statements, patients will need to know that they can expect changes to billing, customer service, payment methods and more. Websites, marketing and other communications should reflect the change and should be carefully scripted to emphasize how they will be favorable. Even earlier, physicians and customer service teams should learn about the changes, so they can begin talking to patients as they schedule services and when they come in for an appointment. Making a sample single-statement template available via web page or video will familiarize patients with all that is entailed in the change, such as new customer service email or phone numbers, different payment options, and the format of service-level details.
Your definition of success will depend on your organization’s needs and goals. Choose metrics for success based on the objectives you want to achieve and be sure that you have a means to measure them. For most healthcare organizations, patient satisfaction scores will help determine whether the current format of a single statement bill is addressing consumer needs. When developing a reporting tool to track and measure patient satisfaction, include reasons for dissatisfaction to identify additional improvement opportunities. The findings may guide future changes to patient statements or other elements of the billing process. This initiative could also be measured via:
- Self-pay collections
- Bad debt write-offs
- Patient billing and/or customer service staffing efficiencies
- Cost savings from vendors and technology maintenance
Selecting the Right Collaborator(s)
Given the range of options, decisions and changes that go along with implementing singlestatement billing, most organizations choose to work with a vendor and/or consultant with a breadth of knowledge in this area. Working through the implications of operational choices and communication formats with strategic collaborators is a highly reliable way to achieve an outcome that is both positive for your patients and operationally sound.
Qualified vendors and consultants should be able to offer you the following:
Depth of Experience: Your organization is unique, and a one-size-fits-all solution won’t work. A partner who has worked with a variety of institutions, organizational structures, and technologies will be better able to help you find the right answers for your specific needs and goals. Especially if you are bringing together multiple data sources, you will need a technology-agnostic partner with the data management capabilities to accomplish your objectives.
Breadth of Services: The adoption of single-statement billing touches several areas of your business, from revenue to operations to technology. An effective vendor will be able to offer guidance in all these areas. In addition, you will want a partner that can walk with you through the entire journey, assisting with visioning and process redesign all the way through implementation.
Patient Experience Insight: Decisions aimed at improving patient experience should be guided by research and data. They should also be informed by your particular patient population. Choose a partner who has robust methodologies for understanding both what patients want and what drives consumer behaviors, especially when it comes to financial communications.
Ability to Innovate: Single-statement billing is becoming commonplace in today’s market. From digital payments, to patient-facing apps, to automation and machine learning, advancements in technology are affecting both your operations and patient expectations. These types of innovations are bound to continue, so make sure you work with collaborators who can help you look to the future and stay ahead.
1. 2015 HCAHPS survey, cited in Chris Seib, “Patient Experience Needs to Play a Bigger Role in Your Payment and Billing Process,” American Journal of Managed Care, January 18, 2018.