Many healthcare organizations depend on the work of financial counselors to help patients understand both their insurance coverage and their financial obligations. These professionals help patients make smart choices by answering questions about the cost of healthcare services, setting up payment plans, or identifying potential forms of financial assistance. Financial counselors also help organizations successfully collect patient responsibility balances, reducing uncollectible debt.
Today, financial counseling services are in high demand as patients face new financial challenges, due in part to growth of high deductible health plans (HDHPs). As patients shoulder more of the financial burden for their care, healthcare organizations should prioritize financial counseling to help patients understand the billing process and meet their obligations — throughout the entire care episode.
After witnessing the evolution of healthcare payment trends, financial counselors are experts in navigating dynamic patient financial interactions. Conversations about finances can be complex and unpredictable, and counselors must maintain a delicate balance between advising the patient and advocating for collections. They must develop empathetic relationships with patients while also protecting a hospital's bottom line.
Before committing to a procedure, more and more patients are demanding cost estimates from multiple providers, comparing prices and payment plans. These patients are seeking financial counseling support on their own, and they expect timely, accurate responses to help them make their decisions.
A financial counselor's typical day includes meeting with patients to provide cost estimates for scheduled procedures, reviewing the billing process, and answering any questions patients may have prior to admission.
Consider the following patient scenarios.
Out-of-pocket healthcare expenses continue to rise at a steady rate, and patients are increasingly confronted with substantial out-of-pocket costs that are often unexpected. In fact, a Kaiser Family Foundation study found that 43% of insured patients said they delayed or skipped physicianrecommended tests or treatments because of cost.1 Simply put, many patients present without the ability to meet their financial obligations up front.
In these cases, financial counselors meet with patients prior to admission to determine insurance eligibility — a strategy deployed by hospitals to improve their collections outlook as HDHPs and self-pay revenues increase. Counselors then provide patients with an estimate of their expected financial obligations based on the services to be rendered, and ask for payments up front. If patients express financial hardship, counselors work to determine if discounts can be applied.
If patients have HDHP insurance or are classified as self-pay, financial counselors conduct screenings and identify other potential financial assistance options. Screenings include personal information such as a patient's marital and dependent status, citizenship, income, investments, and personal assets. The counselor may also determine if the impending medical procedure is related to crimes committed against the patient, or if the patient's motor vehicle insurance or employer's worker's compensation injury insurance might cover the procedure. If a patient is unemployed, the counselor may investigate if the patient qualifies for COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage.
Once the counselor has explored the full financial picture and applied any discounts, the patient receives a final cost estimation. The financial counselor then works with the patient to establish a payment plan and collect an initial deposit up front, if possible.
Financial counselors often engage with patients who are shopping around for services. Today's consumers are savvy about their health care, and they want to take more ownership in the process of choosing a provider. Value is key, as patients must balance increasing personal costs against receiving the best possible care.
Financial counselors walk potential patients through the list of expected charges. Some of these costs can be easily estimated, while others are more dynamic due to variables that occur during care. Counselors use an infrastructure of A Kaiser Family Foundation study found that 43% of insured patients said they delayed or skipped physicianrecommended tests or treatments because of cost.1 Helping patients meet their financial obligations can improve clinical outcomes and increase collections Navigating Patient Payment Conversations with Financial Counseling 3 eligibility resources and estimation tools to conduct a thorough analysis of all factors influencing cost, providing timely estimates that reflect the best available prices. One of their main goals is to ensure that patients make informed choices about their care.
As healthcare billing is quite complex, financial counselors spend a lot of time helping patients understand their insurance coverage and medical bills. Patients who historically have relied on insurance to cover most of their healthcare costs are now trying to decipher billing documents to determine their financial responsibility.
In one example, a patient inquired about scheduling an MRI (magnetic resonance imaging) before leaving for an international trip. The patient's insurance required authorization, but the timeframe for approval was five days — a delay that would not accommodate the patient's pending travel. The financial counselor expressed empathy for the patient's plight, but explained that he would either need to self-pay for the MRI or wait until he returned.
In another instance, a patient with two forms of insurance wanted to access both policies' benefits for the same procedure. One insurer covered 80% of the care received, and it seemed logical to use the other to pay for the other 20%. Unfortunately, the system does not work that way. The financial counselor explained the benefit structure and walked the patient through various scenarios to determine her best path.
These scenarios are common, as the billing process creates considerable confusion for patients. Many patients have misconceptions about the bills they receive due to the disjointed nature of billing processes across health systems. Multiple invoices from hospitals, physicians, and other ancillary health services make it difficult for patients to understand their true obligations, and many believe they are being double-billed.
To alleviate any confusion, financial counselors talk to patients before admission to describe the various charges they will incur. After the bill is received, patients can visit the hospital to review the bill with a financial counselor, who will help them clarify charges and ensure accuracy.
Today's financial counselors must use a variety of resources on the front end of the payment cycle, including screening tools and prescribed processes, to secure eligibility data and determine pre-existing and potential funding sources.
A Kaiser Family Foundation analysis reveals that nearly half of uninsured patients are eligible for Medicaid or other subsidized coverage.2 When financial counselors are equipped with the right tools and information, they can easily identify these opportunities. Expanded connectivity helps counselors improve patients' financial outlooks and ultimately collect more payments.
As the tide shifts toward value-based care, successful hospitals and health systems are recognizing the significant role financial counselors play in patient access. These organizations leverage this role to help patients cope with common financial challenges, understand their financial responsibilities, and select the best possible healthcare services. By arming financial counselors with advanced technological tools, these organizations are able to increase their collection rates and positively impact their bad debt.
Having the right infrastructure in place positions financial counselors for success, especially as patients continue to shop for services and take ownership for their care choices. For example, automation that provides eligibility information and cost estimations at the point-of-care can dramatically improve financial conversations, empowering patients to make the best decisions in a timely manner.
Effective financial counselors possess a unique skillset of communication skills and healthcare expertise. Patients rely on financial counselors to serve as an advisor, which differentiates this role from other administrative healthcare professionals.
Communication skills form the foundation of this profession, as does a solid understanding of insurance and claims processing. Financial counselors are not only knowledgeable about healthcare billing processes, but they are also inherently good listeners who can easily engage with patients.
Many patients with billing questions or financial difficulties simply want to be heard. Expressing empathy is key, as patients often find themselves in highly stressful situations. Counselors who can develop a rapport of understanding and trust with patients are best positioned for success. Counselors must also possess great patience and determination to dig into the details of a situation and problem solve on the patient's behalf.
The vast majority of patients want to partner with healthcare organizations in their care. They want to receive the best care possible while also meeting their financial obligations. Hospitals and health systems need to empower patients to achieve these goals, as encouraging patients' financial accountability is also in the organization's best interests. With the right resources in place, financial counselors can engage patients throughout their entire clinical and financial experience, improving patient satisfaction and securing repeat business.
1 Henry J. Kaiser Family Foundation (January 5, 2016). New Kaiser/New York Times Survey Finds One in Five Working-Age Americans With Health Insurance Report Problems Paying Medical Bills. Retrieved from: www.kff.org, link: https://www.kff.org/health-costs/press-release/new-kaisernewyork-times-survey-finds-one-in-five-working-age-americans-with-health-insurance-report-problems-paying-medical-bills/
2 Henry J. Kaiser Family Foundation (October 13, 2015). Nearly Half of the Uninsured, or 15.7 Million People, Are Eligible for Medicaid or Subsidized Affordable Care Act Coverage, Analysis Finds. Retrieved from www.kff.org, link: https://www.kff.org/uninsured/press-release/nearly-half-of-theuninsured-or-15-7-million-people-are-eligible-for-medicaid-or-subsidized-affordable-care-act-coverage-analysis-finds/
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