How to Support Patients and Help Protect the Bottom Line During the COVID-19 Crisis

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Man at home looking at bills and budget on laptop

Patient Collection Strategies in an Economic Downturn

Today many healthcare organizations are facing new levels of uncertainty as a result of the COVID-19 pandemic. While each organization is focused on caring for patients and keeping team members safe and healthy, providers cannot help but also be concerned about the impact this will have on other areas. This rapidly evolving pandemic has put pressure on all facets of healthcare, including clinical care, the revenue cycle, and personnel management.

As organizations transition to a social-distancing operational model, many are asking what impact this will have on their AR, particularly their patient balances. Across the country, employers are making hard decisions related to how to operate in a decentralized nature and whether to furlough or lay off employees. That means patients—who are also often employees and parents—are facing the same economic risks and fears as the providers who care for them.

Patient liability programs are an essential link between the healthcare event and the patient. Passive outreach and education via print statements remains the first post-care financial interaction, but a strategically designed and proactive communication program can help reduce the near- and long-term impact of this health crisis. 

While there are many headwinds in the patient AR space, this crisis also represents a unique opportunity as it relates to patient outreach as well. Never before have we had a greater opportunity to connect with consumers and patients than today. As patients increasingly transition to a work-from-home model with their employers, the opportunity to connect and engage with these patients also increases.

With that said, it is imperative for providers to evaluate their communications and outreach programs to help ensure that all print, digital, and voice communications have a compassionate, empathetic, and respectful tone that acknowledges the patient’s new and often stressful situation.

There are several steps providers can take now, and over the coming months, to help increase patient-collection outcomes and lower overall revenue risk.

Below are a few strategies that your organization may wish to consider.

Increase screening for commercial and government insurance coverages 

The best way to maximize AR and reduce self-pay risk is to avoid patient collections that are both inappropriate and unnecessary. We know that issues with demographic and insurance data can lead to accounts being billed to patients that ultimately should have been billed to payers first. Consider deployment of automated coverage discovery processes to pre-screen uninsured and balance-after-insurance accounts for missing primary and secondary insurance. Change Healthcare has solutions that can provide this functionality today with the ability to quickly instream this automation into existing early-out programs. This will help avoid unneeded patient calls, improve patient satisfaction rates, and accelerate overall revenues.

Update your patient communications

As many individuals transition to a work-from-home model, the opportunity to connect and engage with them increases. However, many of these individuals are likely to be under increased financial pressure and/or stress as they juggle multiple priorities in the home environment. Now is the time to update all communications—print, digital, and voice scripts—to incorporate acknowledgement of the current national healthcare crisis, potential employment changes, and likelihood of significant financial-status changes that patients may be experiencing, which may impact their ability to resolve balances due. This proactive, empathetic messaging, coupled with updated agent training, will let your patients know you are sensitive to new difficulties and are eager to work with them to alleviate stress where possible. You may want to adjust protocols on the frequency of print, IVR, and outbound callers to avoid excessive interactions and the undue stress this may put on patients. In general, if a patient has engaged with a patient liability agent or portal system, you may wish to consider delaying successive interactions by 5-10 days.

Consider accelerating prompt-pay discounting

Many organizations offer a prompt-pay incentive to encourage patients to resolve open balances within 30 days and may also offer additional discounts later in the aging process. This is a good time to consider short-term plans to increase or accelerate the discounting process in the interest of resolving more open account balances before the larger tide of economic stress hits. Offering a significant discount to self-pay and even balance-after-insurance accounts, where allowed by law or per your payer contracts, may motivate patients to act now.

Deploy and emphasize payment plans

Many patients do not currently or will not have the economic means to fully resolve their balances due to loss of employment or other financial issues. While organizations may currently support the ability for patients to make full and partial payments, offering payment plans can be an important step to help patients start to resolve their balances while still operating within the limits of their income. Payment plans should not be “honorariums,” meaning they should be secured with a credit card or bank account and should be automatically drafted. Leveraging modern patient-portal technologies, these payment plans can be fully administered and even incorporate 30-, 60-, or 90-day delayed drafting schedules to further assist patients. The sooner you have a card or bank account on file, the more likely the patient balance will be paid. In the event your current patient portal does not support self-elected automated payment plans, consider taking the opportunity to make platform changes to enable this functionality.

Consider automated presumptive charity and enhance financial assistance programs

If your organization does not already have a published financial assistance policy that includes discounting or write-off provisions for low-income patients, you may want to consider instituting one to provide you with additional flexibility. Due to widespread unemployment, there may be more patients who meet guidelines for low-income/poverty levels in the near future. You may wish to consider implementing a presumptive charity screening within your existing collections program to help ensure patients who are indigent avoid punitive collection processes. In addition, accounts should be re-screened monthly to help identify accounts that have revised financial conditions. As a reminder, traditional scoring solutions are often based on credit data that may be delayed by as much as 60 days in their ability to identify financial stress or risk indicators. Finally, financial assistance programs should not rely solely on presumptive scoring processes and should encourage patients to file evidence-based electronic or paper applications in the event that their employment status has changed within the last 30-45 days. While this will likely increase manual-review volumes, such applications are vital to ensure patients who qualify are captured. Depending on your organizational structure and government reporting requirements, you may also be positioned to recapture or recategorize some of these write-offs financially.

Delay referrals to bad debt and collections

Many patients who would typically pay their bills are going to be suffering economic hardship over the coming months that could impact their ability to pay. To be compassionate to this changing situation, consider changing your bad debt and collections referral process and timing. This may include delaying the referral of any patient account by an additional 60-120 days beyond current thresholds. This may be customized to allow any patient who has engaged directly and are attempting to resolve balances via payment plan or other measure to be delayed even further, while still forwarding accounts where there has been no engagement and no ability to connect due to incomplete or missing contact information. What should be avoided is negative patient sentiment and bad publicity that could come from aggressive and punitive collection activities as well as lost opportunity to work to resolve balances via payment plans or other means.  

Coordinate with your collection vendors

Engage your collection vendors to help ensure their charters and operational models are updated to align with your early-out/active AR program adjustments. If your collection vendors have not initiated these conversations, consider scheduling calls soon to discuss adjustments to letters, call scripts, and punitive actions (e.g., leans, garnishments, credit reporting, etc.).

Finally, it may seem counter-intuitive, but this is an opportune time to invest in process and technology changes that will support your revenue cycle both now and in the future. For example, digital engagement programs that include text and email alerts or self-administered payment plans were important yesterday and will be more so in the future. Using this time when patient volumes and A/R may be declining to take those big steps may better position your organization when the economy and healthcare begin its recovery in a few months.

We know that this tumultuous period can be very stressful for you and your organization. Change Healthcare is here to help you weather the changing dynamics of the current healthcare environment. If you would like to discuss these or other strategies, please reach out to us.