As hospitals strive to improve patient experience and access, it is important to remember the billing and account resolution process. According to a survey by TransUnion Healthcare, nearly 70 percent of survey respondents who gave the highest ratings to their quality of care over the past two years also gave high ratings to their billing and payment interactions. Poor experiences in trying to resolve an account could have a negative impact on the access image of a hospital. Plus, there are emerging federal requirements to simplify this process for patients.
HFMA released its best practices in the medical account resolution process, which helps the patient navigate an often-confusing situation, to one that provides a better patient experience and greater success for hospital collections.
Part 1: Initial screening and billing
Each patient’s account should be initially screened for programs and services that help with payment such as a primary/secondary payer for billing, discounts for eligible uninsured, eligibility for public programs, bankruptcy or other financial assistance programs. After all options are exhausted, a clean bill is ready to be sent to the patient. Of course, if the patient is granted 100 percent financial assistance or pays in full, then the resolution process stops.
If, when the patient receives his or her bill and the balance remains on the account, then the provider can move in one of two ways – a small balance resolution option or other provider account resolution efforts. The provider may resolve the account internally, send to early out business affiliates, or issue an administrative write-off on the account, depending on the circumstance. Should the account need screening for resolution efforts, it is advised that the provider seek insurance verification, COBRA or public assistance eligibility, data score for financial assistance or develop a payment plan, conduct a presumptive score review, create a patient payment plan, get third-party loans from reputable lenders, or send letters and call on the account.
Part 2: Additional screening and collections
At this point, if a balance remains on the account, it is deemed a bad debt risk. A collection agency then steps in to resolve the debt through provider board-approved policy, which may include: screening or scrubbing (insurance, financial assistance program eligibility, bankruptcy or deceased), propensity to pay, and asset verification. If after these efforts the account is not settled, then continued efforts will ensue. At this point the agency may make a report to the credit bureau, or take legal actions such as wage garnishment or liens. If the account is paid in full, remove the credit bureau report.
The account may also be closed and returned to provider by collections agency. The provider may conduct a second placement with collections, sell the debt or stop all collection activities.