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6 tips for effectively communicating patient financial responsibility

With the rapid rise in deductibles and co-pays, coupled with declining reimbursement and increased expenses, ambulatory surgery centers (ASCs) are under great pressure to collect all the money patients owe for their surgical care. Faced with such tight margins, even leaving a small percentage of a patient's responsibility on the table could eliminate the profitability from a procedure.

To improve the likelihood of successfully collecting in full from patients, ASCs will need to ensure they are overcoming various potential communication obstacles. Following these recommendations may help boost collections and even patient satisfaction in the process.

1. Watch your language. According to the U.S. Census Bureau, there are at least 350 languages spoken in U.S. homes. The top six, according to Babbel Magazine: English, Spanish, Chinese, French/French Creole, Tagalog and Vietnamese.

Be prepared to provide information — including that relating to financial responsibility — in a language patients will understand most effectively. If your ASC is unable to offer such a service, this increases the likelihood of a misunderstanding or hesitation by patients to ask questions that may jeopardize their surgical payments.

Many companies provide medical interpreters who can help ensure patients receive and comprehend the information you need to convey. Facilities can typically choose from telephone, remote video and/or face-to-face services. While this will be an investment, it's one that will likely pay for itself if patients require the service.

A few additional notes:

• When your affiliated practices are providing information on patients, make surepreferred language is included. Consider verifying this information during the initial preoperative call with patients.

• Make sure any written materials are available in different languages or can at least be translated, if necessary.

• Ensure your website can be translated to different languages.

2. Consider literacy. Patients will likely have varying levels of literacy. When developing written materials concerning patient finances (or any patient information, for that matter), be certain it can be understood by all patients.

Materials should be brief and include the critical information a patient needs to understand, avoiding unnecessary details. When developing new or updating existing content, ask individuals outside of the healthcare field to review the information and provide feedback on areas that seem complex or unclear. Revise accordingly.

Other worthwhile considerations:

• Include directions, with contact information regarding how patients can have questions answered and the materials read to them.

• Make font (text) size large, especially if you have an older patient population, and avoid "fancy" fonts that can make reading more difficult.

3. Keep it simple. In all communications, use simple sentences. Avoid jargon as much as possible. Define those terms that may be unfamiliar to patients. Incorporate examples from everyday life to help explain terminology and processes.

4. Invite questions. When engaging in conversations, regularly inquire whether patients have questions. Pause before asking to give patients an opportunity to process what you stated. Note: Avoid asking patients questions such as "Do you understand?" as this can provide the opportunity for patients to answer "yes" even if they do not understand.

In addition, encourage patients to take notes during preoperative discussions and offer to review the notes following the conversation to determine if anything is unclear. For those most critical points, suggest patients circle or star the information.

At the end of the conversation, provide directions for how patients can receive answers to questions. Consider building a "frequently asked questions" resource that answers common questions. Provide this document to patients and publish the Q&A on your website.

5. Use the "teach-back" method. Studies have shown that 40-80% of the medical information patients are told during office visits is forgotten immediately, with nearly half of the information retained incorrectly, according to the Agency for Healthcare Research and Quality. Using the "teach-back" method of education can help improve patient understanding.

The teach-back method asks patients (or family members) to explain in their own words what they need to know or do. If this proves difficult, you know further education — with perhaps a different approach to teaching — is needed. Learn "10 Elements of Competence for Using Teach-Back Effectively."

6. Train. Your business office staff will interact with patients with differing literacy, education and healthcare understanding. Relying upon a single script for staff to work from when discussing patient financial responsibility may result in collections short comings.

Rather, develop multiple scripts to account for the challenges staff will encounter (some of which are noted above). Your team members need to know what to communicate and steps to take if a patient:

• requires information to be provided in a different language;
• struggles to understand basic concepts;
• expresses a feeling of being overwhelmed;
• is unsure about their ability to cover costs.

Staff also need to how to identify potential red flags to comprehension, such as patients expressing understanding when that may not be the case or patients who seem to be distracted during conversations.


The only way to effectively prepare for these and other situations is through training. Build in time for office staff to review and practice scripts. Consider using role play and simulating conversations.

If a staff member encounters a difficult situation with a patient, use the experience as a learning and teaching opportunity. Ask this staff member to explain to your business office team what happened and then discuss how to address this issue if/when it happens again in the future. Incorporate the scenario into your training.

Be prepared to revise your scripts and training if collections are not at the level you expect. Regularly ask your staff if there are resources that can help them do their jobs. Consider bringing in a coach to work with your team to improve their communication skills. Empowering your business office team to succeed can help improve staff satisfaction, patient satisfaction and ultimately collections.

Randy Bishop (rbishop@surgicalfunds.com) is a partner with Surgical Funds, which facilitates patient financing solutions to supplement out-of- pocket expenses for ASC procedures.

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