In this era of new technology, regulatory change and industry consolidation, healthcare providers face an array of cash reconciliation challenges. Following are eight best practices from an industry roundtable discussion among financial and treasury executives of 17 Mid-Atlantic hospitals and health systems.
1. ADOPT A FORMAL CHANGE MANAGEMENT DISCIPLINE
Whether it’s new management, new patient accounting systems or new ways to interact with patients, change is a major factor impacting the financial operations of any healthcare provider today. “Providers need to instill a change management discipline into their financial organizations,” says Chuck Colliton, senior treasury sales manager, Bank of America Merrill Lynch.
2. BREAK DOWN CORPORATE SILOS
Hospital systems have good reasons for separating hospital transactions from physician transactions: They differ in complexity. But there is a way to bridge that gap. Consolidating activities into a centralized business office (CBO) or shared service operation that spans both sides of the business can simplify payment gathering.
3. RATIONALIZE BANK AND PROCESSOR RELATIONSHIPS
Some banks offer less expensive collections-only depository accounts without disbursement capabilities. Assigning one sub account to each healthcare facility can enhance cash reconciliation. Consolidating merchant processing relationships can also create efficiency, given an influx in patient credit card payments.
4. Go cashless
“Some clients are no longer accepting cash for patient payments in physician offices, and some hospitals are getting rid of cash in their cafeterias,” says Kristen Space, senior relationship manager, Bank of America Merrill Lynch. One hospital executive reported saving $100,000 in courier fees annually by minimizing cash. Another pointed to the security benefit of going cashless after an employee fraudulently took funds.
5. Promote advance and point-of-service collections
As patient payment volume grows, many providers collect co-payments in advance of appointments, and collect the remaining deductibles at the point of service. But early collection might require a culture change from front desk employees. “You need to explain to staff that you’re not doing this to be disruptive to the patient,” Colliton says.
6. Automate patient refunds
Providers traditionally refund patients by issuing checks, which add costs, may require manual intervention, and impose on some patients a trip to the bank. That’s why some providers are seeking out electronic alternatives, such as prepaid cards, which don’t even require a patient bank account. Another is an alias-based payment method such as Bank of America Merrill Lynch’s Digital Disbursements, where all a provider needs to initiate payment is a patient’s email address or mobile phone number.
7. Present frictionless ways to pay
Many of the new patient accounting systems process credit card payments and offer clinical portals where patients can review billing information and make card payments, but may also require patients to obtain a unique registration code for each doctor’s visit. Some bank payment portal offerings, such as Bank of America Merrill Lynch’s Healthcare Revenue Manager, bypass registration by integrating directly into a provider’s secure website.
8. Offer insurers payment options
Not all payers, particularly smaller ones, can send 835 remittance data. As a result, providers may want to consider a solution like Bank of America Merrill Lynch’s HealthLogic, which enables payers to send checks with paper remittance advices to a lockbox and create electronic remittance advices with the 835 standard.
Speeding patient collections with HL7
How providers can transform a messaging format into a payment tool
The standard format for transmitting patient demographic information is now paving the way for faster patient collections. “With HL7 messaging, you can create an automated workflow,” explains Jeff Pauly, senior treasury product sales specialist at Bank of America Merrill Lynch.
According to Pauly, the message format can update a provider’s payment system when a patient makes an appointment, co-payment amounts when confirming the appointment, and the deductible balance upon arrival. “HL7 messaging presents such a great opportunity,” Pauly says. “It’s a well understood and widely utilized messaging format, but very few providers today are using it to create additional collection touch points.”
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