The wave of health care reform has led to a closer focus on the need for clear, consistent and transparent communication of patient financial information. Thus, the Healthcare Financial Management Association (“HFMA”) has developed “Patient Financial Communications Best Practices” for improving and standardizing how health care organizations should communicate with patients about their financial responsibilities. The guidance covers several areas of critical importance for community hospitals.
According to the HFMA guidance, the patient or guarantor should have discussions with properly trained registration or discharge representatives for routine scenarios and a financial counselor or supervisor for nonroutine scenarios (for example, no or insufficient insurance). Patients should have the opportunity to request assistance from a patient advocate, designee, or family member.
In emergency department (ED) settings, no financial discussions should occur before the patient is screened and stabilized. If the patient has an emergency condition, the discussion should occur during discharge; otherwise, it can occur during registration or at discharge. Outside the ED setting, discussions can occur during registration or at discharge.
Best practices address typical elements of patient financial discussions, including:
Registration, insurance verification, and financial counseling
In the ED, once a patient is stabilized, you can collect basic registration information and determine the potential need for financial assistance. The representative should review insurance eligibility information with the patient to ensure all information is accurate.
The patient can be referred to a financial counselor or offered related information if needed. The hospital should have a widely publicized toll-free number for assistance in financial matters.
Provision of care
ED patients should be informed that their ability to pay won’t interfere with treatment of any emergency medical conditions. Uninsured ED patients should also be informed that the goal of collecting information is to identify payment solutions or financial assistance options.
Across all care settings, develop clear public policies on how to interact with patients who have prior balances and are undergoing elective or nonelective procedures. For nonelective services, patients should be informed that their ability to resolve any prior balances, or their share of the services they are currently receiving, won’t affect the care they receive.
For elective services, however, patients must make satisfactory payment arrangementsbefore receiving care. Those with prior balances should be informed if your policies regarding prior balances mean the service will be deferred.
Tell patients about the types of providers who typically participate in a service (for example, pathologists, surgeons, and anesthesiologists) and furnish a written list of provider types upon request. Patients should be informed that actual costs may vary from estimates depending on services actually performed, whether the provider performing the service is in or out of network with the patient’s insurance company, and timing issues related to other payments that could affect their deductibles. Patient share discussions shouldn’t interfere with care and should focus on patient education.
You should discuss the services that led to the prior balance and provide a written list, if requested.
Balance resolution discussions are reserved for prior balances being pursued for collection. Inform the patient of the timing of collection activity and ask how the patient would like to resolve the balance for the current service and any prior balance. If appropriate, ask the patient if he or she would like to receive information about payment options and any supportive financial assistance programs. You can also proactively attempt to resolve the prior balance through insurance and financial assistance programs.
The HFMA’s best practices also include general advice for financial discussions — such as compassion, patient advocacy, and education — and measurement criteria for evaluating the effectiveness of your patient financial communications. Although all of the practices are voluntary, compliance can help boost patient satisfaction while improving your hospital’s financial health.
The American Hospital Association (“AHA”) was one of several organizations participating in a task force convened by the Healthcare Financial Management Association to develop guiding principles and recommendations for price transparency — a key component of effective financial communications. The AHA takes the position that consumers and their families deserve helpful information about the price of their hospital care.
The AHA’s own “Principles for Price Transparency,” adopted in 2006, call for pricing information to be presented in a way that:
To achieve price transparency, the AHA has recommended expanding existing state transparency efforts, health plan transparency, research into the information consumers find useful, and consumer-friendly pricing language.
Seek the services of a legal or tax adviser before implementing any ideas contained in this blog. To reach a financial advisor at Lane Gorman Trubitt LLC, call (214) 871-7500 or email firstname.lastname@example.org.
Denise joined LGT in 1998. She serves as principal in Accounting and Consulting Services. Denise has more than 35 years of experience in public accounting. Denise provides proactive tax planning and tax compliance services for individual, corporate and partnership clients. She also assists clients with computer software setup, training, payroll and sales tax return preparation, financial analysis, small business consultations and planning.