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Delivering an upfront patient cost experience
Andrew HardingVice President of Customer Success
Andrew is the Vice President of customer success at Rivet. His primary function is supporting Rivet’s customer in learning,
implementation and adoption of Rivet from patient cost transparency to navigating the waters of insurance contracts. He brings over a
decade of revenue cycle experience to support process and organizational change.
Rivet gets you paid. Whether you need to accelerate out of pocket patient payments or maximize payer reimbursement through payer contract
management and underpayment detection, Rivet offers a powerful software product with a delightfully simple design to ensure you get paid.
DescriptionEverything you need to know from estimating costs, having the financial discussion, collecting payments, and more.
ObjectiveBy the end of this presentation, you’ll have a better understanding of the changing patient financial landscape and feel more comfortable discussing patient payments in your revenue cycle. You will learn about best practices and helpful tips in financial touchpoints to improve collection rates.
Agenda1. When did the patient become the payer?
2. Gearing up for financial transparency
3. Internal process changes
4. Solving for the patient experience
5. Measuring success
When did the patient become the payer?
Patient responsibility has grown
● Large seasonality component to high residual patient balances
● Many patients would struggle to cover their deductible costs
Over 50% of the allowable is patient liability in the early part of the year
92% of consumers want to know payment responsibility prior to a provider visit
62% of patients said knowing their out-of-pocket expenses in advance of service impacts the likelihood of pursuing care.
4x more difficult to collect from patient versus insurance company
90% of patients felt it was important to know their payment responsibility upfront.
● High deductible health plans● Most surgical services● Non-preventive (covered at
100%) care● Multiple procedures performed
on the same day● Patients wanting to understand
their benefits and OOP liability● Patients who have a history of
tough collections, past bad debt or residual balances
At-risk population
Gearing up for financial transparency
If you don’t know, neither will your patients
Verify benefits1. Most EHR/PM systems have
electronic eligibility2. If not, check with your
clearinghouse3. If not, there are additional
vendors4. And last, there are
portals/phone calls
Determining allowables1. Fee Schedules
2. Previous remittances (835/EOB)
3. Cash to Charge reports
1. Provided by payer, comprehensive, get outdated
a. Often best to have a system to store these
2. Evolving, account for adjustment codes, technical
a. Typical require software to aggregate/analyze
3. Really just a best guess, easiest to manage
Bring it all together
Benefits verifiedServices identifiedAllowables determinedEstimate createdPayment requestPayment completed
Internal process changes
Provider team
Registration/Check-in
Insurance Verification
Getting Buy-in
Scheduling Cash posting
Patient collections/AR
Process overviewFlowRequirements
- Must have an idea of patient services (no procedure = no “good” estimate)
- Must be able to determine allowable rates from either fee schedules or historical claims
- Must have an understanding of insurance benefits, and access to verify benefits (270/271)
- Must have alignment in the organization on how to quote and collect on patient costs
Key things to look out for when creating estimates1. Choosing the right fee schedule2. Benefit attribution3. Coverage guidelines4. Communication preferences5. Verifying correct patient record6. Guarantor vs. patient7. Previous balance history8. Awareness of other providers submitting
charges
Solving for the patient experience
Tips for conveying patient costs1. For many patients it can be very stressful, regardless of the financial
components (travel logistics, missed work, recovery concerns)2. Know your information before chatting with the patient - their time is
valuable as well3. Be clear and concise with services and associated costs4. Start with your collection goal, finish with “least acceptable” 5. Know your policies so the patient feels they are in good hands
a. Familiarize yourself with payments terms: length of payment plans, prompt pay discounts
6. Chat with patients on their preferred platform
How Patients Want Their Doctor to Contact Them
42.9% of patients prefer communication by phone
25.1% of patients prefer email communication
Only 13% of patients prefer communication via mail
How to engage the patient financially
having “the” conversation
Better Touchpoints = Improved Collections1. Delivering financial message through a modern platform
2. Establishing upfront collection requirements
3. Engendering trust through transparent conversations
4. Ask the right type of questions
5. Close loop on residual patient questions
Measuring success
Measuring outcomes1. Feedback mechanism
across teams2. Patient satisfaction/
engagement metrics3. Identify point-of-service
cash baseline4. Tracking payments5. Timely correction of
credits/residual balance
Transaction Codes 1. Develop a transaction code in your EHR/PM to identify and track upfront
patient payments2. Make sure you have a proper bad debt or write-off transaction code to
identify failed patient collections3. Underdeveloped transaction codes, and lack of posting adherence, will
make it very difficult to measure improvements
Frequently Asked QuestionsPatient wants to cancel the service because of cost?
Is this the final (and only) bill?
Can I pay later?
Helpful to know before you have to write off bad debt. Too often patients have services that lead to uncompensated care because they can’t afford their deductible or OOP.
No, this is an estimate and actual liability may differ. A helpful disclaimer on the estimate also might state that there are often bills from ancillary providers or facility charges.
Depending on your payment policies, you may require full or partial payment upfront. Ex: We require payment up front and will refund or bill for any residual balance.
Do you have a cash pay price?Again, depending on your practice’s policy, many offer a small prompt pay discount or will quote what the self pay/uninsured price would total.
