HL: In that scenario, what happens if physicians do not document the visit properly?
Reiner: I'm willing to take that risk. If we made a charge capture error, we'll take our lumps. It would be better to miss a charge but get the payment at time of service.
Lelinski: Like it or not, hospitals are involuntary lenders in the same way that patients are involuntary debtors.
O'Donnell: Why do we have to be involuntary lenders? When I walk out of this hotel, the bill will be paid. All charges will be captured and the account will be settled to zero. And yet in our institutions, we are involuntary lenders because we don't capture the charge, code the claim, and send that claim off to the payer in real time.
HL: Patients have never had to pay at time of service—the industry itself has trained them to expect that they can walk out the door without paying.
Yoesle: We have to retrain them.
Reiner: We do offer interest-free financing for one year like Jared's or Best Buy. We are a community provider that does take that covenant seriously, and so we've got to have an option for them. Whether we like it or not, we have become a financer or at least a facilitator of financing—somebody else services the debt, but we facilitate their application process. It's no different than buying furniture.
Yoesle: You can also evaluate a patient's ability to pay and his or her ability to qualify for different payment plans.
O'Donnell: We can provide the patient with a "financial navigator."
Yoesle: I love that term.
Reiner: There are consumers that don't necessarily want to have a long drawn-out discussion with a financial navigator. But there are other patients that want to be walked through the process. We have to change the way we engage patients and meet their individual needs.
Yoesle: One of the things we look for when we hire people for the call center or collections is a customer service background.
Lelinski: Can you afford to compete for those skilled individuals, though? Revenue is going down, there's competition for FTEs, a shortage of a million nurses and 900,000 doctors by 2020. And there are a finite number of capable individuals in the world.
O'Donnell: Registration folks ought to be some of the most highly valued employees—not just because of their customer service skills. Really, it's just attention to detail. They're picking out codes and they're setting up the records and the entire documentation of the revenue cycle. Poor choices that are made at the front end are seen at the back end, and that affects everything that goes into the data warehouse.
Yoesle: I agree—registration staff are the financial gatekeepers of your revenue cycle. Not realizing that will lead to dismal revenue-cycle results.