In the past, healthcare providers have been able to utilize front-end billing and collections staff for most of the financial needs in a practice. But with patients paying more out-of-pocket costs and exchanges increasing the number of plans providers deal with, having financial counselors in a practice may become a necessity.
The good news for providers is that this doesn’t necessarily mean augmenting staff. People already dealing with billing and collections can be trained – internally or externally – to take this responsibility.
David Zetter, founder of Zetter Healthcare Management Consultants and member of the National Society of Certified Healthcare Business Consultants, has been working with providers across the country on training staff to become financial counselors. He said the time it takes to properly train staff can vary widely. Recent training he has provided took two months in one practice; in another, it is taking well beyond six months.
Laura Palmer, senior industry analyst of professional development for the Medical Group Management Association, said there in no one-stop shop for training financial counselors for those who want to do it in-house. It is often learned on the job. If a practice wants some formal training, she recommends mentoring with a financial counselor. When she worked in a small office, her staff spent time at a local hospital, learning from people in their financial aid office.
Other options are going to presentations by payers and working with representatives from health plans, she said. State medical societies also may offer training in this area.
Whether opting for training in-house or through a group like Zetter’s, there are a handful of things practices need to know about the role of financial counselor.
First is creating a financial policy and making sure the counselor understands it. The financial counselor will review the policy with patients on their initial visit. Zetter said patients need to know their part of the payment and the cost of any fees that would be applied if the practice has to begin a collection process.
The second aspect of the job is verifying benefit eligibility. Counselors will check a patient’s eligibility and should be able to communicate what the insurer will cover and estimate the patient’s responsibility.
This is particularly necessary for providers offering services like physical therapy or mental health counseling that may be limited in scope. A patient has to understand what is allowable and what his or her responsibility is. Palmer said specialists or hospital counselors will need to be able to estimate outside facility charges like an anesthesiology or biopsy bills to give patients a full understanding of their financial obligations.
Financial counselors will also have to work with patients on how to pay for services. They need to communicate options like discounts for paying upfront, or how they can pay over time or offer post-dated checks. Zetter recommends keeping credit or debit card information on file if possible to pay for outstanding balances. The financial counselor would be responsible for taking care of that process and ensuring it is compliant with industry and HIPAA regulations.
The most important payment option a financial counselor will deal with is making sure patients are paying upfront for services. If a provider can’t verify eligibility, then they need to have a patient pay upfront. The financial counselor can talk with patients about refunding money after an insurance company pays their share.
Though a lot of work may go into training staff to become financial counselors, practices can reap rewards. Zetter said the financial counselor will be someone who can learn what parts of the revenue cycle are making the practice “chase money,” like not sending outstanding payments to collections swiftly or working with insurers that are paying virtually with credit cards.
“They can see what is working and what isn’t and fix it,” he said.
Zetter said groups eventually realize a reduced denial rate, increase in cash flow, greater collections, less time in follow-up on accounts, and a reduction in days of accounts receivable. In one practice he worked with recently, accounts receivable days have dropped to 22 and they were able to reduce billing staff from four full-time employees to three. The practice spent about $5,000 for his services and training.
“If practices don’t make these changes, we are going to see a lot of them going out of business because healthcare is changing and the way we collect on those services is drastically changing,” Zetter said. “We can’t keep our old policies with all the new changes in healthcare.”