Nearly 60% of patients in a typical children’s hospital is covered by Medicaid. Yet Medicaid reimburses only 80% on average and they are denying greater numbers of claims. These factors, along with the increase in patient financial responsibility and growing competition from adult hospitals, create a challenging environment for children’s hospitals. They simply cannot afford an underperforming revenue cycle team.
Following are five best practices children’s hospitals can use to optimize collection outcomes and improve patient satisfaction and the financial experience.
Be highly selective in your recruiting process. Recruiting and hiring is the foundation of building a high-performing team. If you don’t get this process right, it will show in your bottom line. Look at your application-to-hire ratio. For example, HBCS hires just 150 of every 5,000+ applicants. That’s a rate of 2.7%. While your applicant pool may be much smaller, the ratio is still important and can indicate the need for more stringent criteria. As such, screening should be comprehensive and include education verification, criminal background checks, social security verification, record of employment, and state-specific registries.
Don’t forget to include federal contracting databases such as the EPLS (Excluded Parties List System), which is now a part of the System for Award Management (SAM), as well as the OIG-LEIE (Office of Inspector General’s List of Excluded Individuals and Entities). These resources are invaluable for identifying those who have been debarred, sanctioned, or excluded due to issues like fraud.
Create a list of required criteria. Identify the skillsets and experience that best serve your unique patient population. That means you’re looking for applicants well versed in Medicaid and other government programs, as well as state-specific payers. They should also be adept at self-pay collections and understand the importance of providing a positive, customer-focused financial experience. And, of course, they should have a proven history of quality performance.
Another expertise many hospitals overlook is familiarity with system software. While those skills can and should be a part of training, hiring this expertise means you can achieve optimal team performance faster.
Develop a comprehensive education and development program. The best programs go beyond the typical “how to” training where new team members are educated on workflows and software. They include training for soft skills such as active listening and compassionate, empathetic communications. Each financial engagement with a parent is a reflection on your hospital’s culture and even a single negative experience can impact patient satisfaction scores and cause families to choose a different provider for their child’s future needs. A poor financial experience can also cause families to put off or seek substandard care for their child, which can result in devastating outcomes.
Even team members with a history of performance excellence can benefit from ongoing training to hone their skillset. This is a key driver in building a high-performing team. You can then leverage those team members as mentors for new associations upon their transition from training. For example, HBCS uses a Peer Assisted Learning program that pairs each new team member with a top-performing team member. The tenured PAL becomes a model of what is expected and rewarded at your hospital. It also reinforces best practices for processes such as account follow-up, resolution, and other workflows.
In general, new team members should have four to six weeks of comprehensive training that includes AAHAM (American Association of Healthcare Administrative Management) certification. This certification benefits both your hospital and the new team member. You benefit by building a highly qualified team of patient financial experts. Team members benefit through personal growth and career advancement. Showing your team that you’re willing to invest in them increases employee satisfaction and lowers turnover—both essential elements of a high-performing team. It also helps promote a culture of positivity, which translates into a quality customer financial experience.
Implement a quality assurance and continuous improvement program. Business management expert Peter Drucker said “If you can’t measure it, you can’t improve it.” That’s especially critical in revenue cycle processes that directly impact your bottom line. For example, the effectiveness of your billing team effects days in accounts receivable, cash flow, and the speed and accuracy of payer reimbursements. The quality of your patient financial services team impacts your patient relationships, which is reflected in your margins and brand equity.
Quality assurance measurements for your billing team should include:
- HIPAA compliance guideline adherence
- Use of dispositions/status to track where the account is in the follow-up cycle
- Accurate wait dates so staff are not working accounts until the next step in the resolution process is required
- Quality of documentation
- Account worked using information provided by the payer, patient, clinical teams
- Utilization of account history
- Accurate next steps such as rebill, appeals, and patient contact
- Working accounts to full resolution, timely and accurately
Quality assurance measurements for your patient account resolution team should include:
- Call opening
- Identified and verified caller
- HIPAA compliance guideline adherence
- Accurate documentation
- Effective use of system resources
- Display of active listening
- Followed appropriate protocol
- Updated systems correctly
- Validated insurance
- Secured payment
- Educated caller
- Delivered a positive patient experience
- Maintained call control
- Demonstrated call ownership
Consider a partnership. Building a team of high-quality talent is essential to achieving your long-term financial goals. But it takes dedicated resources with expertise in talent acquisition, as well as selective hiring processes that go well beyond traditional background checks. Partnering with revenue cycle experts with talent acquisition expertise can help you reach your goals faster and with less efforts.
With more than 35 years of industry experience, HBCS has become a leader in talent acquisition of revenue cycle professions, including those with special expertise in pediatric and neonatal hospitals and state Medicaid plans. We serve more than 45 hospitals, including Women and Infants hospital, Beth Israel Deaconess Hospital, NYU Medical Center, Mount Sinai, and Care New England. More than 75 percent of our operational leaders are AAHAM-certified and have an average tenure of 9 years. They work as an extension of your team, either on-site or off. We can also help you develop or enhance your business office culture by reviewing policies, procedures, and processes, and by making strategic personnel recommendations. We integrate your culture and people into every step.
It’s a new healthcare ecosystem
Benjamin Franklin said, “An investment in knowledge always pays the best interest.” This is especially true when developing a highly performing revenue cycle team. In an age of decreasing payer reimbursement, skyrocketing patient financial responsibility, and growing competition from adult hospitals, children’s hospitals need every advantage they can get. Partnering with revenue cycle experts like HBCS can help you protect your bottom line, improve patient satisfaction, and attain long-term financial success.