Annotated Bibliography- From Bottom to Top

Souza, M. & McCarty, B. (2007). From bottom to top: How one provider retooled its collections [Electronic version].  Healthcare Financial Management, 61(9), 67-73.

This article is about how Sutter Health worked to improve their overall revenue. They came together to try and identify key problems that might be causing them to lose out on revenue. Once they identified what they needed to do they put into place a system to help improve their collection process. The first start to improving their process was to first identify how they could improve collections for point of service. They had to identify if there was training needed to correct errors or if they needed to come up with ways to identify which patients needed to make a payment up front.

Since most insurance companies have large deductibles it was obvious that some payment would be due for most services provided. However the best way to get these payments would be to have front desk take action and ask for a payment up front or before the patient is discharged. Since most front desk workers had never really been expected to collect payments, they had to train the staff in knowing what key identifiers to look for and how to know what is due and can be asked for up front. By providing the front desk with the skills to know what copay is do, what deductible needs to be met, and to let them know if there are already bills pending that the patient hasn’t paid they are able to give them more power to collect and also have them take some accountability for the patients accounts.

They also implemented a system to analyze each patient’s registrations that was being checked in. That way they could start to learn if someone wasn’t inputting information in correctly and what training would need to be completed to correct these mistakes. Some key errors this system looked for would be a patient who is listed as a widow, however the insurance carrier listed as the spouse. Another key error was that guardians being entered who are younger than 18 years of age. These errors cause kickbacks on insurance claims, which cause a delay in payment and a hold on revenue or funds that might be needed for other resources.

Since the front desk doesn’t have much insight into what is happening on the back end of a finance account they also created alerts for the front desk. This way they would know if they could ask a patient for payment on an old visit, or if they might not be receiving their mail. So if a bill had been sent back and returned they would put in alerts stating for the front desk to please verify address. This way if a bill was sent they could update the address as well as state right away to the patient that they have a bill and ask them to please make a payment on it. Otherwise addresses might go unchecked, thus bills never received, and never paid.

Once they had learned where the errors had started, they learned how to try and correct this. Once they know that they had been able to train the staff, empower them to take accountability for the patient’s accounts and finances that are being held up, and thus improved their overall revenue. This made a great impact on the overall revenue and point of services payments that sat in a hold status waiting for payment, by getting payment upfront from patients as well as making sure insurance billing was correct on the first try.