The Unconventional Business Office

In his autobiography, Michael Dell of Dell Computer tells a story to illustrate how focused he was at an early age. When he was eight years old, Dell decided he wanted a high school diploma. He saw an ad in a magazine that told how someone could obtain a high school diploma by simply passing a test. He wrote to the company expressing an interest.

One day a woman from the company showed up at his door to administer the test. His mom (not knowing her son had written to the company) answered the door. When the woman asked to talk to Michael Dell, his mom said the woman would have to wait until Michael finished taking his bath. Needless to say the woman was very surprised when an eight-year old boy came down the stairs to take the test for a high school diploma. Even at a young age, Dell didn’t think like the rest of us.

Dell feels success comes form thinking unconventionally and from providing superior customer service. He feels this applies in any service organization. That could probably include your business office.

We know about a 200-bed hospital that decided to do a better job with their accounts receivable. A number of problems were identified:

Good insurance and demographic information was not being obtained.
It was difficult to estimate what the patient owed while the patient was still in the hospital.
Clerks were not adequately trained to ask patients for deposits and balances.
Charity patients were not correctly classified before the billing process began.

The hospital decided to take a very unconventional approach. A number of things were done, but four items will serve our purposes:

The hospital developed a special computer application that admission clerks could use to accurately estimate patient liability at discharge.
Employees were transferred out of the patient pay area into the admissions area.
Salaries were upgraded to find and keep good employees.
Patient-pay accounts were outsourced.

All of this meant that the accounts receivable focus would move from the back end to the front end in order to:

Obtain accurate information.
Collect as much as possible.
Reduce costs associated with attempting to collect the patient balance after the patient left the hospital.

This hospital took a big chance by changing their focus. Their unconventional thinking is paying off.

What are some specific things you can do to change an unproductive conventional mindset in you business office and begin to think unconventionally?

Post the amount of your minimum Level 1 emergency room charge.
One hospital we visit has a sign in the emergency waiting room that says “Our minimum emergency room charge is $76.50.” It does not refuse service or demand payment, but patients seem less reluctant to pay the full amount due, or at least the $76.50.

Enlist the assistance of local businesses in obtaining carrier information.
Send an annual questionnaire to the Human Resources Departments of local employers. Ask for the schedule of benefits for their carrier so you can better serve their employees. Some businesses may send you their employee handbook with the benefit schedule clearly defined. This should make your pre-admission and financial counseling job much easier.

Obtain a signed lien or confession of judgment where possible.
This is one of those areas where your attorney must be consulted. This acts as sort of a prenuptial agreement between you and the patient. In instances where there is an MVA or there are other liable third parties, the standard assignment of benefits may not cover you if the patient receives money directly. If this occurs, the lien or judgment gives the hospital the right to file a lien directly against the patient.

Revisit your patient financial agreement form.
Many forms simply state that the patient authorizes assignment of benefits on their insurance and that the patient agrees to pay for sums not covered.

It is imperative that your agreement form includes assignment for any insurance, personal or third party.

Your assignment could state, “Facility agrees to file and accept assignment of benefits on any and all insurance as a courtesy to the patient. However, the patient will be held liable for any uncovered or unpaid portions, regardless of assignment.” Of course, this would not be applicable with managed care contracts.

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