How Prioritizing Financial Counseling Can Reduce Your Debt and Drive Business
Whitepaper | Kristen Coletto
Vice President Financial Counseling, Change Healthcare
Kristen leads the Change Healthcare Financial Counseling and Early Out solutions to help providers manage patient obligations. Previously, she served as an analyst with The Advisory Board and led corporate and international strategic planning at Aetna.
Many healthcare organizations depend on the work of financial counselors to help patients understand both their insurance coverage and their financial obligations. These professionals help patients make smart choices by answering questions about the cost of healthcare services, setting up payment plans, or identifying potential forms of financial assistance. Financial counselors also help organizations successfully collect patient responsibility balances, reducing uncollectible debt.
Today, financial counseling services are in high demand as patients face new financial challenges, due in part to growth of high deductible health plans (HDHPs). As patients shoulder more of the financial burden for their care, healthcare organizations should prioritize financial counseling to help patients understand the billing process and meet their obligations — throughout the entire care episode.
After witnessing the evolution of healthcare payment trends, financial counselors are experts in navigating dynamic patient financial interactions. Conversations about finances can be complex and unpredictable, and counselors must maintain a delicate balance between advising the patient and advocating for collections. They must develop empathetic relationships with patients while also protecting a hospital's bottom line.
Before committing to a procedure, more and more patients are demanding cost estimates from multiple providers, comparing prices and payment plans. These patients are seeking financial counseling support on their own, and they expect timely, accurate responses to help them make their decisions.
A financial counselor's typical day includes meeting with patients to provide cost estimates for scheduled procedures, reviewing the billing process, and answering any questions patients may have prior to admission.
Consider the following patient scenarios.
Patient Scenario No. 1: Screenings and Counseling Influence Decision to Receive Care
Out-of-pocket healthcare expenses continue to rise at a steady rate, and patients are increasingly confronted with substantial out-of-pocket costs that are often unexpected. In fact, a Kaiser Family Foundation study found that 43% of insured patients said they delayed or skipped physicianrecommended tests or treatments because of cost.1 Simply put, many patients present without the ability to meet their financial obligations up front.
In these cases, financial counselors meet with patients prior to admission to determine insurance eligibility — a strategy deployed by hospitals to improve their collections outlook as HDHPs and self-pay revenues increase. Counselors then provide patients with an estimate of their expected financial obligations based on the services to be rendered, and ask for payments up front. If patients express financial hardship, counselors work to determine if discounts can be applied.
If patients have HDHP insurance or are classified as self-pay, financial counselors conduct screenings and identify other potential financial assistance options. Screenings include personal information such as a patient's marital and dependent status, citizenship, income, investments, and personal assets. The counselor may also determine if the impending medical procedure is related to crimes committed against the patient, or if the patient's motor vehicle insurance or employer's worker's compensation injury insurance might cover the procedure. If a patient is unemployed, the counselor may investigate if the patient qualifies for COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage.
Once the counselor has explored the full financial picture and applied any discounts, the patient receives a final cost estimation. The financial counselor then works with the patient to establish a payment plan and collect an initial deposit up front, if possible.
A Kaiser Family Foundation study found that 43% of insured patients said they delayed or skipped physicianrecommended tests or treatments because of cost.1 Helping patients meet their financial obligations can improve clinical outcomes and increase collections