On the road to consumer-driven health care - Patient Financial Services

Healthcare Financial Management, Sept, 2003 by Bobette M. Gustafson

Providers also will need to consider less-aggressive policies and procedures for collecting payment from patients before or at the time of service. Instead, providers may wish to consider an approach that provides a substantial customer-loyalty advantage by implementing technological and other solutions to assist patients in meeting their payment obligations in other ways. Such solutions include automatic credit card transfers, on-line access to extended payment plans with external parties, and flexible self-pay balance-resolution plans, arranged with the help of PFS consultants, that allow patients to defer payment until later in the cycle. Many patients would prefer this approach to the pre- or time-of-service payment demands that many providers are now making. This new approach would present a truly customer-focused image, while ensuring that the balance is still secured for the provider.

Patients enrolled in CDHPs also will take a greater interest in billing and claims processing. Concerned about the deductions from their medical savings accounts and their increased out-of-pocket liabilities, patients will demand more clearly understandable, itemized bills.

Patients also will inquire more aggressively and often about the accuracy of their charges. PFS representatives will need to respond to patients' requests to review and approve their bills before they are submitted to the health plan for processing. As never before, the patients will want to carefully reconcile the plan's adjudication of their claim with the subsequent patient balance bill that the provider forwards to them. Once again, PFS team members will require outstanding customer-service skills to handle such requests. And providers will need to offer on-line bill inquiry and payment functions to these more-informed and inquisitive patients.

At the Threshold

Industry experts agree that all national carriers and many new plans will enter the CDHP market in 2003-04. Gaining the loyalty of the new CDHP member will require revenue-cycle leaders to make a greater commitment to improved customer service and enhanced customer-focused technologies and processes. By effectively preparing to meet the needs of this new healthcare consumer, you can ensure that your organization will enjoy a strong competitive advantage in the future CDHP marketplace.

RELATED ARTICLE: what is a CDHP?

In a typical CDHP, the employer deposits money--a defined contribution-into the employee's tax-free health savings account (HSA), allowing the employee to make his or her own health coverage decisions. Few employers simply abandon their employees to meet this responsibility, however. Employers often offer employees assistance in the form of Internet access to various health and wellness information, for example, and they encourage the employees to evaluate the various options before selecting their preferred type and level of coverage.

Unlike traditional HMO or PPO plans, CDHPs give employees the option of selecting coverage for "lifestyle" services such as acupuncture or laser eye surgery, in addition to more traditional services. The employees then draw against their savings account to pay for the services they have selected.