With more employers offering high-deductible health plans as an affordable insurance alternative, health care providers recognize their patients’ out-of-pocket financial responsibility is steadily increasing. ASCs often struggle with adeptly handling patient communication regarding this monetary component of surgery. It is challenging enough for most patients to understand the nuances of their health insurance plans without adding the potential stress of thoroughly evaluating their personal financial obligations for each episode of care. Patient satisfaction surveys frequently reflect this stressor. However, this added challenge is easily avoidable with clear, advance communication. Many ASCs have responded to this patient need by adding a financial counselor to their staff.
Educating patients is the most effective way to minimize confusion, maximize time of service collections, and increase patient satisfaction. Reading an explanation of benefits (EOB) can be daunting. Deciphering up to four EOBs for one surgery can be downright overwhelming and, in some cases, shocking. In 2015, 77 percent of consumers reported they were confused by the explanation of benefits they received from their health plan. Seventy-six percent were confused by bills from their providers. By the time a patient is scheduled for surgery, they have often received an estimate of charges and made a payment to their physician’s office, not realizing there is a separate financial obligation to the facility and, in many cases, the anesthesiologist and/or pathologist.
Creating an ASC financial counselor role ensures your facility has a dedicated person responsible for patient communication and financial education in advance of surgery. The ASC financial counselor also plays an integral part in preparing cost-benefit analyses and providing the details to management for consideration.
When contemplating the addition of an ASC financial counselor, items you may want to evaluate include the following:
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Is the ASC maximizing time of service collections?
- A financial counselor will improve the percentage of up-front collections through patient education and setting expectations. Advance communication allows patients the time necessary to plan for their financial outlay. By adding an ASC financial counselor, patients receive this information in a timely manner, depending on when the surgery is scheduled.
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Does the ASC have a high percentage of bad-debt write-offs or accounts in collections?
- A high percentage of write-offs and accounts referred to collections is indicative of failure to maximize up-front collections or develop formal payment plans. In contrast, a dedicated financial counselor clearly communicates the financial obligation to the patient and formulates a plan for payment in advance of the patient’s episode of care. This includes a written contract if payment is not made in full by the day of surgery, thereby eliminating confusion and creating a firm commitment of payment from the patient.
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Is the ASC aware of the costs associated with the cases they perform?
- ASCs, like other businesses, must evaluate which surgeries consistently lose money. The ASC financial counselor is tasked with flagging such surgeries and assisting with minimizing up-front losses. Oftentimes, properly evaluating and documenting these surgeries will provide your payor contracting team with the leverage they need to negotiate proper reimbursement.
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Is the ASC receiving negative feedback regarding finance on patient satisfaction surveys?
- Patients will be much more pleased with their overall experience if they fully understand their financial obligation and do not face unexpected or minimal post-surgery expenses when their EOBs arrive.
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Does the ASC have the case volume to support a full-time or part-time position or can this responsibility be added to an existing employee’s job description?
- A high-volume center will benefit from adding this position as a full-time role. This person provides a final verification of demographics, as well as confirmation of insurance authorization, leading to fewer avoidable denials. A financial counselor is valuable to every ASC, regardless of size. If the center cannot support this position independently, consider adding the responsibilities to an existing front-desk role.
An ASC financial counselor typically reduces frustration for patients as well as staff. Having a person dedicated to this role improves collections, reduces bad-debt, decreases avoidable insurance denials, and minimizes financial losses due to poor reimbursement, all of which bringing substantial value to the ASC.
Lori Tamburo, Director of Operations
