How consumer-centric is your organization’s patient financial experience?
What can you do to improve it, based on your organization’s current level of consumerism maturity? HFMA’s new Consumerism Maturity Model builds on our industry-consensus consumerism best practices to guide hospitals and health systems in their efforts to improve their patient financial experience.
Select an option that best describes your organization.
Level 1
The health plan’s provider information is available in printed form and updated at least annually. More current information may be available on the plan’s website.
The provider only posts the mandatory charge posting as required by CMS.
Level 2
The health plan provides online access to its provider enrollment information, office locations and hours, as well as quality ratings for providers (i.e., physicians and hospitals).
Network participation is not made available by the provider; consumers are referred to health plans for all eligibility and benefit information, pricing and network status information.
Level 3
All applicable items in Level 2 plus:
Price information for the most common services from in-network providers may be available from the providers.
Ability to accept new patients is identified.
Level 4
All applicable items in Level 3 plus:
Providers may provide links from their websites to health plan websites.
Level 5
Incorporates all applicable aspects of the lower levels plus
Health plans and providers support visibility and access to online and mobile tools for:
Provider enrollment information
Office locations and hours
Quality ratings for providers (all types)
Price information for all services from in-network and out-of-network providers
Consumer’s current benefit status for deductibles and other out-of-pocket responsibility
Physicians accepting new patients are identified.
Links to individual provider websites are included for in-network providers.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Appointment Scheduling
Select an option that best describes your organization.
Level 1
Providers schedule services based on a consumer call or upon receipt of a request or order from the physician.
When ordering a service, the physician instructs the consumer to contact the provider or the provider contacts the consumer to schedule based on the physician’s order.
Orders may be received via fax, hardcopy or electronically, and incorporated into the electronic health record (EHR).
Schedules are updated and electronically distributed to the preservice team and service departments.
Level 2
All applicable items in Level 1 plus:
Scheduling is primarily initiated by physician offices.
Preregistration information is collected but not validated with consumers until they arrive for service.
If provided, insurance information is verified.
Level 3
All applicable items in Level 2 plus:
Consumers may call or use a patient portal to request services.
Confirmation of the scheduling request is usually available within 2 or more days of the request.
Required orders are distributed electronically within the health system or via fax to external provider organizations by the ordering physician.
Additional calls from providers to the consumer are needed to complete the pre-registration and financial clearance processes.
Level 4
All applicable items in Level 3 plus:
Confirmation of the scheduling request is available within 24 hours.
Basic registration information and insurance information is collected.
Insurance is verified and price information is provided upon request.
Account resolution is pursued for designated high-dollar cases.
Level 5
Incorporates all applicable aspects of the lower levels plus:
Comprehensive electronic tools are provided for real-time scheduling access to provider services, including secure online, portal or mobile apps for use by providers and consumers.
The experience is customized with consumer preferences for functionality, providers, days, times and locations.
The clinical information is reviewed via artificial intelligence application to proactively suggest scheduling needed services, such as annual mammograms, routine diabetes rechecks, etc.
Chat applications are used to provide real-time assistance and resolution of inquiries.
Required orders are processed via the provider’s EHR.
Scheduling confirmations are automatically generated and distributed to providers and consumers.
Comprehensive information needed for completing the access process is identified, collected and distributed electronically.
Appointment reminders are auto-generated and delivered according to consumer preferences.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Information-Providing Process
Select an option that best describes your organization.
Level 1
The provider calls the consumer at least two days prior to the service date.
Demographic information is collected or updated.
Insurance information requested and recorded in the pre-registered account.
Arrival and other instructions are provided based on the services scheduled.
Level 2
All applicable items in Level 1 plus:
Price information is provided upon request.
Uninsured individuals are flagged for financial counseling or rescheduled for a later date if a predetermined down payment cannot be made.
Level 3
All applicable items in Level 2 plus:
Applying patient financial communications best practices, a price estimate is provided and resolved in advance of service.
If account resolution cannot be completed, the account is flagged for financial counseling or rescheduled for a later date.
Level 4
Level 3 plus:
The provider sends an electronic communication to the consumer at least five days in advance of the scheduled service. The communication allows consumers to access the provider portal, update insurance and demographic information, view their estimated out-of-pocket responsibility and make a payment.
Individuals who do not log in to update their information are contacted by phone at least two days prior to the service date to update information.
Payments may be made in advance via credit card, e-check, etc., or at time of service. If a payment cannot be made, the account is flagged for financial counseling or rescheduled for a later date.
Level 5
Level 4 plus:
For known/returning individuals, a comprehensive patient matching activity confirms their demographics using the most convenient electronic tools available, including online, mobile app, or biometrics. It allows updates, as appropriate, to any demographic, insurance or other payer information.
The health plan provides the status of the amounts owed as deductible, coinsurance or copayments as of the current date.
A price estimate is prepared and shared with the consumer, in accordance with patient financial communications best practices.
Applicable benefits are confirmed, or, the consumer is made aware of and resolves any issues related to the applicability of the insurance benefits to the scheduled service (This activity occurs concurrently with, or immediately after the completion of, the scheduling activity and applies to all scheduled patients, regardless of the timing of the scheduling activity in relationship to the date and time of the service).
For uninsured individuals, appropriate financial counseling activities are initiated and completed prior to the completion of the information-gathering work,
Electronic confirmation of information and scheduled date and time of service is automatically provided.
Payments may be made in advance via credit card, e-check, etc., or at time of service.
New patients are electronically guided through a series of streamlined questions designed to establish a master patient record and subsequently complete the balance of the pre-registration activities outlined above.
Chat options and a live transfer to a patient access representative is available as needed throughout this process.
Maturity Scale for Authorization Resolution
Select an option that best describes your organization.
Level 1
Providers post charges on their website in machine-readable format for the 50 most common procedures.
For ambulatory services, the consumer is expected to identify and request resolution of any preauthorization requirements.
Case management staff identify and manage inpatient and observation requirements.
When a denial is received for lack of prior authorization, a retroactive authorization is requested by the provider.
Level 2
All applicable items in Level 1 plus:
A list of the most common ambulatory services that require pre-authorization is maintained and used to trigger pre-authorization requests to the ordering physician’s office.
If a pre-authorization is not completed by the date of service, the consumer is asked to sign an electronic advance beneficiary notice of noncoverage (ABN) and may be billed if the authorization issue is not resolved.
Level 3
All applicable items in Level 2 plus:
For ambulatory services, after insurance is verified, a pre-authorization is requested either by the physician or the hospital.
The pre-authorization may be called, faxed or electronically sent to the payer’s authorization unit.
Routine follow-up to resolve the authorization occur may occur.
Level 4
All applicable items in Level 3 plus:
Provider staff routinely and purposefully follow-up to resolve the authorization, engaging the consumer and/or the physician as needed to resolve the issues prior to the date of service.
The consumer is routinely advised about outstanding issues and options.
Level 5
All applicable items in Level 4 plus:
Prior authorization requirements are electronically identified as a component of the automated insurance verification process and completed using the electronic prior authorization data set and the EHR information provided by the ordering physician.
Incentives are aligned within the provider/health plan relationship.
Patient status decisions are determined by a third party and agreed upon by both health plan and provider.
There is clear and timely communication between the provider and the consumer to ensure that the consumer understands the process. If applicable, the consumer may be asked to assist with resolving health plan roadblocks.
Any failure to receive an authorization at least two days prior to the scheduled date of service is electronically referred back to the ordering physician for resolution; electronic ABN documents are completed, as appropriate.
Medical staff and provider rules apply to the rescheduling of elective cases failing to complete the authorization requirements.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Price Transparency
Select an option that best describes your organization.
Level 1
Providers post charges on their website in machine-readable format.
Consumers seeking specific price information are instructed to call for more information.
Level 2
Upon request, a charge estimate is provided for the 50 most common procedures.
Individual test charges are provided on the provider’s website.
Consumers are directed to contact their health plan for more specific information.
Level 3
All applicable items in Level 2 plus:
Specific price information, based on the provider’s average charges, the health plan and the individual’s benefits are provided upon request.
Copayment requirements are identified through the insurance verification process and requested at time of registration or service.
Deductibles and coinsurance status are provided as available from the health plan.
Level 4
All applicable items in Level 3 plus:
HFMA’s consumer guide to understanding prices and consumer guide to avoiding surprise bills are readily available to consumers in accordance with HFMA’s Price Transparency guidelines.
A dedicated price line is available to discuss procedure- or test-specific prices, based on the caller’s insurance information. The provider responds to all requests within two days of the request.
Patient financial communications best practices are used throughout the financial experience.
Price transparency guidelines are incorporated into the patient experience.
Level 5
All applicable items in Level 4 plus:
Consumers are able to obtain a current price estimate via a call, patient portal or mobile application. The technology has a one-touch link to all major health plans in the provider’s service area and uses the real-time status of the consumer’s benefits to develop a transparent price estimate. The price estimate indicates the average charges, total price and consumer’s responsibility for the requested service.
The health plan is viewed as the most accurate source of information regarding price.
Quality ratings based on the health plan’s specific quality rating system are also provided.
Estimates may be confirmed and guaranteed by the provider.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Financial Responsibility Resolution
Select an option that best describes your organization.
Level 1
Consumers are solely responsible for determining their own insured status and personal financial responsibility.
Level 2
The financial counselor determines the consumer’s insured status through inquiry and insurance verification during pre-registration for scheduled services or at initial registration for nonscheduled services (i.e., emergencies).
No assistance is provided with financial responsibility or with a charity care application.
Level 3
The financial counselor determines the consumer’s insured status through inquiry and insurance verification during preregistration for scheduled services or at initial registration for nonscheduled services (i.e., emergencies).
For uninsured or underinsured consumers, the financial counselor assists the consumer or responsible party in completing a charity care application.
Level 4
For insured individuals, the individual’s anticipated financial responsibility may be determined and communicated to them. For uninsured or underinsured individuals, the financial counselor assists them or the responsible party in completing a charity care application and may discuss payment plan options.
Patient financial communications best practices are used throughout the financial experience.
Price transparency guidelines are incorporated into the patient experience.
In the event the patient has completed services and has a balance due, HFMA’s Best Practices for Resolution of Medical Accounts are followed.
Level 5
All applicable items in Level 4 plus:
For uninsured or underinsured individuals, the financial counselor discusses payment plan options and offers comprehensive financial counseling services, as applicable.
Online and mobile access for benefits and automated calculation of the individual’s out-of-pocket estimates are available via a self-service application or portal, or via telephone contact with the financial counselor.
Payment plan options may be automated to enable consumers to self-select options and tools best suited to their needs.
Technology such as ApplePay or equivalent may be deployed by the provider.
For individuals who need or want to consider applying for financial assistance, the mobile app or portal includes an automated financial assistance application.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Service Arrival
Select an option that best describes your organization.
Level 1
Consumer is given information over the phone (if they call and request) regarding what to bring and how to prepare.
A manual map or wayfinding page is mailed to the consumer.
No financial expectations or price estimates are provided unless specifically requested by the consumer.
Level 2
All applicable items in Level 1 plus:
Information is prepared and mailed to every patient based on the type of visit scheduled. Materials include facility map, parking information and preparation instructions.
Insurance eligibility is verified in advance and consumers are told of their expected out-of-pocket expense, but nothing is collected in advance and no financial counseling is available in advance of visit.
Level 3
All applicable items in Level 2 plus:
Consumers are provided an online website or portal where all information is available by visit type and location. Online site includes an electronic map of the facility.
Consumers are asked to pre-register online and complete all paperwork including electronic signature.
An out-of-pocket estimator is available, including links to the various health plan websites so consumers can calculate their estimated cost.
Level 4
All applicable items in Level 3 plus:
Consumers are provided with an online website or portal where all information about their visit is already populated. Location and driving directions are provided via a hyperlink that will be sent to their phone with one click.
Preparation instructions are available by procedure type and a calendar invite option is available to schedule any prep reminders (fasting, medications, etc.).
Price estimation is provided based on health plan and expected procedure code.
Patient financial communications best practices are used throughout the financial experience.
Price transparency guidelines are incorporated into the patient experience.
Level 5
All applicable items in Level 4 plus:
Consumers receive a text message or email upon scheduling with a link to a portal where all information about their visit is already populated. Location and driving directions are included and will automatically be replicated in a calendar appointment that will be sent to consumers via text.
Payment may be made in advance via Google Pay-type feature. Payment plan may be set up and charged to credit card automatically.
Consumers receive a “green card” electronic message that notifies them when all required forms are completed and payments are posted, advising them to proceed directly to the location of the procedure/visit upon arrival and bypass the registration desk.
Upon arrival, the consumer’s smartphone may synch up with the scheduling board, alerting the provider that they are ready.
A text directs the individual to the exam or treatment room to enter; biometrics may be used to confirm their identity.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Post-Service Communications
Select an option that best describes your organization.
Level 1
Statements are mailed to the guarantor monthly; hospital and physician accounts are not combined.
Guarantor has the option to pay via check, credit card or by telephone during normal business hours.
Level 2
All applicable items in Level 1 plus:
Statements are mailed to the guarantor monthly and are available online through the patient portal.
Payments may be made online using a credit card or check.
Level 3
All applicable items in Level 2 plus:
Guarantor has access to statements online, via the patient portal or on the mobile app. Detailed charge and payment information may be provided.
Payments may be made online or on the mobile app using a credit card or check.
Guarantor may opt out of paper statements and establish payment plans within established guidelines.
For patients who have balances due postservice, HFMA’s Best Practices for Resolution of Medical Accounts are followed.
Level 4
All applicable items in Level 3 plus:
Detailed charge and payment information is provided for all accounts, as well as real-time balances.
Hospital and physician accounts may be combined.
Proxy access is available for family members to access and manage a relative’s account.
Level 5
All applicable items in Level 4 plus:
An automated “track my claims” function automatically notifies guarantor any time activity is posted to an account; the function also provides tracking functionality for one or more accounts at the same time.
Health plans, providers and consumers collaborate to ensure accurate and timely communication among all parties.
Payments may be made via monthly scheduled automatic payments (EFT), online or on the mobile app using a credit card or check.
Guarantor may opt out of paper statements and establish payment plans within established guidelines.
Artificial intelligence tools are used to personalize each consumer’s propensity to pay and collections practices are synchronized with the propensity-to-pay scores.
Secure text messaging is used post-visit to immediately confirm any unpaid copayment responsibility and to initiate a payment request.
Guarantor and patient demographic and insurance information may be updated through online access, patient portal or mobile app.
Patient financial communications best practices are used throughout the financial experience.
Price transparency guidelines are incorporated into the patient experience.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Medical Records
Select an option that best describes your organization.
Level 1
Records are not available to consumers via online portal or mobile applications.
Consumers must request, and often pay for, copies of records.
Hospital or physician visit discharge instructions are limited to follow-up orders given to consumers on paper along with prescription(s) ordered after an encounter.
Level 2
All applicable items in Level 1 plus:
Provider portal allows consumer to confirm and order prescription refills.
Encounter listing is available.
Detailed records of visits or encounters, including medical examination notes, diagnosis codes, etc., are not available online.
Level 3
All applicable items in Level 2 plus:
Provider portal allows consumers to send messages to providers as follow-up to visits and schedule primary care appointments.
Limited records of office visit encounters and some test results are available to consumers online or via mobile app.
Level 4
All applicable items in Level 3 plus:
Records of all ambulatory visits and procedures are available for this provider online.
Records cannot be transmitted or sent to providers (hospitals or physicians) outside this provider’s EHR network.
Level 5
All applicable items in Level 4 plus:
Records from other providers are available to consumers via this portal or mobile options based on appropriate authentication; consumers communicate with providers from diverse health systems through one portal.
Communication from consumers is held in a secure section of EHR for appropriate follow-up from provider.
Documentation of all prescriptions ordered and used is available to all clinicians involved in an individual’s care, including recognition of medication interactions or excessive dosing (e.g., opioids).
Consumers may choose to refer copies of this medical history to another provider not previously consulted; this information is also retained for future reference.
Information from all providers is retained and available via one portal for consumers.
Consumer’s electronic record portal includes and provides reminders for diagnostic or required annual visits based on individual’s condition, and sends reminders to them, noting their preference for follow-up location.
Diagnostic results are retained and available for consumers in provider’s medical records, and patient portal or mobile device.
Mobile app or web portal accepts data from other health tracking devices (Fitbit, Apple Health, etc.); stores these data points for future medical visits.
Provider’s EHR includes healthy options and recommendations for individuals based on their profile for health improvement; tracks individual’s health outside of encounters with healthcare providers.
Consumers may review medical records at any time and request clarifying data to improve their understanding of medical conditions.
All visits are available on patient portal (inpatient, ambulatory, post-acute, etc.) for their review.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Bill Generation
Select an option that best describes your organization.
Level 1
Everything is manual. Charges are captured on paper.
Coding is completed by reviewing records and selecting the appropriate services for billing.
Claims are generated with manual editing of the claim values prior to submission.
Level 2
All applicable items in Level 1 plus:
Charges are primarily captured on paper with some electronic charge feeds for limited services.
Billing data is processed through a claims scrubber to detect inconsistencies and errors that would result in a denial. Errors are corrected and claims released.
Level 3
All applicable items in Level 2 plus:
Charges are primarily captured electronically with paper processes used for peripheral areas.
Integrated or bolt-on coding tools are used to increase speed and accuracy of coding.
Clinical documentation improvement (CDI) efforts are decentralized with limited documentation of policies, procedures and metrics
Level 4
All applicable items in Level 3 plus:
Charges are primarily captured electronically, including interfaces with peripheral systems.
Integrated billing edits identify missing and incorrect data before claims generate.
Errors are corrected in the revenue management system before claims are created.
Final claims submitted through a claims scrubber are 99+% clean.
CDI programs are standardized to enforce policies and procedures.
Level 5
All applicable items in Level 4 plus:
Computer-assisted coding is used to optimize speed and accuracy of coding.
Charge data reports and errors are electronically routed to responsible service lines for review and timely correction.
CDI programs are standardized and routinely tested to confirm compliance and enforce policies and procedures.
Metrics are established and measured regularly.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Claims Submission
Select an option that best describes your organization.
Level 1
Claims are manually reviewed for correct health plan identification.
Claims with missing or incorrect health plan information are sent to the patient for correction.
Level 2
Primary health plan identification is based on the results of any insurance verification work completed prior to or at the time of service.
Any edits failures for incomplete patient identification with the health plan require manual intervention. The result is that the claim is sent to the patient for additional information.
Level 3
All applicable items in Level 2 plus:
Any edit failures based on the health plan’s inability to identify the patient are automated so the claim is immediately reclassified as a self-pay claim and sent to the patient for resolution.
Documentation is automatically included with the claim sent so the patient may identify how to resolve the claim with the health plan and the provider.
Level 4
All applicable items in Level 3 plus:
All health plan identification edit failures are automated, including reverification routines triggered based on the use of artificial intelligence applications.
The results of the automated patient contact are recorded and used to trigger additional steps, as appropriate. These claims are held in a pending status and routinely routed on a pre-set timing sequence to assigned staff for additional interventions.
Level 5
All applicable items in Level 4 plus:
As part of the pre-billing routines, all claims are scrubbed to ensure accurate and complete identification and sequencing of health plans.
Reverification is automated and conducted based on the type of edit failures identified through the claim scrubbing processing.
Manual intervention is minimized through the automated claim flow and editing based on scrubber results.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Quality Information Access
Select an option that best describes your organization.
Level 1
Quality data is not routinely provided on the provider’s website, patient portal or mobile app.
Consumers are referred to the state hospital association website, and/or to CMS Compare websites for information.
Level 2
All applicable items in Level 1 plus:
Consumers are referred to their health plan or the CMS website for quality information.
The provider only lists high-level, summary information from the most recent annual survey or CMS report.
Level 3
All applicable items in Level 2 plus:
The provider acknowledges the importance of the consumer’s ability to compare quality results for both the facility and individual provider services.
Basic information such as CMS star ratings, readmission rates, hospital-acquired infection rates, etc., are routinely posted to the provider’s website and updated at least annually.
Contact information is provided to allow the consumer to obtain additional information about the quality information posted.
Level 4
All applicable items in Level 3 plus:
Provider-specific quality ratings from CMS and private ratings (e.g., Press Ganey, etc.) are available on the provider’s website, patient portal and mobile app.
Searchable tools allow consumers to easily compare hospitals, physicians and services within a healthcare system and with other healthcare systems.
Level 5
All applicable items in Level 4 plus:
Pricing information is provided from provider’s price estimation tool once a service and/or provider are identified.
The consumer’s insurance information and preferences are securely stored to streamline additional inquiries, either concurrently or at a later time
A link to the provider’s scheduling tools is also available as part of an automated scheduling tool.
Patient financial communications best practices are used throughout the financial experience.
Price transparency guidelines are incorporated into the patient experience.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Quality Ratings Utilization
Select an option that best describes your organization.
Level 1
The provider does not encourage or respond to the publicly available rating applications.
Level 2
The provider monitors the publicly available rating applications and responds, as appropriate.
Level 3
Level 2 plus:
The provider identifies the most common public rating applications on their website, patient portal and mobile app.
Consumers are encouraged to use these tools, although they are not linked to the provider’s systems or applications.
Level 4
Level 3 plus:
Usage is routinely monitored.
Comments from consumers are monitored and shared internally.
Level 5
All applicable items in Level 4 plus:
Direct links to the most common public rating and scheduling tools are provided on the provider’s website, patient portal and mobile app.
Consumers are encouraged to use these tools, which include direct access to provider information, availability of services and scheduling tools
Comments from consumers are responded to as appropriate, preferably within 24 hours or less from the day of service.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Consumer Feedback Methods
Select an option that best describes your organization.
Level 1
Survey activities are limited to post-service random surveys administered by a third party or internal research operation.
Results are shared with department leadership.
Corrective action plans are developed and implemented as necessary.
Level 2
All applicable items in Level 1 plus:
Survey activities are administered by a third party or internal research operation to a random sample of consumers on a post- service basis.
Customized surveys are deployed to compile additional information on specific trends.
Level 3
All applicable items in Level 2 plus:
Survey activities are expanded beyond those administered by a third party or internal research operation to a random sample of consumers on a post-service basis to parallel the survey results produced by CMS through their survey activities
Level 4
All applicable items in Level 3 plus:
A variety of survey tools and approaches are used, including but not limited to, one-question post-contact surveys (telephone, website, patient portal or mobile).
Patient advisory councils may be used specifically in revenue cycle operations when deploying new statement models, payment options or other new services.
Level 5
All applicable items in Level 4 plus:
Comprehensive survey tools are also used and deployed based on identified patient preferences.
All aspects of services are randomly surveyed.
High tech electronic “suggestion boxes” are also deployed throughout the organization. Results are compiled and distributed real-time as well as on a monthly, quarterly and annual basis, as appropriate
Surveys are supplemented by the use of patient advisory councils in both clinical and revenue cycle operations.
Social media are routinely monitored, and trends compiled.
Compliance with key principles of HFMA’s consumerism best practices, including patient financial communications and medical account resolution best practices, and price transparency guidelines, are incorporated into the survey questions.
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Digital Experience
Select an option that best describes your organization.
Level 1
Consumers may access via a desktop application provider information that includes location, hours of operation and quality ratings.
Consumers may call to speak with a representative for additional questions.
Health plan websites may also provide subscriber-specific information to consumers.
Level 2
All applicable items in Level 1 plus:
Using a desktop application, consumers may request appointments.
Consumers may view bills online.
Consumers may make profile information updates.
Level 3
All applicable items in Level 2 plus:
Using a desktop application, consumers may access billing information and pay online, request medical history and view lab results.
FAQs for the most common inquiries are provided.
Automated emails are deployed to acknowledge the consumer’s inquiry.
Level 4
All applicable items in Level 3 plus:
Using a desktop application, consumers may request appointments and reminders via call or text.
Consumers may call in to speak with a qualified representative for additional questions or chat with a bot to answer general questions.
Response times are monitored, and additional resources used during periods of high call volume.
Level 5
All applicable items in Level 4 plus:
Based on their customized preferences, consumers may access the provider’s digital experience via desktop or mobile.
Consumers may submit insurance information in advance of an appointment and request appointment reminders via text or direct to calendar.
Providers are able to electronically push address information links to map utilities, calculation of travel time, etc., directly to the consumer’s mobile device.
When an insurance card is uploaded, the patient’s copayment, deductible and related information are displayed on the screen for patients.
Consumers may access live billing information, pay bills online, view medical history and lab results.
Consumers may make profile information updates.
Consumers may live chat with a live service representative or call-in to speak with a representative—if there is a wait time, the consumer will be offered an auto-call back without losing their place in the queue
Emphasis is placed on a system of immediate, personalized follow-up to all consumer inquiries.
Key principles of HFMA’s consumerism best practices, including patient financial communications and medical account resolution best practices and price transparency guidelines, are incorporated into the patient experience
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Inquiry Resolution
Select an option that best describes your organization.
Level 1
Provider does not use a customer management platform.
Each unit has its own contact information and resolution team; resolution is independent and not shared with others involved in consumer’s care or stored for future reference.
Level 2
All applicable items in Level 1 plus:
Consumer is required to present diverse or complex inquiries multiple times and navigate a complex system without significant assistance from the provider.
Level 3
Level 2 plus:
Provider uses more than one customer management platform; each business unit uses its own platform to intake customer relationship issues that impact this business unit’s processing.
There is no coordination on resolution with more than one department. When consumer has more than one inquiry or has inquiries that cross over multiple providers, resolution is fragmented, leading to consumer dissatisfaction.
Level 4
Provider uses a single, integrated consumer management platform to intake all consumer relationship issues.
Provider then refers consumer to the most appropriate resource for resolution.
Performance on consumer interaction is not tracked, as resolution management is decentralized.
Diverse methods or channels used by the consumer to communicate with provider are not directed to one central location for continuity and clarity in communication; inquiry is often repeated by consumer.
Level 5
Provider uses a single, integrated consumer management platform to manage all customer relationship issues. This platform is available and integrated with patient billing, telephone and web portals to ensure accurate communication is provided to consumer via appropriate authentication, and communication is not repeated unnecessarily.
Questions are directed to customer management representatives via a sophisticated algorithm that connects consumer with the right resource the first time, without need for call transfers or delegation to others.
Provider uses artificial intelligence tools to generate generalized responses as well as the appropriate routing of more complex issues to the appropriate representative.
Provider acknowledges consumer inquiries and responds timely.
Provider tracks % of completion for same-day inquiry, whether via portal, online, mobile device, phone or in person.
If inquiry or dispute cannot be resolved same day (or same call), provider sets expectations for resolution with consumer, and provides resolution within agreed time frame.
Customer management representatives identify additional opportunities for improvement or provide patient resources for additional clarity regarding medical care, billing and quality data for providers, including external data, e.g., CMS.gov, state agencies or health plan portals.
Provider accepts the burden of resolution for the consumer.
Key principles of HFMA’s consumerism best practices, including patient financial communications and medical account resolution best practices and price transparency guidelines, are incorporated into the patient experience
Other innovative ways or initiatives to improve the patient experience are sought.
Maturity Scale for Satisfaction Guarantee
Select an option that best describes your organization.
Level 1
Provider does not have a centralized unit empowered to resolve patient satisfaction issues.
Dissatisfied patients may resort to external communication (media) to highlight variances between expected care, quality, or effectiveness of service.
Level 2
Provider has dedicated resources empowered to resolve patient satisfaction issues.
Patient feedback is decentralized.
Level 3
Level 2 plus:
Provider has developed a model standard of minimum behavior and communication requirements to ensure patient satisfaction with every interaction with provider staff—clinical and nonclinical.
Level 4
Level 3 plus:
The model standard becomes a key performance management attribute measured with feedback provided to all staff.
Patients can provide feedback through surveys (e.g., Press-Ganey) or online directly to clinician or staff.
Key principles of HFMA’s consumerism best practices, including patient financial communications and medical account resolution best practices and price transparency guidelines, are incorporated into the patient experience.
Level 5
All applicable items in Level 4 plus:
Provider has dedicated resources empowered to resolve consumer satisfaction issues.
Consumers may provide feedback through diverse survey channels, including mobile or portal applications, for any specific encounter.
Consumers may request a refund or a balance waived based on encounter not having met their expectations for quality, efficient or effective compassionate care.
Provider tracks all consumer feedback for root cause and improvement purposes, including how the program may impact HCAHPS scores
Management of patient experience is centralized; all employees are empowered to resolve consumer dissatisfaction as close to the encounter as possible.
A centralized team creates a partnership between clinical and nonclinical teams charged with responsibility for promoting a positive patient experience throughout an encounter.
Issues are resolved within seven days, or, the consumer is contacted to explain a longer delay.
Other innovative ways or initiatives to improve the patient experience are sought.
Your Maturity Model Ratings
Consumer Interaction Channels (Rating 1 to 5)
Rating
How consumers locate providers for needed services.
How consumers schedule an appointment for needed services.
How consumers provide comprehensive information prior to the scheduled date/time of service.
How the provider resolves needed authorizations for consumers.
What consumers can expect to pay for services.
How consumers can understand and resolve financial responsibilities.
When consumers arrive for service, what should they expect.
How consumers receive post-service financial communications from providers.
Quality and Accuracy (Rating 1 to 5)
Rating
How available, accurate and complete are the consumer’s medical records.
How accurate and timely is the consumer’s bill generated.
How the patient’s claim is submitted to the correct health plan and plan.
Provider (All ) Compare Quality Ratings .
Consumer Experience (Rating 1 to 5)
Rating
How consumers use publicly available ratings of providers and the patient’s experience.
How consumers rate their experiences with a provider.
How complete is the consumer’s digital experience with the provider.
When consumers request information, questions are answered timely and completely.
Consumer satisfaction with services received is guaranteed.
Score
73
Your Total Score of Consumer Maturity Model out of 85
Cash collection as % of net patient service revenue
%
Aged accounts receivable > 90 days*
%
Discharged not submitted to payer*
%
HCAHPS “would recommend” score
%
Consumerism Maturity Index Score (CMIS)
0%
* Before entering the data for this metric, it must be normalized against results achieved by HFMA’s MAP Award for High Performance
in Revenue Cycle winners. See the online worksheet for instructions.
Your Score: 0%
Underdeveloped
Initiating
Emerging
Consumer Centric
Level Attained
Overall Score
Level Description
Consumer Centric
>90%
The organization has mastered capabilities needed for meeting and exceeding consumer expectations related to the financial experience.
Emerging
70-80%
The organization has demonstrated a commitment to improving the consumer’s financial experience and has made significant progress toward development of the requisite organizational capabilities.
Initiating
60-69%
The organization has begun the process of developing organizational capabilities for improving the consumer’s financial experience.
Underdeveloped
<60%
The organization has yet to demonstrate that it is developing organizational capabilities for improving the consumer’s financial experience.
Take the self-assessment and plug in your scores and other metrics to our online calculator. You will learn whether your organization’s consumer maturity level is consumer-centric, emerging, initiating, or undeveloped. You can then use the specifics from your Consumerism Maturity Index Score to create a process improvement plan that is tailored to the needs of your organization and patient population. From scheduling appointments to resolving preauthorizations to submitting claims—and much more—you will come out of this self-assessment process with a road map for improving your patient financial experience.
The model is built on HFMA’s Patient Financial Communications Best Practices and price transparency guidelines. Access these and other HFMA consumerism resources.
The Consumerism Maturity Index Score incorporates five HFMA MAP Keys.
Use Chrome, Firefox or Safari to calculate your score.
After entering data on the CMIS Worksheet, use this calculator to discover your score.
