Communications Best Practices Measurement Criteria

Following are criteria for evaluating the effectiveness of patient financial communications in a healthcare organization. These are based on the Patient Financial Communications Best Practices. HFMA offers a recognition program so organizations can demonstrate their implementation of the practices.

1. Training program evaluation
     a. All staff, including Patient Access, Financial Counseling and Customer Service dealing
        with patient financial discussions should go through training on an annual basis.
     b. Evidence that training occurred is presented to the Executive Leadership Team on an
         annual basis.
     c. Training can be provided through a variety of forums (e.g. Web-based or in-person).
     d. Training can be provided by qualified resources (internal or external) as deemed
         appropriate by a designated quality officer (e.g. Compliance, Quality, or Human
         Resources).
     e. Training must cover:
         i. Patient Financial Communications Best Practices specific to the staff role
         ii. Financial assistance policies
         iii. Available patient financing options
         iv. Alternative solutions for the uninsured
         v. Standard language to be used in patient discussions
         vi. Laws and regulations (e.g. EMTALA, FDCPA, TCPA, etc.) specific to the staff role

2. Process compliance evaluation
     a. Ensure provider organization is compliant with the Best Practices through annual
         observation, monitoring and tracking of results.
     b. The evaluation will be comprehensive and cover all relevant parts of the Patient
         Financial Communications Best Practices:
         1. Best Practice Scenario 1 – Patient Financial Communications in the ED
             i. Registration
             ii. Patient Share
             iii. Prior Balance
         2. Best Practice Scenario 2 – Patient Financial  Communications in Advance of Service
             i. Registration
             ii. Patient Share
             iii. Prior Balance
         3. Best Practice Scenario 3 – Patient Financial  Communications at the Time of Service
            (Outside the ED)
             i. Registration
             ii. Patient Share
             iii. Prior Balance
         4. Best Practice Scenario 4 – Best Practices for all Patient Financial  Communications

    c. Process compliance evaluation can be performed by any organization independent of the
        department being audited (e.g. internal audit, compliance, quality or a 3rd party).
    d. A report containing the results of the process evaluation is presented to the Executive
        Leadership Team on an annual basis.

3. Technology evaluation
     a. Ensure technology is in place to support informing the patient of the following:
         i. Verification of insurance eligibility for current services
         ii. Verification of existing prior balance within organizational control
         iii. Estimated cost of the current services and the consumer responsibility portion
     b. A report containing the results of the technology evaluation is presented to the
         Executive Leadership Team on an annual basis.
     c. The technology evaluation can be performed by any qualified individual or organization
         (e.g. technology, compliance, quality or a 3rd party).

4. Feedback process and response evaluation
     a. Ensure process is in place to regularly solicit input and receive feedback from key
         stakeholders in compliance with Patient Financial Communications Best Practices
        (e.g. community, patient surveys, physicians)
     b. Ensure process is in place to measure and respond to input and feedback received
     c. Ensure provider organization has an escalation process for patient complaint resolution
     d. A report detailing the feedback and response process that is in place and a summary of
         the feedback and responses that have been exchanged is presented to the Executive
         Leadership Team on an annual basis.

5. Executive level metrics reporting evaluation
     a. Ensure process is in place to consolidate the reports from the 4 areas listed above into
         an overall Compliance Report and presented to the executive leadership team on an
         annual basis.