Best Practices for Communications in Advance of Service

Following is Section 3 of the Patient Financial Communications Best Practices. This section addresses communication in advance of service. See the complete Patient Financial Communications Best Practices.

3. Patient Financial Interactions in Advance of Service

3.1. Discussion participants: Appropriately trained provider representatives will have these discussions with the patient or guarantor. Patient should be given the opportunity to request a patient advocate, designee or family member to assist them in these discussions.

3.2. Setting for discussion: Discussions will occur using the most appropriate means of communication for the patient. These discussions may take place via: 

• Outbound contact to patient in advance of a scheduled service.
• Inbound contact from patient inquiring about their upcoming service.
• Scheduling / Contact center when appointment is made.

3.3. Timing of discussion: A reasonable attempt will be made for discussions with patients to occur as early as possible, taking place before a financial obligation is incurred up to the point at which care is provided. Timely discussions will ensure patients understand their financial obligation and providers are aware of the patient’s ability to pay and/or source of payment.

3.4. Registration, insurance verification, and financial counseling discussions: Provider organizations will maintain a thread of pre-registration discussions that occurred with the patient. If pre-registration discussions took place, these discussions will not occur again.

3.4.1. Registration: The provider organization will first gather basic registration information including demographics, insurance coverage, as well as determining the potential need for financial assistance.

3.4.2. Insurance verification: The provider organization will review insurance eligibility with the patient to ensure information accuracy. Uninsured patients will be informed the goal of collecting information is to identify paying solutions or financial assistance options that may assist them with their obligations for this visit.

3.4.3. Financial counseling: If appropriate, patient is referred to a financial counselor and /or offered information regarding the provider’s financial counseling services and assistance policies.

3.5. Provision of care: Provider organizations will have clear policies on how to interact with patients with prior balances choosing to have elective or non-elective procedures. They will also have clear definitions for elective and non-elective procedures. These policies will be made available to the public.

3.5.1. Elective services (As defined by the provider):

3.5.1.1. Patient share discussions: Patients have the obligation to make satisfactory payment arrangements before receiving care.

3.5.1.2. Prior balance discussions: Patients with prior balances will be informed by the provider organization if the provider’s policies regarding prior balances mean the service will be deferred.

3.5.2. Non-elective services (As defined by the provider):

3.5.2.1. Patients will be informed that ability to resolve patient share or any prior balances will not affect provision of care.

3.6. Patient share and prior balance discussions: Interactions will not interfere with patient care, and will focus on patient education. During patient share and prior balance discussions, the provider representative will:

3.6.1. Patient share discussions:

3.6.1.1. Provide a list of the types of service providers that typically participate in the service both verbally and if the patient requests, in writing.

3.6.1.2. Inform patient that actual costs may vary from estimates depending on actual services performed or timing issues with other payments affecting the patient’s deductible.

3.6.1.3. If appropriate, ask the patient if they are interested in receiving information regarding payment options.

3.6.1.4. If appropriate, ask the patient if they are interested in receiving information regarding the provider’s financial assistance programs.

3.6.2. Prior balance interactions discussions:

NOTE: Balance resolution discussion occurs on prior balances that are being pursued for collection by provider, collection agency or other organization. There will be many scenarios where patients will not have prior balances.

3.6.2.1. Discuss with patient the services that led to the prior balance, including the dates of service and the resulting prior balance. Upon the patient’s request, provide the patient a written list of the services provided, dates of service and the resulting prior balance.

3.6.2.2. If appropriate, ask the patient if they are interested in receiving information regarding payment options.

3.6.2.3. If appropriate, ask the patient if they are interested in receiving information regarding the provider’s supportive financial assistance programs.

3.6.2.4. Proactively attempt to resolve prior balances through insurance and financial assistance programs.

3.7. Balance resolution: Once the provider organization has fulfilled the best practice steps as outlined above, it is appropriate to inquire about how the patient would like to resolve the balance for the current service and any prior balance the patient may have, as well as informing the patient of the timing of collection activity.