March 11, 2015

Navigating Patient Financial Options | Patient Financial Engagement Best Practices

By laura aylward

Navigating Patient Financial OptionsJust as providers are expanding their patient care beyond their four walls, they need to extend their definition of patient care beyond clinical conditions to include financial matters. The two are inexorably linked as patients bear growing responsibility for their medical costs and too often must choose between avoiding care because they find it unaffordable or running up medical debt that’s hard or even impossible for them to pay. It’s up to healthcare providers to help consumers navigate the patient financial options.

Both patients and providers deserve better options, and that’s where CarePayment’s 10-step best practices for patient financial engagement come in. The sequencing and workflow are designed to improve patient financial interactions at every step of the revenue cycle, increasing patient engagement and satisfaction right along with patient collections, which represent an increasingly substantial portion of provider revenue.

The first stage of the best practices workflow is actively communicate about patient financial services, described in a previous post, and these first three steps take providers and patients to the crux of the financial discussion—communicating the availability of patient financial options for accessing needed care. This second stage is all about navigating financial options using a step-by-step approach that maximizes the success for both patients and providers.


These steps do require some changes for both providers and patients, neither of whom has much experience talking about medical costs with each other, especially before treatment.  Just as providers need to take the lead in actively communicating about patient financial services, they also must take responsibility for helping patients address financial matters.

It means helping provider staff develop the ability to have what are sometimes tough conversations. That’s where training and tools can make all the difference. To reduce legal or regulatory compliance risk, it also demands strictly enforced formal policies and procedures so they apply to every patient and reining in any staff members inclined to freelance on payment screening and options.

  • Step 4: Validate patient identity. Verifying a patient’s identity in real-time is a key step in arriving at an acceptable payment method and for subsequent communications. The ability to access the right identification information upfront is directly tied to the provider’s ability to collect. Done routinely, promptly and matter-of-factly, a smooth and efficient process also raises patient satisfaction.
  • Step 5: Evaluate ability to pay. A reference for assessing the likelihood to pay in real-time can play an important role in determining a viable payment option. By calculating patient-owed balance combined with financial indications, provider staff can segment consumers for appropriate patient financial options, including possible eligibility for Medicaid or other financial assistance. Evaluating the ability to pay is a critical component to ensuring as many patients as possible receive the help they need as well as reducing time to collect and increasing efficiency.
  • Step 6: Offer customized payment options. This is the moment of truth for the many patients who don’t have cash on hand or access to credit to cover their out-of-pocket costs. Using the identification and ability to pay information, providers can offer suitable payment programs or ask for cash, check, or charge.The ability to present the patient balance and effectively configure payment terms that fit a patient’s budget is the real key to patient financial engagement. For patients, knowing they have choices and talking them over can help them reach a decision that works for them without forcing them to forgo care or making extreme financial sacrifices. By putting the patient in the right plan and for a workable payment amount, providers can realize a more predictable cash flow, reduce rework and bad debt and help people get needed care without the worry of how to pay.  At this point in the process, there should be a plan for every patient.
  • Step 7: Confirm patient’s payment choice.Allowing patients to actively participate in the selection of payment arrangements and to manage their medical expenses over time has proven very successful and is why more providers are introducing or expanding such financing programs. At this point, patients agree to an action plan for paying their bill, such as paying a deposit in cash or enrolling in a financing program. Then they are given the appropriate customized paperwork and instructions indicating the financial next steps and confirming the plan.  Again patient participation and this confirmation approach solidifies buy-in, reduces confusion and reduces likelihood of non-payment.

These best-practices are designed as a kinder, gentler way to expedite the financial process for providers and their patients. They work to engage new healthcare consumers throughout, helping them become comfortable with their choices and enabling them to make informed decisions as early as possible.

For a more detailed discussion on this topic you can download our white paper, Patient Financial Engagement for the New Healthcare Consumer: A Best-Practices Approach, which ran in the April 2015 issue of Healthcare Financial Management.