Hospital makes billing changes

Recently, Hot Springs County Memorial Hospital implemented some changes in the way the billing process is handled.

Chief Financial Officer Shelly Larson explained the hospital currently partners with First Party Receivables Solution (FPRS). The organization sends out statements and makes phone calls to patients. There has always been a 120-day workflow with FPRS, Larson said, explaining when insurance billing is complete the account balances become patient responsibility.

Outsourcing for balances has become a standard practice, Larson said. "It's very efficient. It provides a nice, consistent process for getting our self-pay billing out." She added hospitals typically don't do a lot of their own self-pay because of the number of accounts handled and the cost of specialized equipment.

On top of that, FPRS also provides services for recording phone calls. If one happens to go bad, Larson explained, they can pull the record and determine whether something has been done in a professional manner and correct those issues.

Business Office Director Larinda Bushur stressed the insurance billing is done in-house, and FPRS is utilized only when bills have gone to the patients' responsibility. "Until that time," she said, "we do handle that."

What has changed with FPRS's part lies within the 120-day workflow. Larson said the first change made was the result of several requests for itemized billing, which provide more detail than the typical statements. Once insurance billing is completed and the account is loaded with FPRS, the hospital also sends out an itemized statement.

This document from the hospital, Larson noted, has a stamp on it that indicates the statement is for informational purposes only, and is not a bill. However, the bill from FPRS is sent in the same time frame, so the statement acts as something of a notice that the bill is coming.

Bushur added the itemized bill also lets people know what their insurance paid, so they can compare it to their insurance companies' explanation of benefits. Larson said if there is any kind of discrepancy, patients are encouraged to call the hospital to further discuss the matter.

Bushur thinks offering the itemized bill will open communication and help identify discrepancies.

Financial Counselor Jessyca Rodriguez added since she has been with the hospital, most of the calls have been requests for itemized statement. These statements, she added, help patients see exactly what services were rendered during visits.

Patients receive a second statement from FPRS, reflecting any payments made within the first 30 days, Larson said. On day 45, they would receive a phone call from FPRS if no payments in full have been made, or there has been no discussion regarding financial assistance or a payment plan.

Bushur noted the phone call used to go out on day 25, rather than day 45. This would allow patients more time to set up payment arrangements if they need.

At 60 days, Larson said, patients get a third statement from FPRS, and a second phone call at day 75. At this point, she added, they still have every opportunity to set up payment plans or financial assistance.

At day 90, they get the fourth statement, with the third phone call on day 105.

At that point, Bushur said, they still have 15 days to set up a plan or seek financial assistance. On day 120, if there has been no attempt to pay the account it is recommended for bad debt. It comes back to the hospital, and reflects four months of inactivity.

"We then research that account," Bushur said, "for possible pay plans or financial assistance. We check with First Party Receivables to make sure every statement and phone call have went to the patient."

If such efforts have been done to no avail, the account is sent to collections.

Larson pointed out FPRS has access to the hospital system, so the partner company is able to look at the same information available to hospital staff.

"We work closely with First Party Receivables," Bushur said, noting Rodriguez is in contact with them nearly all day every day.

"I work very closely with them also, Bushur said, "so we are aware of what they're doing at all times. If they have questions for us, that comes to us very timely and we get back with them very timely."

Bushur noted if patients set up a payment plan with FPRS within the first 30 days, then they would not continue to receive phone calls. However, they would continue to receive statements and payment reminders. "The thing with that," she said, "you have to set up a formal pay plan. You can not just choose your own." This can be done either verbally or through a written notice to FPRS or the hospital.

Those with a balance of $250 or less are required to make minimum monthly payments of $50 per month; those with balances of $250 to $2,500 are required to pay at least 10 percent of the amount owed and sign a payment agreement with the hospital; those with a balance greater than $2,500 are expected to make minimum payments of $250 per month and sign a payment agreement with the hospital.

Larson explained if patients set up plans, and they happen to miss payments, they have entered into a broken promise and will be contacted as a reminder that their payment is late. Bushur said they would receive a phone call until the plan is reset.

Larson noted there is work being done to get a local number that would be utilized for the phone calls. Keeping in mind there is always some caution regarding fraudulent phone calls, she said people might not answer calls from numbers they don't recognize.

John Gibbel said the hospital is working to make the whole process more patient-centric. "We're hearing what they want, and we're trying to respond to them." Larson said the biggest impact is making sure patients are comfortable with the billing process once it becomes their responsibility.

"Hopefully we're seeing a happier patient. We can provide the best care in the world, but a billing issue can really blow that perception."