The document discusses how healthcare organizations can better engage patients in financial conversations earlier in the revenue cycle process. It recommends training staff to feel confident discussing costs and payment options with patients upfront. It also suggests educating patients about rising healthcare costs and their obligations. The document proposes implementing data-driven workflows at key points like patient access, financial navigation, and revenue recovery to simplify financial conversations and enable continuous process improvements. The goal is to empower staff to act as financial advocates for patients, improve outcomes like collections and bad debt, and create happier employees and more satisfied patients.

1. $
“Patients come first.” We’ve all heard the
phrase, but what does it really mean from
a patient access or financial standpoint?
Historically, putting patients first has meant
addressing clinical concerns immediately and
having financial conversations later. Although
the focus is right, the financial outcomes are
typically less than desirable. Patients have
grown accustomed to scheduling appointments,
showing up at the hospital or doctor’s office,
and even handing over their insurance cards
without ever knowing how much they’ll owe
for their care. The well-intended response to
those patients who do inquire about the
balance is traditionally, “Let’s see what
insurance pays first…”
Many providers still allow patients to get what
they want without paying anything upfront.
Only about 35% of hospitals currently collect at
the point of service1
, relying on the traditional
billing statements they mail weeks later, hoping
they will bring payments through the door.
This so-called “envelope process” may have worked
in years past, when patient payments represented
a small portion of revenue. Now, however, “patients
are the new payer.” Employers and payers are
continuing to shift an increasing cost burden onto
patients, and today they shoulder roughly 30%-
35% of their healthcare bills.2
Money talks: Rethinking what
it means to put patients first
Best practices for empowering revenue
cycle staff to become patient advocates
Patients are the new payer,
shouldering 30-35% of
theirhealthcare bills2

2. That’s a lot of moneyto track
down, especially at a high cost.
Keep in mind that the least
expensive cost to collect is at
or before service; it gets much
costlier down the line.Yet even
though patients represent
the fastest-growing revenue
source for most healthcare
organizations, it’s a responsibility
many are unprepared to manage
and a rising source of patient
anxiety. In fact, one in four
families has unpaid medical bills
it can’t afford,3
and medical costs
continue to represent the leading
cause of bankruptcy filings.4
Patients need to be engaged
in the revenue cycle early and
often. To truly put patients
first means rethinking the
dreaded “money talk.” It requires
innovative mindsets, data
and revenue cycle workflows.
Hospitals and health systems
must equip staff with resources
and tools to talk with patients
about the financial aspects of
their care at every interaction.
Access to pertinent information
is necessary; the financial
administrative team must
be able to identify costs and
coverages — and offer payment
options — ideally prior to service.
Well-informed staff can help
patients make well-informed
decisions. For healthcare
organizations, the resulting
trifecta is hard to beat:
happier employees, more
satisfied patients and a
healthier bottom line.
Partner with patients to
overcome payment barriers
As deductibles and out-of-
pocket costs rise, many patients
are suffering “sticker shock.”
It’s hardly surprising given
more than 80% of employed
workers have a high-deductible
health plan (HDHP), and patients
experienced a 13% increase in
both deductibles and out-of-
pocket maximum costs between
2014 and 2015.5
Plus, while 51% of
patients owe more than $1,000
to their healthcare providers,6
they have less revolving credit
with which to pay the higher
costs.7
Patients have essentially
become the new “payer,” and
they have very different payment
behaviors compared to insurance
carriers. There is great need to
educate and engage the patients
into revenue cycle processes so
they can be guided along the path
to payment.
For example, those who are
newly insured or who have
selected a HDHP may not fully
understand all their financial
obligations, yet many of them
want to know their costs and
want to pay what they owe.
For healthcare organizations, a
successful financial outcome
for patients can be assured
by recognizing the crucial
difference between a patient’s
willingness versus ability to pay.
Employers can also help by
sharing practical insights into
their benefit plans. An advocate
within an employer’s benefits
department, for instance,
could present the company’s
various insurance offerings in
74%
of those with
insurance
indicate they are
both willing
and able to pay
out-of-pocket
medical
expenses of
up to $1,000
per year.8
are willing and able to pay
up to $500/year.8
A full 90%

3. terms of plans and affordability —
perhaps by creating examples of
premiums and costs for common
healthcare scenarios, such as a
knee replacement, childbirth, ED
visit or appendectomy. Hospitals
and health systems can assist
in much the same way, by giving
staff the tools and training to
speak with patients early on
about their financial obligations
and options.
Best practices for a
productive financial dialog
Tools and processes that
streamline front-end financial
conversations with patients
create opportunities for
revenue cycle staff, enabling
them to become “financial
advocates” for the patients they
serve. In turn, the increased
financial awareness can relieve
patients of payment unknowns
that lead to sticker shock and
anxiety. Hospitals and health
systems, too, are better able to
manage payment risk.
To support improved employee
and patient satisfaction and a
healthier bottom line, hospitals
and health systems should
consider these best practices
to empower revenue cycle staff:
Train staff
Taking a proactive approach
to the revenue cycle requires
rethinking staff roles and
responsibilities. To put it plainly:
It demands a cultural shift.
Financial matters should no longer
be treated as an afterthought
of clinical care. Rather, they
must be viewed as an integral
component oftwo very important
organizational objectives:
1 make it easy for patients
to understand the cost
of their care, and
2 help patients effectively
navigate those costs.
To support and ensure
success with these goals,
most organizations will need to
update their policies,procedures
and job descriptions. Explain
the goals and roles to all staff
— including billing and financial
employees, administrators,
registration staff and even
clinicians. (In truth, physicians
and other clinicians are perfect
advocates for cost-effective
care because their orders drive
most services and procedures.
They should be just as aware
of financial issues as clinical
ones, and encouraged to talk
holistically with patients.)
To make staff comfortable with
upfront financial conversations,
arm them with scripts, FAQs and
practice sessions. Teach them
how to be empathetic to each
patient’s situation, and how to use
available tools and data to feel
confident presenting reasonable
payment opportunities —
including upfront collections.
Staff must learn how to be
respectful yet direct in their
patient dialog. A carefully
designed staff incentive program
to support upfront
collections can help balance
revenue, offset bad debt and
provide stellar patient service. For
greatest impact, organizations
should define exactly who is
eligible for incentives, whether
they will be monetary or non-
monetary, and the target
objectives to meet. Incentives
should balance the rewards for
high performance with coaching
actions for non-performance.
Educate patients
Although stafftraining is an
important part of shifting an
organization’s culture, it’s only

4. half the battle. Healthcare
organizations also must
communicate the changing
environment and expectations
to their patients, clinical staff
and the community at large.
A marketing and
communications plan that
includes straightforward letters
and brochures, for example, can
explain the benefits of bringing
financial considerations to the
forefront. Patients frustrated
by having little understanding
or control over their healthcare
finances now have the
opportunity to fully participate
not just in their care, but also
in the cost of their care. Useful
language to convey these ideas
might include:
“Our hospital strives to
help patients understand their
healthcare costs. In that effort,
coverage is verified, costs
are discussed and payment
arrangements are made - in
advance. Through this, bad debt
is reduced and the operations of
our hospital remain financially
viable to continually serve
our community.”
Simplify financial
conversations
Up-to-date information is the
key to enabling revenue cycle
staff to take a more confident,
competent, collaborative and
compassionate approach to
patient financial discussions.
For maximum impact, hospitals
and health systems should
adopt data-driven workflows
at three strategic points
— patient access, financial
navigation and revenue recovery.
Patient access workflows
Verify identity.
According to a Medical Identity
Fraud Alliance study, medical
identity theft increased 22%
between 2013 and 2014.9
With
such crime on the rise, robust
identity verification procedures
are necessary to protect both
patients and the revenue cycle.
Verify insurance coverage.
Leverage task-driven,
user-defined work queues to
check all scheduled patients
for insurance eligibility,
authorizations and benefits.
This information forms the
foundation for next steps —
such as obtaining needed
pre-authorizations — as well
as for engaging patients in
payment decisions. A process
that retroactively looks at
the outcomes can also foster
reengineering and improvement
to denials management.
Deliver cost estimates.
The chances of collecting
money from patients after
service becomes costlier
and is less likely.
The longer a
facility waits,
the less the
value of the
collection.10
The longer a
facility waits,
the less the
value of the
collection.
60 days,
the value drops to
75% of the bill
90 days,
the value
plummets to
60% of the bill
180 days,
the value is only
25% of the bill
FOR EXAMPLE:

5. By contrast, though, providers
are twice as likely to receive
payment if they ask for it in
advance.11
In fact, 52% of people
would pay from $200 to $500
or more if an estimate was given
at the point of care.12
So, providing every patient
with a payment estimation
prior to service or discharge is
a critical piece of the financial
planning puzzle.
Financial
navigation workflows
Present the best
payment choices.
Every scheduled patient should
select one of three funding
mechanisms before their date
of service — either insurance,
“mutually agreed” self-pay
or another avenue such as
charity care. The funding
mechanism chosen determines
the direction of the resulting
workflows and conversations.
To arrive at the right payment
mechanism, however, hospitals
and health systems must equip
staff to compare the payment
estimation against the patient’s
ability to pay. This allows them
to work as advocates, matching
the ideal payment arrangement
with each patient.
Stratify patients’ ability to pay.
This lets staff work with patients
collaboratively — at the right
time, and in the right way. There
are three types of patients —
those who can pay, those who
need help paying and those
who cannot (or refuse) to pay.
Those who can pay should, and
those who cannot should get
assistance. Patients willing to
pay but who lack an ability to
do so may be candidates for
medical credit cards or payment
programs, for instance. Others
may not have any ability to pay a
healthcare bill (or any other kind
of bill) and are likely eligible for
financial assistance or charity.
Helping patients pinpoint the
most appropriate funding
mechanism ensures a
good experience and financial
outcome for all.
Engage in proactive dialog.
Financial counselors should
scrub the schedule for self-
insured patients, then reach
out to discuss potential eligibility
for payment paths such as
Medicaid, health insurance
exchange plans or charity care.
Information including benefits,
eligibility, authorizations,
propensity to pay and credit
scores should be used to find
the most advantageous
funding mechanism.
Part of the exchange might
include saying to the patient, “I
see you’re self-insured, but my
goal is to establish a funding
mechanism that meets your
needs to fund the care.” If the
patient is not able to cover the
payment, assessing propensity
to pay can help differentiate
between a bad debt risk and a
likely payment plan.
Revenue
recovery workflows
Enable continuous improvement.
Little communication has existed
historically between the “front”
and “back” ends of the healthcare
revenue cycle. As hospitals and
health systems begin to manage
growing amounts of financial
Hospitals and
health systems
must equip staff
to compare
the payment
estimationagainst
the patient’s
ability to pay.

6. risk, however, the ability to position that risk early
becomes increasingly valuable.
Even on the back end of the revenue cycle, tools
exist that can often locate insurance coverage
for patients such as Medicaid, Medicare, TRICARE
or commercial plans. Communicating such
information to registration and other patient
access staff can better inform future patient
discussions, driving continuous improvements
to the financial engagement process.
With proactive and data-driven workflows, staff
can begin to work with patients to offer payment
options instead of ultimatums.
Rather than acting as “collections agents,”
practical data gives revenue cycle staff the unique
power to strengthen their organizations’ bottom
lines and reduce financial stress and anxiety for
their patients.
PATIENT ACCESS WORKFLOWS
Verify identity | Verify insurance coverage | Deliver cost estimates
FINANCIAL NAVIGATION WORKFLOWS
Present the best payment choices | Stratify patients’ ability to pay
Engage in proactive dialog
REVENUE RECOVERY WORKFLOWS
Enable continuous improvement
Hospitals and health systems should adopt data-driven
workflows at three strategic points to maximize impact.

7. For more information, visit
www.transunionhealthcare.com
or email hcsolutions@transunion.com.
Insightful employees, happier patients,
healthier bottom line
Healthcare organizations must change their
approach to patient payments. The “envelope
process” that chases payments long after services
have occurred is no longer feasible. Hospitals that
assess funding in advance can couple patients with
the best possible funding mechanisms.
To keep hospital and practice doors open and
continue to serve their patients, healthcare
organizations must empower staff to better
manage financial risk. The earlier they can position
risk, the earlier they can find ways to both mitigate
it and put patients back in control of their financial
decisions. The right tools and data empower staff
to empathize with patients and offer solutions
in an approach that’s confident, competent,
collaborative and compassionate.
Knowledgeable staff can assist patients in making
payment decisions, relieving them of payment
unknowns and anxieties. In a time of great change
throughout the industry, hospitals and health
systems can take one clear-cut step to help
strengthen the revenue cycle while also improving
staff morale and patient satisfaction. Giving
revenue cycle staff the information and support
they need to move the financial conversation
upfront can increase their job satisfaction, fortify
their organization’s bottom line and enrich their
patients’ financial care experience.
1.
The Impact of Consumerism on Provider Revenues, Availity research study, Feb. 2015 2.
InstaMed “Trends in Healthcare Payments” Annual Report 2014
3.
National Center for Health Statistics, National Health Interview Survey, 2012 4.
The American Journal of Medicine Blog, “Under #ACA , Medical Bankruptcy Continues,” 12 Jan. 2016
5,6,7
2016 TransUnion Healthcare Report 8.
Key Trends in Patient Payment, J.P. Morgan 9.
2014 Fifth Annual Study on Medical Identity Theft, Medical Identity Fraud Alliance
10.
Improving Self Pay At All Points of Service, Relay Health 11.
Hospitals Ask Patients to Pay Upfront, CNN Money, 29 Sept. 2014 12.
Key Trends in Patient Payment, J.P. Morgan