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Financial Counseling – The Critical Difference

By Gail Scarboro-Hritz, Principal, Consulting Division

It is essential to do a thorough job of gathering current demographic and third-party payer information from each new patient at the earliest possible point in the pre-scheduling or scheduling process. This information is vital to moving forward with the care and support of your patients and their families. In addition, EthosPartners recommends that established patients who have not visited the practice in the last 60 days should be considered as “new” patients in terms of gathering updated information. If you do not have a formal financial counseling function at your practice, we recommend you act quickly to establish this vital role to more effectively manage the ever-growing uninsured and/or under-insured population.

Also, established patients should be processed as “new” patients at the beginning of each calendar year. This is particularly critical with recently-introduced Medicare Replacements plans with lower premiums. Such plans average out-of-pocket costs to the Medicare patient of $6,000 per year. If these patients do not have a “gap” policy, they are rarely prepared to pay these high out-of-pocket costs that would not be due from them under the traditional Medicare program. Your financial counselor may inform the Medicare beneficiary of the differences between traditional Medicare coverage and Replacement Medicare coverage such that the patient may re-enter the traditional Medicare program if they choose to do so.

Once information is gathered from patients, the next step is to investigate and verify the information. We do not do this because our patients are not trustworthy. We do this because it is a highly valuable service to the patient and because it is critical to the financial stability of our practice. We do a disservice to our patients if we do not investigate and verify their third-party payer information. They could end up with unexpected financial burdens and undue stress if we fail to do a thorough job and report our findings to our patients.

If financial assistance is indicated and the practice offers payment options to self-pay patients, there must be a clearly established means to administer payment arrangements. Well documented, clearly written Financial Assistance policies and procedures, typically based on current federal poverty guidelines and a financial assistance application completed by the patient, provide the road map for staff to distinguish between those patients who are unable to pay and those patients who are unwilling to pay. This is a critical distinction that guides us in how to best manage patients who owe us money.

Conducting financial counseling based on thoroughly verified demographic and third-party payer information is often the critical difference between those practices that are financially stable and enjoy high marks in patient satisfaction and those that do not. Financial counseling is the process during which a well-qualified representative in your practice talks with the patient about their insurance coverage, eligibility and benefits. The Financial Counselor works with your patients to be sure that they receive the care that they need and have a clear understanding of their financial responsibilities throughout the term of their care. They offer your patients the facts and the assurances they need to move forward with their care as well-informed customers of your practice.

EthosPartners highly recommends having a special brochure that offers information about the financial polices under which your practice operates and that orients patients and their families to the business activities that take place in your practice. Please email Gail Scarboro-Hritz at ghritz@ethospartnershc.com to request a copy of the generic Patient Financial Services Brochure developed by EthosPartners for our clients. This piece may be easily customized for use in your practice.

If you have questions about financial counseling and/or financial assistance programs, we invite you to contact Barbara Noon at bnoon@ethospartnershc.com or by calling Barbara at (404) 316-2252. EthosPartners is fully prepared to work with you to establish a comprehensive financial counseling program for your practice.