Meritus Health: Improve patient experience one medical bill at a time

For hospitals, the business office and patient experience are not mutually exclusive, with previous research linking billing processes to long-term patient satisfaction.

To hear how organizations can ensure patient-friendly billing, FierceHealthFinance talked to George Semko (pictured), vice president of Revenue Cycle at Meritus Health System in Maryland. In part 2 of this exclusive interview, he discusses how Meritus is improving experience by preventing billing issues.

In part 1 of this interview, Semko talked about the health system's commitment to serving financially disadvantaged patients and fulfilling its charity care mission.

FierceHealthFinance: How can hospitals enhance the patient experience on the business side of healthcare?

Semko: When a claim becomes a self-pay event that's when the patient truly gets involved. Whether it's a true self-pay or a balance after insurance, until that point a lot of people really don't understand their bills and don't care to understand; they just want to know what do I have to pay.

And that in our case is where we brought in a self-pay vendor that has the ability to look into our systems and understand the accounts. They can talk patients through it. Say you had Blue Cross insurance and had a $10,000 bill, they'll explain that the insurance company paid $6,000 and there's an adjustment of $2,000 and the balance that we are trying to collect from you is related to your co-insurance deductible or whatever it may be.

But it's through an education process; it's being a financial advocate for them, if you will. We try to give the tools to understand the finances and payment arrangements to make their payments, so it's very patient-centered in that respect.

FHF: How do you facilitate that education process?

Semko: Healthcare bills are very confusing. And then they're getting multiple bills not only from the hospital but from their physicians. At Meritus, we're able to marry that conversation because we have one company working our hospital bills and they're also working the physician bills.

We basically have a financial liaison here for patients to explain their bill. So we've taken the guesswork out of it and we're putting people at ease because they have someone they can talk to that will understand their bill and if not, be able to get the answers for them in a timely fashion and prevent them from getting into any credit issues.

So that's how we attacked it--by being more proactive with it rather than reactive and just letting it go to a bad debt agency and all the negativity that comes along with that. We want to make sure patients have a good experience and they have someone they can call and feel comfortable to talk to.

FHF: For self-pay patients, when unpleasant billing experiences occur, what should the hospital do to remedy the situation?

Semko: Depending on what that scenario may be, number one we have all phone calls--inbound or outbound--related to self-pay patients recorded. So we're going to go back and listen to those phone calls so there's no he-said-she-said. We hear the conversation, we understand the conversation.

From the hospital's perspective, we're going to look at it as an opportunity for improvement. If there is something that wasn't appropriate we'll thank the patient and relay how we improved going forward based on their concerns. Depending on what those concerns may be, there may be an adjustment to their bill. Or the issue could be with our self-pay partners and there's something wrong with one of their employees.

For example, about six months ago, one of our patients called in talking to a representative and when it was all said and done, the representative--whether he did it by mistake or intentionally--clicked off the headset or hung up the phone. We recieved a complaint and we were able to listen to the voiceover at 9:00 at night. At 8:00 the next morning, the gentleman was terminated. There's a zero tolerance because you're treating patients in an inappropriate matter.

That's the type of company we're dealing with, so it is a respectful conversation 100 percent of the time. If it's not, it's dealt with very quickly because patients are our lifeline.

FHF: Anything you'd like to add about improving patient experience?

Semko: Again, it's devising a program that hovers a very strong self-pay program because that's where your patient connection really happens from a billing perspective. Because if your insurance company is paying for it, you don't really care. Most people don't really care, they don't look at it. It's whenever they have to put in out-of-pocket additional funds it can become an issue.

So make sure it is a solid program and the people handling it are just not off the street and they really can understand it. They can look at the bill and they can talk the talk at that point, or if not, get it to the right person so there can be an educated discussion with the patient. If not, it creates frustration, which creates negativity around the organization, from the patient's perspective.

Healthcare finance is confusing and every system is a little bit different. On the hospital side you've got UB-04. Bottom line is that a uniform bill is nowhere near uniform because every payer is allowed to do what it wants. It's a uniform form but it's not uniformly used. So until that happens I don't think we'll ever get there.

Editor's note: This interview has been edited for length and for clarity.

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