Revenue Cycle Revolution

Mike Simms revamped Cone Health’s billing and collections process to improve the organization’s bottom line—and its relationships with patients

Rapid consolidation in the healthcare industry, coupled with reductions in Medicare and Medicaid reimbursements, is forcing healthcare providers to get creative.

More than ever, it’s become critical for care providers to find ways to make themselves stand out as exceptional customer service representatives if they want to have positive patient experiences. For Cone Health, a nonprofit health system headquartered in Greensboro, North Carolina, the answer to that mandate is coming from an unlikely department: finance.

According to Mike Simms, hospitals are having a difficult time with increased patient-responsible balances. “The increase in these balances is due to the Affordable Care Act and employers making employees more responsible for cost-sharing,” says Simms, Cone Health’s vice president of revenue cycle. “It’s important for revenue cycle teams to develop technology and processes to handle this increase in patient-responsible balances.”

Often, care providers prioritize their first impressions with patients, making sure experiences with front-desk personnel, nurses, and physicians are satisfactory. But collections and billing, which is often one of the last touchpoints a patient has, is a just-as-important, yet often forgotten, aspect of patient care, Simms says.

Mike Simms, Cone Health

“If we don’t do a good job explaining to our patients what they owe and if we don’t give them a web portal that allows for easy access of information and an easy way to communicate with us, then they’re going to have a bad experience,” he says.

Simms knows from experience the power of clear, concise billing and a user-friendly web portal for a patient’s experience, as he and his team recently led the revitalization of Cone Health’s billing and collections process.

Simms oversees Cone’s patient registration and back-end patient accounting processes, including claim submissions, refunds, denials management, and more. Over time, he saw that these processes were not meeting patient expectations and created difficulties for patients and the organization when it was time for individuals to pay their bills.

He identified two main issues: confusing billing statements and a rigid collections process that didn’t provide patients with enough options to pay their accounts. This frustrated patients who wanted to make payments and led to more accounts going to a collection agency. Simms and his team first set out to revamp the billing statements.

Before the revitalization, the bills sent to Cone Health’s patients were bland and uninformative, and patients often called the organization’s customer service line for clarification on their statements, Simms says.

To address this concern, Simms and his team spearheaded a request-for-proposal process, where he and the team asked third-party vendors for their ideas about how Cone Health could improve its web portal and online billing statements. The team prioritized vendors who could provide state-of-the-art technology and patient-friendly deliverables, as well as capabilities such as an online messaging system and ways for patients to set up and manage their own payment plans without having to pick up the phone. After reviewing proposals and scoring each vendor, the team selected one and began implementing the new solution with Cone Health’s IT department.

Now, Cone Health’s statements are colorful and easy to read, providing a quick summary of a patient’s accounts as well as a more detailed breakdown of the charges from their visit. Whereas before Cone Health’s system left patients waiting to speak to customer service representatives, now the system is receiving a 95 percent satisfaction score from patients who are using the new and improved web portal and billing statements.

“We don’t get as many calls to our customer service department about not understanding statements,” Simms says. “Our employees enjoy it because there’s some other added functionality, such as cash posting, which makes it easier for them. Our customer service reps process credit card payments through this vendor as well. So, from a patient satisfaction standpoint and an employee satisfaction standpoint, it’s helped us.”

While working on upgrading the company’s web portal, the team also worked to implement new billing and collections tools and procedures. At the time, patients had six months to pay the balance on their medical bills before the account would be handed over to a third-party vendor to handle collections. But Simms found that this structure didn’t allow patients enough time to pay, which resulted in individuals getting upset about the billing process.

To remedy these issues, the team decided to bring certain aspects of the collections process in-house instead of using an outside vendor. Although the third-party vendor calling patients about their bills was acting on behalf of Cone Health, Simms often heard complaints from customers who thought that it was a collections agency, which hurt the organization’s relationship with patients.

As part of the effort to improve the organization’s relationship during this process, the team implemented a predictive dialer within the customer service department, which automatically calls patients to remind them that an upcoming payment is due. This not only frees up Cone employees to perform other tasks, it also improves the institution’s relationship with patients because it’s clearly identifiable as a call from Cone Health, with whom the patient already has a relationship.

Additionally, the team spearheaded an effort to make the payment process more flexible for patients, such as by increasing the time that patients had to pay their bills to twelve months. The team also routed patients who could not pay within twelve months to a third-party loan vendor, which allowed them to pay over a longer period of time at a low monthly interest rate.

At the same time, this vendor provides cash funding minus a service fee of the account balance to Cone Health based on the patient’s propensity-to-pay scoring. Without this assistance, the established payment plans could remain on Cone’s accounts receivable for years, Simms says. There is always the possibility that the patient will stop paying the vendor, in which case the account would be returned to Cone and the organization would have to pay back the advanced funds. Known as the recourse rate, this scenario has only applied to about 3 percent of Cone Health’s accounts since the switch. More healthcare organizations are looking to implement these loan programs to help solve some of the issues with the high out-of-pocket costs that patients are experiencing, Simms says.

“I’m very proud of these projects,” Simms says. “The revenue cycle team and the IT team worked together great, knowing that this was the best thing for our patients.”

Photo by William Jarrett

The continuous and dramatic changes in the healthcare industry demand attention. CMRE has responded by providing customized receivables solutions that optimize cash flow and provide a superior patient experience. Hospitals, healthcare systems, and physician billing companies across the nation have partnered with CMRE for over four decades to maximize cash flow and ensure their patients are treated with compassion and dignity when resolving their financial obligation. CMRE continues to invest and focus on people, processes, and technology to ensure our clients and their patients are afforded the results and experience they require and deserve.