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Effective Communications Skills
and Best Practices in Billing & Collections:
Part 2
Tuesday, May 19, 2015 1:30pm – 2:45pm
A training webinar brought to you by the National Center for Farmworker Health
Important Reminders
Webinar will last approximately 1 hr and 15 min.
For any technical issues, send a chat to me, “the organizer” (Christina)
Everyone participating in the webinar should be on mute.
• If you are listening on the phone, please accept the audio pin when joining or mute your phone and computer microphone.
Move your cell phones away from computer
Important Reminders
There will be a few opportunities for your participation.
• At the designated time, respond by sending a chat to “all participants” or click on the hand icon and wait for organizer to call your name and unmute you before speaking.
Q&A will be held at the end if time allows.
• If you think of a question before the end, send your question via chat to me (Christina) privately.
• Your question will be shared with the group
Any questions that cannot be addressed during the webinar will be responded to the participant directly via email.
The presentation and handouts for this webinar were sent to all registered participants.
• You can also access them in the “materials” section of your control panel.
Please complete the evaluation survey that you will receive via email after the webinar.
The presenter will be using a webcam. You can adjust your screen to be able to see both the presenter and the presentation slide.
Important Webinar Reminders
Vangie Orozco, M.A., M.P.Aff.
Product Development Manager
NCFH
Meet the presenter…
Webinar Learning Objectives
After this webinar series, you will be able to:
• Give examples of common problems in billing and collections, and some best practices and solutions
• Know some tips and techniques for collecting payment assertively and handling negative responses
• Understand the important of educating the patient on their financial responsibility and the need for staff training, including the use of scripts for communicating with patients
Webinar Outline
In part 1 webinar we talked about:
• Why billing and collections is so important to a health center
• Common problems in billing and collections
• Best practices in billing and collections
• Assertive as key communication strategy
Today we will talk about:
• Applying assertive communications to collections/billing
• 3 key moments to educate and ask for payment, and sample scripts
• Techniques for handling negative responses, and de-escalating difficult situations , and sample scripts
Assertive Communication as Key
Communication Strategy
Assertive communication is the ability to express
positive and negative ideas and feelings in an open, honest and direct
way.
Six Main Elements
1. Eye contact to demonstrate interest, show sincerity
2. Appropriate body posture to support the message
3. A level, well-modulated tone of voice
4. Appropriate timing
5. Content should be simple, straight and to the point
6. Make use of “I” statements and limit “you” statements
Guidelines for Assertive
Communication
Scenario Example:
Your colleague who is
habitually late has arrived late
again for an important
meeting.
Don’t Exaggerate
It is important to describe the results and effects of their behavior specifically. Don’t generalize, expand or judge.
What not to say:
“There is no point having a meeting now. This project is hopeless!”
Assertive Communication:
“We are going to have very little time left for this meeting as I need to leave for another meeting at 3:00.”
Use Factual Descriptions
If you want to change someone’s behavior use factual descriptions rather than your judgment or opinions. Do not label them.
What not to say:
“You’re always late. This is not acceptable!”
Assertive Communication:
Any suggestions?
“The meeting was scheduled for 2:00, it’s now 2:35.”
Use “I” Statements, but be careful If you don’t use “I” statements, you may appear passive. If you
use too many “I” statements, you imply that you don’t really care for others. If you use you it can appear accusatory. So use “I” statements in moderation and avoid “you” statements to get the best of both worlds.
What not to say:
“You cannot be late again!”
Assertive Communication:
Any suggestions?
“I’d really like you to be here on time so we can spend enough time on this project.”
Passive vs. Aggressive vs. Assertive
Passive vs. Aggressive vs. Assertive
Passive Behavior
Is afraid to speak up, speaks softly
Slouches and withdraws
Avoids looking at people, shows little or no expression
Aggressive Behavior
Interrupts and ‘talks over’ others, speaks loudly
Stands rigidly, crosses arms, invades others’ personal space
Glares at others, intimidates others with expressions
Assertive Behavior
Speaks openly, uses a conversational tone
Relaxes and adopts an open posture and expressions
Makes good eye contact, shows expressions that match the message
Enhancing Your Assertiveness Skills
Assertiveness is learned and developed over time.
Chances are you may be assertive in some areas of your life but maybe not on other areas.
• You must try to recognize those areas where you are assertive more comfortable being assertive, and try to apply those same skills in the other areas where you want/need to be assertive.
Using techniques like established policies and scenario scripts, helps you be more assertive, since you already know what to say and can just focus on how to say it (tone, body language, etc).
Sell the patient on the importance of paying today. It is the best collection chance you have.
Don’t ask if they want to pay today, expect them to pay….
Don’t ask how much they want to pay, expect that they will pay the full amount
Mindset for Assertive Collections
Communications Tips for Assertive
Collections
Not becoming emotional
Not arguing with the patient
Sounding confident and assertive
Being courteous, but always waiting for the patient’s response…
“Remember…the first person to speak, loses.”
Practicing scripts
3 Key Moments to Educate and
Ask for Payment
Prior to Service
At Time of Service
After Service
What policies or procedures
does your health center
currently have for collecting
prior to service, on day of
service, and/or after day of
service? What has been
successful? What hasn’t
been as successful?
Please respond via chat or click on the hand icon and wait to be un-muted before speaking.
Prior to Day of Service
Informing patient of expected financial responsibility
Be Positive and factual with informative tone
“Mr. Brown, I contacted you insurance company and according to your insurance the procedure the doctor has ordered for you is a benefit under your plan…..(pause)….I also want to let you know that according to your insurance you have a co-pay of 30% after deductible. I calculated what you would have to pay. You will be responsible for approximately $120. We do require payment on the day of the appointment. We accept Mastercard, Visa, Checks and Cash. Do you have any questions?
When a new patient makes an appointment “Payment is due at the time of service, unless you bring your current insurance card, in which case only the co-payment and deductible amount will be due.”
When the patient does not have insurance “Payment in full is due at the time of service”
Prior to Day of Service
When a patient with a previous balance makes an appointment
“Both your payment (or co-pay) for this visit and
your prior balance of $75 will be due at the time of service.”
When the patient does not have insurance “Payment in full is due at the time of service”
Prior to Day of Service
On Day of Service (check-in)
Welcoming attitude
Check your body language and make eye contact
Persuade to pay any past due balances in addition to today’s fees
“Mrs. Lee, the charge for today was $10 due to your copay responsibility according to your insurance. You also have a previous balance of $320, so the amount due to today is $330. Will you be paying by cash, check or credit card?”
Say: “Mrs. Lopez, the charges for today’s visit is $120. After I apply your discount of $80 your payment is $40. Would you like to pay with cash, write a check or with a credit card?”
WAIT – WAIT – WAIT for answer…don’t say anything but keep eye contact with the patient.
On Day of Service (check-in)
Before giving follow up appointments Apply discount if applicable but always, always
let the patient know what the total charges were, what the discount is, and what their portion is….
Start off by saying: “The total charge is $___ but after I apply your
discount of $___your portion is $____.”
On Day of Service (check-out)
If patient cannot pay in full
• Obtain date they will return to pay for today’s visit in full. Check your policy on how much time can give.
• Develop urgency. Explain that the health center needs to be paid so it can continue to provide care.
• Take a look at options for the patient, such as patient assistance or payment arrangement.
On Day of Service
If cannot pay in full say: “Ms. Jones, if you are not able to pay today when will you come back within the next week to take care of this payment? Your payment is very important to help us keep our services going….” OR
“Ms. Jones, what day of next week should I schedule a call from our billers to obtain your payment over the phone? Your payment is very important to help us keep our services going….”
Mention any policies such as late payment fees.
On Day of Service
After Day of Service
Send a reminder of payment arrangement agreement
Follow up with phone call if payment not received
Unpaid balance collection letters: • Short and focused
• Don’t give the patient excuses or alternatives
• Don’t use judgmental or accusatory tone
• Command the patient to take action by a specific date
• As account ages, letter becomes more assertive
Unpaid Balance
Collection Calls
Patient calls are more effective than mailing statements • Statements often placed at the bottom of the pile -
payment returned only 5-15 % of the time
• Calls get a better return
Work accounts in dollar amount order, not alphabetical - work large accounts first
All accounts, no matter how small, are important
Review Account before Calling
Patient
Is the balance correct?
Have they been sent a statement? When?
Did the insurance pay their portion?
Have they been overdue before?
Have they established special payment arrangements?
When Making the Call
Be professional • Polite, courteous, business like
Be positive • Emphasize how you can help
Keep calm and cheerful • Never raise your voice even if they do
• Don’t allow yourself to get emotional
Listen • Maybe they need to vent, let it happen
Don’t threaten or make false accusations
Ask for full payment • Once you’ve listened, return to your goal
What to Say
Make sure you are talking with the patient who owes the money
Say who you are and why you are calling
“This is Ana Gonzalez and I’m calling about your
balance of $1000 which has been outstanding over 75 days. Mr. Rivera, your account has been given to me for special attention, I’m here to help in any way I can”
Make it positive and a commitment - Will vs. Can
“Will you mail a check today?”
“Can you mail a check today?” is not a real promise
Pause and Listen
Patient responds: “No, I don’t have the money now”
Look for solutions
• Why can’t he/she pay?
• Can they pay next week?
• Can they postdate a check or pay by credit card?
Negotiate
Negotiate
Always start higher than you expect
Establish exact amounts and time frame - don’t accept “as soon as I can” “So, you will pay $50 every month for 6 months, to pay your $300 amount due.”
Establish how payment will be made
Confirm agreement “I’m very pleased we were able to work out a payment plan that will get your account up to date. I will expect your first payment of $50 on January 1st, and then every first of the month through June 1st.”
How to Deal with Excuses
Check is in the mail… “Thank you for mailing your check. What day did you mail it? Where? Amount?”
I don’t pay the bills. Talk to my wife… “Mr. Jackson, you are our patient. That is why I’m calling you regarding the account…” OR
“Mr. Jackson, you are our patient, however, let’s schedule a time I can speak with both of you…”
I can’t pay it all now… “The balance has already been extended for over 3 months. Let’s establish a payment plan than can bring you current within a 6 month timeframe….”
Follow up if money not received
Follow up call:
“I’m calling about the check you said you would mail by May 1st. I see there have been no payments posted to your account and I wanted to be sure it wasn’t lost or posted to the wrong account. When did you mail the check?”
Scripting Activity: Asking for Payment
Refer to handout. Pick one scenario from your category based on the first letter of your last name: • A-I: Prior to service
• J-R: Day of service
• S-Z: After service
Read your scenario and develop a very brief script to address the task.
When you are done, share via chat to all participants or click on hand icon and wait to be un-muted before speaking
What about Negative Responses?
• Thought this was a free clinic • Doesn't have any money to pay • Doesn't have the money to pay in full, and wants to
pay only a partial amount • Forgot checkbook, cash or credit card so cannot pay
right now • Expects service but owes a balance from previous
service • Has never had to pay upfront before and did not
know would have to pay • Shouldn’t be charged because has insurance • You are charging more than the insurance says you
should, so doesn’t want to pay • Someone else pays all the bills (spouse or ex-spouse)
Handling Negative Responses
Patient: “I’ve never had to pay at the time of service before. Can’t you bill me later?” Response:
“Many patients like taking care of their balances up front so they don’t have to worry about it later. That’s why we’re giving you the opportunity to pay now. Would you like to pay by cash, check or credit card?” “Paying now helps the health center avoid further billing cost. We’re trying to do all we can do to control health care costs for our patients, and to make sure we are here if you need further care. So, how would you like to take care of your balance today?”
Patient: “I didn’t bring my checkbook.” Response:
“Payment is due at the time of service. We accept cash or credit cards.”
“Payment is due at the time of service. Would you like to call home to get your credit card number, if you didn’t bring it?”
“Payment is due at the time of service. You can call us when you get home to give us your credit card number or you can come back later today with your payment.”
“Payment is due at the time of service. So you don’t have to worry about your checkbook in the future, I can swipe your credit card today and pre-authorize any future payments.”
Handling Negative Responses
Patient: “My ex-husband pays for all medical bills”
Response: “No problem, I’ll give you a receipt showing you’ve paid and you can send it to your ex so he can repay you.”
“If you put this on your credit card today, you can send the credit card bill to your ex to pay.”
Handling Negative Responses
Patient: “I can’t pay in full” or “I don’t have the money.” Response:
You know we applied the discount to your charges and payment is expected at time of service.
You can pay with a post-dated check.
You can pay half today, and then come in and pay the remainder before statements go out on (date).
Handling Negative Responses
Patient: “I have insurance. They pay for everything.” Response:
“According to your insurance, when you come in for a visit you have what’s called a co-payment which is due at the time of service. Your co-payment is $25. This is what you have to pay today. The insurance will then take care of the rest of your bill for todays’ visit which the estimate shows may be around $160. I would be happy to help you call your insurance to clarify.”
“Here is a document showing that the insurance company already took care of a portion of your bill ($120). The rest of your bill, $45 is what you must pay. Would you like to call your insurance company to clarify?”
Handling Negative Responses
Scripting Activity: Handling Negative
Responses
Refer to handout. Pick one scenario from your category based on the first letter of your last name: • A-I: Scenario #1
• J-R: Scenario #2
• S-Z: Scenario #3
Read your scenario and develop a very brief script to address the task.
When you are done, share via chat to all participants or click on hand icon and wait to be un-muted before speaking
Handling Difficult Situations
Patients who have been waiting a long time
Patients who are not feeling well
Rude or other inappropriate behavior
Patients who feel like victims
Patients who feel their need is greater than other’s needs
Patients who are stressed out financially
Most conversations go well but at times situation may escalate
• Be mentally prepared!
• Stay calm!!
• Practice responses.
• Time to apply the 3 C’s – Competence, Confidence and Caring
When the Situation Escalates…
Behaviors that are Guaranteed to
Frustrate Patient
Being treated like a number
A cold attitude
Blaming the customer
Being spoken down to
A recitation of the rules
A run-around
Lack of accountability
Diffusing the Situation…
3 – Get to the “yolk”!
You must find a solution
1 – Crack the “shell” You must break through the emotions
2 – Deal with the “white” You must understand the problem
Imagine a hardboiled egg…
Diffusing the Situation…
Deal with the patient’s feelings:
• Empathize - put yourself in his/her shoes
First 30 seconds, just listen…never interrupt. Let him/her vent
Ask questions
Summarize the problem - restate in your own words
Demonstrate the behavior that you want from the customer (talk calmer, slower…)
1 – Crack the “shell” Phrases that Make Things
Worse…
• “ You don’t understand...”
• “ You have to…”
• “ We won’t...”
• “We never...”
• “We can’t…”
• “ You’re wrong…”
Phrases that help de-escalate…
• “ I can see why you feel that way”
• “I can see what you mean.”
• “That must be very upsetting.”
• “I understand how frustrating this
must be.”
• “ I am sorry about this.”
• “Let me see what I can do.”
1 – Crack the “shell”
Apologizing Without Blame
• “I’m sorry this happened to you.”
• “I’m sorry for the inconvenience.”
• “I’m sorry this turned out this way.”
• “I understand your frustration.”
1 – Crack the “shell”
Do’s and Don’ts
• “No.”
• “I don’t know.”
• “That’s not my job.”
• “Calm down.”
• “But…”
• “I’m busy right now.”
• “The only thing we can do.”
TRIGGERS
• “What I can do is….” • “I’ll find out.” • “Let me find the right
person who can help you with…..
• “I’m sorry.” • “And..” • “I’ll be with you in just a
minute” • “The best option I think”
CALMERS
2 – Deal with the “white”
What is required for us to really understand the problem or the patient’s situation?
2 – Deal with the “white”
What may happen in a difficult situation if we don’t listen first?
Problem solving takes place after active listening.
• De-value the person
• Damage the relationship
• Escalate the problem
• Jump to problem solving too quickly
3 – Get to the “yolk”! Find a Solution or Positive Outcome
• Find out what the person wants. Move the conversation gently towards problem solving.
• Suggest alternatives.
• Share information.
• Agree on a solution.
• Follow-up as necessary.
• End on a positive note.
• Demonstrate respect at all times.
Practice Scenarios
“The doctor makes enough money anyway!”
“None of my other doctors charge me!”
“Stop bothering me. You are harassing me!”
“Your charges are too high…the insurance says you overcharged me!”
“I just lost my job! Could you just leave me alone!”
“It may feel like collecting from your patients is not providing good customer service, but it is! By
informing, educating and helping them understand what they are
paying for, how much, and why, the patients can focus on their health
without financial distractions.” Julie Ingraham,
Huron Healthcare
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