The Role of the Benefits Advisor in the Revenue Cycle
Most organizations have a financial counseling component as part of their revenue cycle. Financial counseling, where a financial counselor meets with a patient face-to-face or over the phone to discuss payment arrangements and/or financial assistance, is usually targeted at self-pay patients with the assumption that if a patient has insurance, he/she should be able to pay. This is not always the case with high deductible health plans, where patients are taking on more of the cost share. Patients do not need financial counseling, they need benefits advising. This opens up a new way to maximize cash collections.
An insured patient has the benefits of his/her specific plan while a self-pay patient may qualify for Medicaid or other third-party assistance. All patients have benefits, but do they understand their benefits? This is where the benefit advisor comes into play. By educating patients about their benefits and helping them to understand their financial responsibility, organizations can increase the likelihood of collecting payment at the time of service.
Benefits advisors should be used in the pre-arrival setting to handle all self-pay patients prior to being scheduled for an elective procedure. The benefits advisor will determine the patient’s estimated out of pocket costs and ask for payment. If the patient is unable to pay upfront, then the benefits advisor will discuss financial assistance options offered by the organization. All pricing requests via a pricing hotline or emails can be handled pre-service by the benefits advisor as well.
Benefits advisors should be used in the hospital with a presence in the Emergency Department (ED) and on the inpatient floors. The ED benefit advisors act in a manner similar to the pre-arrival benefits advisors with the difference being they actually see the self-pay patients face to face at the bedside. The ED benefit advisors must work closely with the registration staff to create a smooth hand off when the registration is complete, so they can collect any monies due and discuss payment options.
Inpatient benefits advisors are needed to man the patient care floors and should see, at a minimum, all patients who owe money. It is a nice gesture to also see those patients that do not owe anything (patients who have a secondary insurance, VA, or a plan that covers at 100%) to explain their benefits and ease their mind that their hospital stay is 100% covered. Due to the complexity of the situation, being in the hospital and seeing multiple doctors, nurses, receiving tests outside the patient room, etc., it is not always easy to access the patient at the bedside. Multiple attempts should be made to see the patient while he/she is in-house. Once the patient is discharged the chances of getting payment from him/her drops significantly since now the benefits advisor must rely on follow up phone calls to reach the patient. These benefit advisors can also be the ones to take care of any walk-in patients that need to pay a bill or have questions about the cost of their care.
Including a benefits advisor role in the revenue cycle puts a new and patient-friendly positive spin on the old financial counseling process. With the industry focused on patient experience, hospitals and healthcare organizations need to exceed the patients’ expectations when it comes to knowing their benefits and helping them afford their healthcare. The benefits advisor does just that…everyone has benefits.
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