Building Loyalty with your Revenue Cycle Process

The significant increase in patient out-of-pocket costs has caused revenue cycle leaders to search for new ways to increase the value of the consumer’s healthcare dollar. Additionally, they are looking to become more efficient in the way that their patients enter, move through and exit the revenue cycle.

This is critical since the patient experience most often begins and ends with staff interaction directly linked to revenue cycle functions.

According to America’s Health Insurance Plans (AHIP), the prevalence of high deductible health plans (HDHPs) is a major contributor to rising out-of-pocket payments for insured patients. These expenses have grown from $250 billion in 2009 to $420 billion in 2015, a 68 percent increase in five years.

Challenged with making self-pay profitable while also competing on patient experience, Revenue Cycle Leaders are shifting the way self-pay is managed. Traditionally, outstanding patient balances received little attention until the back-end of the revenue cycle. Taking deliberate action to address self-pay obligations with patients early in the care process - often prior to treatment - is now considered best practice. 

Maximize Use of Staff Resources and Technology

A multi-pronged approach which includes both staff resources and new technology can ensure the building blocks are in place to successfully enhance operations and patient satisfaction.

Build Knowledge and Skill

Ensure frontline staff are equipped with the knowledge and tools to be successful. Review job requirements for patient access staff. Consider adding additional skill requirements such as knowledge of medical terminology and basic coding. Provide current staff with opportunities to obtain additional training.  Partner with local technical and community colleges to teach the needed skills and to use as a resource in recruiting new staff.  

Evaluate the Pay Scale

Work closely with human resources to communicate that the new skills required to determine a patients out-of-pocket expenses and ensure an optimal patient experience may demand a hike in the pay scale. Document necessary advanced skills such as in-depth insurance knowledge, use of common applications or software, and how to request patient payments. As skillsets increase, wages should be adjusted accordingly.

Reassess the Financial Counselor Role

Many hospitals have had financial counselors in place for a considerable amount of time. Now is the time to redefine the role they play in today’s revenue cycle environment. Consider updating the job title to Patient Advocate and add responsibility for managing the financial clearance process. Focus the staff’s attention on high dollar revenue areas such as surgery, cardiology and oncology.  Patient Advocates should meet or talk with patients who have large out-of-pocket responsibility prior to scheduled procedures and services to review payment expectations and discuss alternative payment options.

Streamline Processes

Streamline processes to reduce the number of staff members a patient must interact with. An example is eliminating the need for a patient to visit the cashier to make a payment. Equipping other staff in Patient Access to handle payments can provide a welcomed convenience to patients. The goal is to make the financial portion of the patient experience as seamless as possible.

Maximize Use of Technology

The use of technology to support and enhance critical front-end processes is a critical component. Often this will include software to determine insurance eligibility, estimate patient out-of-pocket costs, manage prior authorizations, calculate cost estimates, provide automated program screening (Medicaid, state programs) and facilitate management of cashier, credit card and balancing functions.

Optimize Patient Communications

Even though the number of individuals covered by insurance has increased as a result of the ACA, the amount patients typically pay out-of-pocket for healthcare services has also risen. Patient payments now account for 25-30 percent of total revenue. 

It should not come as any surprise that satisfied patients are more willing to pay their bills. They are also more likely to recommend the provider to a friend and to return for future services. Here are several ways you can improve patient engagement and increase self-pay collections.

Effective Patient Communications

Nothing is better than providing clear, concise, patient-friendly communication following a patient’s encounter to help avoid confusion and assist with prompt claims filing, reimbursement and payments.

The manner in which this communication is shared can make a huge difference.

This is the perfect time to review current communication mechanisms and expand the options that will increase patient engagement. The goal is to keep patients informed about their account status, outstanding balance and payment options by providing consistent communication.

A perfect way to accomplish this is to appeal to each patient’s preferred method of communication. Generational preferences can vary greatly. Take advantage of those differences.

  •          Retired individuals may prefer to receive communication through the mail
  •          Young mothers to the baby boomer generation focus on email communication
  •          Millennial patients primarily communicate through the use of text messages


The 501r Regulation places a strong emphasis on consistent and effective communication of an (not-for-profit) organization’s financial assistance policy for patients. Charity care policies must be updated to identify who is eligible and how to share information about the policies with patients.

Provide Flexible Payment Options 

Unlike many other purchases or expenses, healthcare costs are often unexpected. Patient financial situations vary greatly, as do their out-out-pocket obligations. You can improve your ability to collect self-pay balances by offering flexible options for payment. These could include time-of-service discounts, prompt pay discounts, short term interest free payment plans and optional extended payment plans.

Variety of Payment Mechanisms

Providers may want to give patients simple payment mechanisms, like traditional paper checks, but they must also be prepared to offer additional options for payment. This provides patients with the option to choose the method of payment they trust most. Consider accepting payment by:

  •          E-check
  •          Credit and debit card
  •          PayPal/Apple Pay or Google Wallet
  •          HRA/HSA debit cards


Not only is it important to offer a variety of mechanisms for payment, making it easy to pay is also paramount. Appeal to the patient’s needs. Make it convenient for them to pay their bill by providing multiple opportunities for payment:

  •          In person at time of service or anytime during the billing process
  •          Online bill pay
  •          By phone – through a live call or using interactive voice response (IVR)
  •          By mail


As the percentage of healthcare revenue from patients continues to grow, it is essential to maximize patient engagement. Providing effective, focused, patient-friendly communication and delivering that communication in a manner that will solicit prompt and proactive attention helps improve patient satisfaction. Offering multiple mechanisms for payment provides patients the convenience of paying any time during the day or night in their preferred method.

In Summary

Re-engineering revenue cycle staff interactions to address self-pay obligations with patients early in the care process along with providing effective patient communication can serve to not only improve the patient experience but to also improve the bottom line through increased self-pay collections.

Author information:

Name:                                  Laurie Shoaf, CRCE

Member Affiliation:              Carolina Chapter

Company:                           CCI

Position:                              Chief Operations Officer

Phone:                                 336-761-1524 ext. 1250

Email address:                   [email protected]