Patient Access Monthly Journal
Source: The Academy of Healthcare Revenue

Patient Access Benchmarks: Point of Service Collections

In the past four issues of PAM, The Academy has discussed the importance of utilizing effective benchmarking data in patient access.  As revenue cycle processes traditionally associated with the business office continue to move further upstream in the revenue cycle, patient access leaders will need access to pertinent benchmarking metrics that they can use to measure performance and identify opportunities for improvement.  Previously, we illustrated several of the benchmarking metrics currently being utilized by some best-performing providers to measure and optimize pre-registration, registration, and insurance verification processes.  In this final segment of our patient access benchmarking series, we will illustrate benchmarking metrics that providers are utilizing to effectively measure their point of service collections. 

Implementing a point of service collections culture has become even more important as patients’ out-of-pocket financial responsibilities—in the form of increased co-pays, deductibles, and co-insurance—grow, thus increasing the total amount of self-pay dollars that providers must collect.  Self-pay receivables are typically the most difficult to collect in a timely manner, especially after patients’ discharge, as patients tend to view medical debt as a last priority behind mortgage, vehicle, and credit card payments.  By optimizing patient access processes for verifying patients’ insurance benefit information and estimating patients’ balances, patient access staff are better able to inform patients of their out-of-pocket financial responsibilities before service and request payments. 

According to Academy surveys, more than two-thirds of providers request payments from scheduled patients at or prior to service.  For non-scheduled patients, slightly less than two-thirds of providers request payments from patients upfront, as the graphs below illustrate.

Since more providers are implementing point of service collections policies at their facilities, revenue cycle leaders are developing metrics to measure the performance of their point of service collections efforts.  Some providers track the average dollars collected per patient at point of service, tracking ED and non-ED collections separately.  Although this metric can be valuable for making internal comparisons, it can be a difficult benchmark to utilize for comparing performance with other facilities, since the average dollars collected per patient can vary from facility to facility based on a number of factors.  Furthermore, tracking the average dollars collected per patient can also vary from inpatient departments to outpatient settings, as the total dollars requested for inpatient services tend to be much higher (often the difference between deductibles and co-pays). 

Another benchmarking metric that some providers are utilizing is point of service collections vs. total potential collections.  As an example of how to calculate this metric, consider the following scenario.  If a scheduled patient has a $2,000 deductible and a patient access staff member is able to collect $400 upfront, this means that 20 percent of the potential was collected at point of service.  Some providers may not have the systems necessary to track this data automatically.  If providers use a manual system, they can compare the amount collected at point of service to patients’ final bills.  However, it is important to recognize that patients’ final bills may not reflect the initial out-of-pocket balances verified by staff members at point of service, as staff members may not be able to estimate final balances upfront based on co-insurance and historical service costs.

Point of service collections as a percentage of total patient cash collections is a similar metric that is being utilized by providers to track front-end collections.  The following graph shows the national average of point of service collections performance of providers surveyed by The Academy.

Leaders who desire to utilize these benchmarking metrics should carefully assess the tracking capabilities of their patient access departments and devise a calculation methodology that will best reflect upfront collection performance.  For example, leaders will need to determine whether to include co-insurance amounts when calculating potential upfront collections.  As more facilities adopt the metric to track point of service collections vs. potential, providers will be able to more accurately assess their upfront collections performance compared to peer facilities. 

The Academy of Healthcare Revenue
The Academy of Healthcare Revenue is a membership-based community that provides healthcare leaders with objective research focused specifically on the healthcare revenue cycle. Members receive an unlimited supply of all research--including benchmarking and best practice reports, implementation tools, monthly journals, attendance to virtual conferences, and more--designed to enable them to improve their revenue cycle processes and financial health from within. Furthermore, The Academy's membership offering is tailored to team members throughout the revenue cycle, from executive leadership to patient access, coding, billing and collections, and clinical staff, helping to drive process improvement efforts revenue cycle-wide. Patient Access Monthly is one of four journals written by The Academy of Healthcare Revenue monthly.

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