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  • Matt Kiefer

The Shifting Tides of Healthcare Finance


Matt Kiefer has spent two decades helping patients with their medical bills, on both sides of the transaction. Kiefer started as a registration rep in the emergency department, and later as a financial counselor and legal coordinator within the Patient Financial Services department at Florida Hospital (rebranded as AdventHealth in 2019). He has since moved on to become the Chief Officer of Information, Compliance & Development for Preferred Collection and Management Services, a 35-year healthcare collection agency based in Tampa, Florida.

Kiefer has noticed a shift in recent years, as healthcare providers are focusing more time and resources on patient collections upfront than in years past. Years ago, insurance reimbursement was the highest priority, but the amount that providers are receiving from insurance companies is decreasing since the inception of the highly-favored “High Deductible Healthcare plan” that many employers offer today.

“The focus used to be on ensuring that the insurance information was correct and billable and all requirements necessary by the insurance were met to obtain reimbursement such as precertification or notification of an ER visit,” Kiefer said. “Today, the patient responsibility portion for medical care has greatly increased so the focus is on obtaining both accurate insurance and patient demographic information

and collecting the copay or deductible before service, when permitted, while trying to do so as quickly and efficiently as possible.” 

What has also changed, Kiefer noted, is the expectation of how much is going to be collected from a patient once he or she leaves the hospital, especially when a patient presents in an ER.

“Years ago, there was very little expectation, from the patient’s point-of-view, to pay before services were rendered even when they were asked for payment,” he said. “This was especially true in the ER as a result of the Emergency Medical Treatment and Labor Act (EMTALA) which guarantees treatment in the ER regardless of a patient’s ability to pay.”

Patient responsibility was left to a series of statements sent by mail on a cycle of every 30 days and eventually wound up with the hospital’s then-owned collections agency. Having risen to the point of leading that agency before it was sold to an outside company, Kiefer noted that what was missing on the front end of the revenue cycle — and still is true today in many regards — is an expectation of payment when a financial services rep is dealing directly with the patient. Kiefer added, “Many times, the representative, who makes a relatively small hourly wage, puts themselves in the financial shoes of the patient and projects what he or she could pay instead of asking for and expecting payment in full for the copay or deductible or securing a payment plan at the least.” Kiefer states that this sets the negotiation off on the wrong foot and can lead to higher amounts that need to be collected later on in the revenue cycle.

That interaction is changing, but not quickly enough. This is especially true for an industry that is now losing money hand over fist as it grapples with a global pandemic and revenue loss as a result of fewer hospital visits and procedures as a result of fear which is driven by the media. People are delaying care and needed procedures because they are simply afraid to go. When and if they do show up they are in a higher state of acuity of care needed.

When this nation gets back to some sense of normalcy and patients get the care they need and on time, point-of-service collections can save hospitals a ton of time and money and should be an emphasis from here on out for PFS reps and financial counselors. Talk to a collection agency today about how to structure the conversations your employees are having with patients to help them collect more early in the revenue cycle process. Preferred Collection and Management Services (d/b/a The Preferred Group of Tampa) also offers early-out services to assist providers with collection services that that lack the resources to collect after the point of service but before the account goes to bad debt. Preferred third division, Preferred Impact, offers training and consulting for its clients that desire it.

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