We have all been patients at one time.  Watching over the revenue cycle gives us a unique perspective on how billing processes affect the Patient Experience.   I have been a patient at different hospitals, triaged in Emergency Rooms, seen by the NP when I was really sick, and have sat in waiting rooms like everyone else.  Each time I needed medical service I felt lucky that the care I was receiving was top notch.  I felt reassured by the providers and their staff that I was in good hands.

What separated the good experiences from the bad was how I was handled from an administrative perspective; more specifically how the billing was handled.

Walking into my PCP’s office feels like walking into some building operated by the CIA.   When I arrive, automatic doors whoosh me into the building.   A velvet rope ushers me to a hand sanitizer station where a sign reads, “Please have your insurance information and photo ID ready when you arrive at the scheduling desk”.    Just beyond that there are 3 to 4 front desk staff sitting behind glass like you would see at a bank.   Each station has a privacy partition.  When I am called up I am quietly asked for my insurance information and photo ID.

The scheduler confirms the name of the Doctor I am scheduled to see and asks me to verify some other personal information she has on file.   She asks for a moment to check my insurance eligibility.   After a moment or two of prodding around in her computer, the printer in the back starts to rumble and she grabs the print-outs.  She returns to tell me that I have a $25 copay for the visit and asks me how I would like to pay (not if I would like to pay).     She swipes my debit card for me, prints a receipt and a routing form.  With a sympathetic smile asks me to take the elevator to the second floor to my Doctor’s suite.

When I arrive upstairs, it is only 10 feet from the exit of the elevator to the next “guard”.  When I get to the window the scheduler behind the glass simply reaches out her hand for the routing form I am holding.  “Thank you” she says, “Have a seat we will call you in a moment or two”.   As I sit waiting I notice how empty the waiting room is.   There is only one other person sitting there with seating for at least 20.    Before I get a chance to check the score of the Red Sox game on my smartphone, a nurse opens a door and quietly says “Jeffrey?”  She’s looking right at me and the other person in the waiting room is a woman, so I am pretty sure she means me.

I wait a little longer in the exam room after I am weighed, meet with my Physician for my check-up and am on my way.  As I am leaving I ask where I check out and am told “you don’t need to, have a nice day”.   A week later I get a survey from them, and that is it.

Mission accomplished.

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Last summer I was vacationing at the beach and woke up with one of my eyes swollen shut.  Needless to say I wasn’t really happy about it so my wife took me to the urgent care center down at the end of the beach road.   It was a small building with a normal door.  I walked in the front door and the place was packed with vacationers who were having their week ruined by some injury, allergic reaction or other ailment.

I found my way to the front desk where a woman was seated behind a monitor.  I stood there for a few moments until she looked up at me and handed me a clipboard with a series of forms.   “Have a seat and fill these out”, she asked.     I filled out the forms and went back to the front desk.   She took a copy of my insurance card (which lists my co-pay on the back). “You can have a seat” the woman said, “Doctor will see you in a minute”.   I asked her about my co-pay.  “Don’t worry about it, we’ll just bill you” she replied.  I offered to pay again and was told to just sit and wait.    So I did.

Eventually it was my turn and a woman emerged from the back bellowing “Jeff Di, Di… Dilidiolodio? Swollen Eye?”   Thanks for broadcasting that, I thought as got up from my chair.  The Nurse Practioner kindly washed some sand out from under my eyelid and said I would be good as new in a day.

A month or two later I started to get bills in the mail from them.   Turns out their claims got denied.  Despite having copied my insurance card and my filling out their form, they sent out the wrong number and then transferred the balance to me when it wasn’t paid.  This was almost as annoying as the sand in my eye.  I called the office to help get them the right insurance information, they agreed to resubmit the claim, and they went silent again.  Sometime later I got a bill for my co-pay.  There was an interest charge on it dating back to when they originally transferred the balance to me the first time.  For some reason that was never removed once they got their claim paid.  Figures.   I called to protest, sitting on hold for quite some time before someone got it straightened out.

Mission… sort of accomplished

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Two different visits and what set them apart was the annoyance of dealing with billing issues after the fact.   My PCP’s office takes a little bit more work to get into, and some of the process feels very “sterile” but in the end it makes the experience better for me.  I go in, I know what to expect, I get top notch care, and then I leave.  There isn’t this belly ache after the fact and they don’t have to put with me calling them back about two separate invoices.

Comparing an urgent care setting in a seasonal vacation spot to my PCP’s office might not be a totally fair comparison, but it highlights the process differences.   My PCP’s office makes it clear to me where I need to go and what information they need from me to get bills out correctly the first time and then they double check the info I gave them.   I know when I go there that the billing office is in good order so I can just worry about my visit.  Sure, they ask more of me, but I would prefer to handle it then rather than having to sit on hold later on.

Billing process controls (like checking a patient’s eligibility while they are in the office) make it easier on all of us, but it has to start when the patient walks in the door.