Tagged in healthcare


How Busy Healthcare Call Centers Benefit from Customer Service Outsourcing

July 12, 2018


Influenced by the high-touch, high-quality customer service they receive in retail, today’s healthcare members expect prompt results and top-notch customer service. Since healthcare is a major expense for families, members expect even higher rates of service and hassle-free support. Properly meeting these expectations requires expertise and investments of time and money, so many healthcare call centers are turning to customer service outsourcing, reaping the benefits of knowledge and readily-available resources.

  1. Manage volume spikes for increased member satisfaction

There are countless call center factors that impact member satisfaction. At the top of the list are hold times, accuracy of information, IVR/call routing effectiveness, and handle time to answer basic questions. Open enrollment is a good example. It’s a stressful time for members, particularly those new to healthcare. It’s also a member’s first impression of your company and sets the expectation for future interactions. Customer service outsourcing during open enrollment can help you utilize additional subject matter experts in the short-term to help with this spike in call volume, keeping members happy and looking forward to their relationship with you.

  1. Increased flexibility for internal staff

Outsourcing part of your customer service, particularly for FAQs and low-tier questions like in-network PCP options, frees up your more experienced staff to handle members with complicated concerns. Segmenting your front-line provides more flexibility in scheduling and handle time. It allows your lower tier calls to get answered quickly while also giving your staff the time to properly address less frequent though more nuanced and complicated calls.

  1. Improved outbound communication

Most healthcare companies offer exclusive member benefits like gym reimbursement, telehealth vendors, and even online wellness portals. These benefits can help shape a healthier member pool, which can help reduce healthcare payouts over time. They’re also great topics for outbound communications to your members to get them enrolled in these programs and to provide updates about new features or policies. This “extra-mile” effort can make a difference in retaining members and in increasing awareness for the benefits that set you apart from your competitors. Plus, if you’re involved with Medicare, it can help increase your star rating.

  1. Reduce stress related to temporary employees

Recruiting, hiring, and training temporary healthcare call center employees can take up a lot of your HR and management teams’ time. Customer service outsourcing vendors are experts in finding agents with the skill set and industry experience you need. They’re used to the ebbs and flows of the call center environment and already have pools of qualified applicants they can pick from to create achieve service results through the right staffing configuration for your anticipated call volume and call complexity.

  1. They’re subject matter experts

A good outsourcing vendor does more than just staff your phone lines. They provide insights on how to improve your call handling and escalation processes, revamp scripts for more productive communication, update your customer service handbook, and deliver cost-effective, reliable technology your members crave.

Customer service outsourcing can provide the extra help you need to connect with your members in meaningful, effective ways. Members who feel valued and respected by their healthcare companies are more apt to select your plans in the future, take advantage of preventative programs and other member benefits, recommend you to their friends and family, and are more willing to build that all-important and hard-earned trust that’s so critical to healthcare decisions and member lifetime value.


Featured Image: Shutterstock/ideyweb

NOPLG Recap: ACA Changes a Top Concern for Healthcare Payers

April 30, 2018


April once again brought Windham to the National Other Party Liability Group (NOPLG) Conference, hosted in sunny Scottsdale, AZ. A top concern among healthcare payer leaders this year was, of course, the impact of big changes to the Affordable Care Act (ACA) made late last year. Though payers braced themselves over the winter for the changes, now with 2018 fully underway and a clearer picture of actual impact available, payers are assessing what other changes they need to make, specifically in preparation for open enrollment later this year. Legislative changes to ACA are set to impact payers in four major ways:

  1. Raised premiums

Citing desire to give subscribers more choices when selecting health plans, the individual mandate and cost-sharing reductions (also known as subsidy payments) were stricken from the ACA in 2017. These subsidies were one of the ways payers were able to offset the costs of required discounts offered to moderate-income subscribers. Though the subsidies are gone, the discounts must continue to be offered.

With the ACA’s individual mandate repealed under last December’s passed tax bill, starting in 2019, individuals will no longer face a tax penalty if they don’t enroll. A rising fear is that healthier people will opt not to enroll in healthcare plans leading to destabilized risk pools.

Payers must now determine what the best course of action is for them to reduce losses associated with these changes. Increasing premiums is an obvious and likely option. Premiums could increase as much as 30%.  Some may also weigh whether it’s more advantageous to drop their individual health plan offerings from state exchanges where poverty levels (and healthcare discounts) are highest. However, this can increase financial strain on the remaining payers, forcing them to raise premiums or also drop out of the exchange. This could leave some states without any options for individual plans–particularly those states with higher poverty and unemployment or underemployment rates.

  1. Short-term coverage acting as long-term coverage

The executive order signed by President Trump last October, in part, increases the length of time association health plans (AHPs) can cover individuals. Once structured as short-term coverage, the executive order allows AHPs to be bought and used as a long-term alternative to regular health plans. It also allows for individuals to pay for AHP coverage with health reimbursement agreements like HSAs.

Like with the repeal of the individual mandate, this provision could destabilize individual market insurance by unbalancing risk pools as healthier people are more tempted by AHPs because of their lower costs and they don’t necessarily need essential health benefits (EHBs) that less healthy subscribers do.

  1. Medicare reimbursement obstacles rise

Though not directly tied to the changes the ACA saw last year, the changes have increased challenges for Medicare payments and reimbursements, putting additional strain on payers and consumers alike. Overcoming these obstacles begins with better Medicare screening and educating patients on the benefits of supplemental insurance. It also requires providers to be more in sync with payers’ goals by facilitating more sustainable and accurate appointment registration to collect essential bill and payment processing information while also committing to timelier patient follow up.

  1. Increased subscriber confusion and questions

Many subscribers still don’t fully understand what these changes mean for them and their families until they receive an estimate for service or a bill. That can translate to more calls to customer service, especially as open enrollment approaches. Picking an outsourcing vendor who stays up-to-date on these kinds of legislative changes can make all the difference in explaining coverage and costs to existing and potential subscribers to ensure they’re selecting the most appropriate health plans for their needs.

While these changes aim to increase competitiveness and to give people who buy their own insurance more options to choose from, some of them are forcing payers to reevaluate costs and plan coverage in order to remain profitable. Still, more changes are expected throughout the year as spending bills and budgets are reviewed, so it’s become essential for payers to monitor impact on subscribers and to find better ways of educating them on the changes.


Featured Image: Shutterstock/GoodStudio

7 Tips for More Effective Self-Pay Payments Management

April 13, 2018


As healthcare costs rise, more patients are shouldering increased self-pay responsibility, including higher deductibles, premiums, and copays. This rise in the number of self-pay payments has become a major concern for providers and physicians as self-pay patients default at a rate of 30% or more. Optimizing your revenue cycle management to include a more strategic, proactive focus on addressing self-pay payments can help reduce your overall bad debt and reduce costs associated with collections or write offs. Here’s seven tips to get you started:

  1. Focus on pre-service initiatives

Pre-service is the easiest and most cost-effective time to collect patient information and identify alternative payment sources. Always verify patient information upon check-in. Even if information was verified when scheduling the appointment, patient information changes rapidly. Without the proper information in your system, payment follow-up becomes much more difficult and costly to manage.

Asking the right questions in the pre-registration process can help you screen for patients eligible for charity care, which many patients don’t know about. Investments in eligibility verification can help further identify insurance coverage like Medicaid and Medicare that patients may not be aware they qualify for, reducing their self-pay balance.

  1. Revisit your patient communications

Revising your patient communications—both service and bill reminders—so they’re easier for patients to understand the charges and when payment is due can increase the likelihood of payment. Keep in mind: there have been nearly 20 million people newly insured since 2010. Many of these have had limited access to healthcare previously, so they’re unfamiliar with the terminology and payment process. 

  1. Consider billing and payment consolidation

When applicable for their facility, more providers are offering consolidated bills that capture services performed by the lab, the physician, and the hospital on one statement. Giving all service and payment info at once increases understanding of what’s owed and makes repayment easier for patients and their families to track and budget for.

  1. Take a page from the retail industry

Retailers are highly consumer-focused, bringing in technologies and processes that consumers crave and appreciate. Healthcare providers can do the same. Accepting online payments makes repayment more convenient than trying to find their checkbook and a stamp. Giving patients online portals where they can access all their lab, physician, and hospital records—as well as their statements and payment history—in one place can make the self-pay patient feel more empowered. 

  1. Make pre-service estimates a priority

Nine in ten consumers want to know payment responsibility upfront. Medical costs can often surprise patients, especially as costs to serve and insurance eligibility fluctuates. To bolster the effectiveness, you can also offer the patient a payment schedule in advance with the estimate. When they know what they’ll be expected to pay and when, the patient can plan ahead and ensure they have the proper funds available when the bill comes due.

  1. Look into service deposits

If you make the switch to pre-service estimates, you may also want to consider a deposit program. Requiring a 25-50% deposit before point-of-service encourages patients to keep their appointments and lessens the repayment burden afterwards. It can also help offset the financial strain your practice feels when 100% of the bill goes unpaid.

  1. Send past due accounts to collections

Recovering self-pay balances without tarnishing the patient relationship requires specific expertise most billing departments don’t have. Collection agencies are trained to identify alternative sources for payment and can dedicate the time to educating the patient on their bill, increasing the likelihood of payment to your facility next time. By outsourcing self-pay collections early (0-90 days), the collection agency can reach out to the patient in your name (commonly called first-party recovery) for a soft-touch collections call.

Managing your self-pay payments boils down to better communication and more proactive engagement with your patients. The easier you can make the repayment process and the clearer you can be when notifying patients of services and costs will help increase the likelihood of on-time repayment.