艾米, 一名30岁的健康女性, suddenly developed a mysterious illness that required extensive medical testing and forced her to go on short-term disability leave, 减少她的收入. 在她康复的六个月里, 她欠了好几千美元的医药费. 虽然有私人健康保险, 艾米无法应付在她的高免赔额健康计划(HDHP)下产生的费用。, 她的账单变成了收藏品. 不幸的是, at no point during her journey was 艾米 introduced to a financial counselor who could provide guidance or help her understand available options for her specific situation.

艾米的情况并不罕见. 在过去的几年里, 注册倾向于hdhp和增加员工成本分担. 的 疾控中心的年度全国健康访谈调查 发现65岁以下拥有私人保险的人参加HDHPs的人数从25人增加了.从2010年的3%到2018年的47%. 然而, 消费者, 现在预计将承担更多的成本负担, 还没有适应这些变化吗. A major contributor to this problem is the fact that 消费者 generally lack the tools and/or knowledge to make informed decisions about their healthcare and do not fully understand the ramifications of their choices as they relate to personal finances, 给他们留下了他们无法负担的医疗账单. 全球支付公司最近的一项研究 TSYS 研究发现,2016年约68%的患者未能支付医疗保险账单, 高于2014年的49%. 进一步, the survey found that 37% of Americans said they would be unable to pay for an unexpected medical bill of $100 or more without going into debt.

这种趋势会影响组织收入周期操作的运行状况 , 特别是关于坏账水平和病人应付余额的收取, 以及病人的经济状况. So how do healthcare organizations successfully navigate these realities and continue to provide high-quality care to the communities they serve while establishing a system that increases self-pay collections and reduces bad debt at a reasonable cost?

许多组织求助于 技术 或第三方供应商补充其内部资源或完全外包. 这些策略取得了不同程度的成功. 而技术和外包可以提供交钥匙解决方案, organizations must also 评估 their overall 方法 to self-pay collections from the perspective of the patient. Transitioning from post-service debt collectors to patient advocates can help build meaningful and lasting relationships with patients as they navigate the complex healthcare reimbursement landscape.


Establishing a culture of patient advocacy is a journey that takes thorough planning and organization-wide dedication to a 成规 方法. 它不仅需要对内部工作人员进行再培训,还需要对患者群体进行再教育. It is also important to note that patient advocacy is not a “one size fits all” 方法; it requires a deep understanding of the community to ensure the 方法 is tailored to be most effective for the people involved. 为你的病人做一个更好的财务倡导者, 你可以做三件事, 如下面.


Healthcare organizations should aim to establish a financial clearance model that communicates proactively with patients ahead of their scheduled services. 的 goal of the proactive financial clearance model is to ensure there is a mutual understanding of financial responsibilities between the patient and the healthcare organization and to assist patients with evaluating options and/or securing assistance in the event of a financial hardship.


  • Ensure patients understand their eligibility and benefit levels as communicated by their insurance plans.
  • 获得授权和/或预认证.
  • 为患者提供基于计划指南的自付费用估算.
  • Provide patients with an option to prepay (for scheduled testing, imaging, procedural services, etc.).
  • 沟通对云顶集团时间付款的期望(共同付款、过去余额等).).
  • 提供财务困难时可用资源的信息.

另外, a proactive financial clearance model allows for organizations to collect patient balances at a reduced cost, as it may limit the volume of statements and follow-up activities required after service by taking advantage of multiple patient contacts prior to service (see figure 1). 各组织投入大量资源来收集病人应得的余额, 但大多数公司倾向于将精力集中在裁决后的程序上, 哪些是组织需要收取的最高费用.


自费后续活动往往支离破碎, with tasks assigned to staff who do not have a complete understanding of the resources available to patients in the event of financial hardship. This can create confusion for the patient and result in an unnecessary referral of the outstanding balance(s) to a bad debt collections agency. 创建一个PFA角色,为坏账提供了另一层保护, 随着这些工作人员成为所有可用资源的组织主题专家, 包括但不限于:

  • 付款计划.
  • 医疗补助资格.
  • 组织慈善关怀.
  • 授予资格.
  • 可用的豁免程序.
  • 医疗融资公司.

的 goal of the PFA role is to create a one-stop shop for patients experiencing financial hardship and ensure that all available options have been exhausted prior to a bad debt referral.


Taking these three proactive steps will not reduce bad debt overnight; however, 将它们嵌入组织结构将会, 随着时间的推移, 将追求债务的文化转变为耐心的倡导. Improving patient relationships does not address the growing cost and income divides associated with health plans, but it conditions the patient and the organization to take a more proactive role in understanding the cost implications of care.

Learn more about ECG’s capabilities to help reduce bad debt and optimize revenue cycle operations by reading the Memorial Health System case study.