Adapting Patient-Friendly Medical Billing to a COVID-19 World

Patient friendly Medical Billing

Monument Health in South Dakota is adapting to a new definition of patient-friendly medical billing as COVID-19 transforms patient needs and their ability pay for healthcare.

Patient financial responsibility has been impacting the hospital revenue cycle far before the world knew what COVID-19 was. But the unprecedented public health crisis has shed new light on patient-friendly medical billing.

“My team has reported that they’re starting to see a shift brought on by the fact that a lot of patients are at home, spending time on their computers,” said Stacie French, manager of patient access at Monument Health, a five-hospital system headquartered in Rapid City, South Dakota. “They’re able to do research, look at our estimate tool, calculate payments, and generally figure out the types of things that they used to not spend a lot of time doing.”

Prior to the COVID-19 crisis, Monument Health’s revenue cycle had seen increased demand for price transparency, payment plans, and other patient-friendly medical billing options. However, inquiries skyrocketed as the pandemic turned into a financial disaster.

Calls related to financial assistance jumped between 30 and 40 percent during the crisis, Monument Health’s Ted Syverson reported.

“While our volumes in the clinical sense have gone down in some areas by as much as 60 to 70 percent, our questions have really increased,” the vice president of revenue cycle stated. “Very fortunately for us, most of the workers that we furloughed were not patient financial advocates, so we still have availability to take and process those calls.”

Like many healthcare organizations across the country, Monument Health has had to furlough staff due to the financial challenges stemming from the public health crisis. And like many organizations, administrative positions like those in the revenue cycle have been significantly impacted.

But the health system is pressing on and doing so successfully by adapting and ramping up collection strategies to align with the new definition of patient-friendly medical billing during a crisis.


The COVID-19 crisis has disrupted the country, resulting in the highest unemployment rate observed in the last decade. As more people file for unemployment, healthcare organizations are fielding more questions about how patients can access and pay for care without employer-sponsored coverage.

Monument Health has responded to the current climate by reevaluating the organization’s financial policies.

“One of the things that we’ve done recently and put a lot of effort into is reevaluating our uninsured discount policy, as well as our charity care and sliding fee scale,” Syverson said. “We are making sure that those are complementary to the financial conditions that patients can encounter, and that people across our organization have better general understanding of the impact of those and their availability.”

To ensure all patients knew of their financial assistance options, especially during the crisis, Monument Health leaned on its patient financial education and training.

The health system has been focusing on preregistration improvements for over a year to maximize collections and implement patient-friendly billing options. A critical part of those efforts was training frontline staff about financial assistance policies and patient financial responsibility in general.

“What’s important about the changes that we were looking at and started to implement is utilizing our frontline staff more as advocates and helping them gain a full understanding of the full spectrum of wellness,” explained French. “So, we’re not just looking at treatments and balancing what’s going to be out of pocket. What we’re doing is trying to educate our staff, so that they fully understand coinsurance, deductibles, out-of-pocket costs, and all of the costs associated with related treatment plans.”

French also stressed the importance of soft skills to her revenue cycle team. As important as cost estimates and treatment plan prices are to patients, being able to ask financial questions in an appropriate manner is essential to engaging patients with their financial experience and understanding what else is impacting their clinical and financial health outside of the hospital’s purview.

“The big thing is learning how to ask the right questions,” French said.

Scripting has played a large part in how Monument Health engages patients with the financial aspect of healthcare, but in light of the pandemic, so has educating providers.

“It’s more important at this time for people like physicians, nurses, and APPs to have some degree of understanding and act on their sensitivity to help align patients with advocates,” Syverson elaborated. “We’ve spent more time developing educational resources, but it really started with looking at what those policies were.”

“I would strongly encourage people to put that at the forefront of consideration right now.”


As frontline workers and providers gained more insight into their patients’ financial situations, Monument Health learned that engaging the community around them was the key to helping patients pay their medical bills, especially during a crisis.

“There’s a mind shift and a market shift that’s occurring, and we’re trying to evolve to that standard,” Syverson stated. “Financial wellness is not always taken care of at a bank anymore. It has to be taken care of at a healthcare system level and through a community channel.”

Even before the first case of COVID-19 hit the US, Monument Health has been partnering with local financial institutions to offer additional ways for patients to pay, including zero-interest payment plans. And these efforts have really expanded the health system’s patient-friendly billing options, which used to be limited to one type of payment plan.

Now, Monument Health can offer patients a variety of payment plans through local banks and help them navigate those options to identify the best plan for them and their families, French stated. The relationships the health system has forged with local institutions are also proving especially useful for adapting to the changes brought on by COVID-19.

“We jumped outside of the four walls of our organization and looked to our community to find out the different things that are available to help during this time. We also engaged partners that we’ve had before that have been able to gain grants and different types of funding,” French said.

Leveraging existing partnerships, Monument Health has been able to find resources to alleviate not just financial concerns related to healthcare, but also social determinants of health that are being stressed during the crisis, like housing and food insecurity.

With these partnerships, the health system has redefined patient-friendly billing to fit the current climate.

Monument Health, for example, has worked with its local collection agency to improve how their staff talks to patients about needing assistance with existing payment plans. Together, the organizations created a script that asks more questions about the patient’s overall financial welfare and does so in a more compassionate way.

Similarly, the health system is leveraging its other vendor relationships to implement a community-based approach to patient-friendly medical billing during a crisis. Syverson used the vendor management partner Healthfuse to identify opportunities to use technology, flexibility, and other strengths of vendor partners to better assist patients at this time.

“If those vendor partnerships are not healthy and they’re not effective, then that makes our furloughed status even more detrimental to patient care and our ability to provide financial advocacy for patients. It’s really highlighted the need to have those technologies and partnerships in place,” Syverson stated.

COVID-19 hit the US fast and has continued to wreak havoc on virtually every aspect of daily life, including the ability to pay for healthcare. The novel coronavirus will have lasting implications on patient collections and medical billing, long after researchers develop a vaccine.

Engaging the community and vendors, as well as those within the health system, will be key to weathering the storm and adapting to a new definition of patient-friendly medical billing in a post-coronavirus world.

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