Don’t let print and mail become the last bottleneck in your patient billing cycle.

The pressure you’re under

The claim has been adjudicated. Patient responsibility has been calculated. The account is ready to move forward.

But the statement is still waiting to be printed.

For revenue-cycle and Patient Financial Services teams, that seemingly mundane production delay matters. A patient cannot act on a statement that hasn't reached them, and month-end runs, staffing shortages, multiple facilities and competing print jobs can turn the last mile of patient billing into an unexpected bottleneck.

The stakes go beyond cash flow.

Patient communications can contain protected health information, bringing HIPAA privacy and security considerations into the workflow. Organizations using service providers that create, receive, maintain or transmit PHI on their behalf generally need appropriate business associate arrangements and safeguards.

Source: HHS HIPAA business associate guidance

Tax-exempt hospital organizations also operate under IRC Section 501(r). Among other requirements, hospital facilities must maintain Financial Assistance Policies and make reasonable efforts to determine FAP eligibility before engaging in certain extraordinary collection actions.

Source: IRS Section 501(r) financial assistance requirements

So when patient financial communications slow down, the consequences can extend well beyond the mailroom.

There are three ways to reduce this risk, depending on where you are today.

1.Business continuity: protecting the last mile of the revenue cycle

Consider what happens if your production facility suddenly cannot operate.

An equipment failure delays a statement run. Severe weather closes a centralized business office. A cyber incident interrupts systems. A staffing shortage leaves too few operators available to complete production.

Meanwhile, patient statements, balance-due notices, payment-plan correspondence and other financial communications continue accumulating.

For healthcare organizations, business continuity should therefore extend beyond core clinical and IT systems to the communications patients rely on after care has been delivered.

A continuity arrangement gives the organization another production path.

Rather than trying to establish an emergency vendor relationship after a disruption occurs, files, templates, security requirements and operating procedures can be prepared in advance. When predetermined conditions are met, affected jobs can move to alternate production capacity.

That means asking practical questions before an event: Which patient communications receive priority? How will files be transferred securely? How quickly can alternate production begin? How will PHI be protected? How will the organization confirm what was produced and mailed?

This approach is ideal for health systems that have a capable centralized business office or internal print operation and want to keep it.

You're not outsourcing the revenue cycle. You're making sure one failed printer, facility or staffing model can't stop its communications.

Related reading: What true business continuity looks like

2. Hybrid onsite/offsite: building for the normal month, not the worst one

Healthcare billing has a capacity problem familiar to many industries but amplified by complex revenue-cycle workflows: volume isn't constant.

Month-end statement runs, changes in patient responsibility, acquisitions, system conversions, multiple hospitals and practices, financial-assistance communications and unexpected backlogs can all create peaks.

Do not let print and mail become the last bottleneck in the revenue cycle.

One answer is to size equipment and staffing for the largest possible run. But then the organization pays for peak capacity even when it doesn't need it.

A hybrid approach separates core capacity from peak capacity.

Routine volume continues through your existing operation. When a statement cycle exceeds a predetermined threshold, or when a particular facility, job type or special communication creates additional demand, that work can move to an external production environment.

The arrangement can be temporary, recurring or job-specific.

Related reading: Explore flexible print and mail production

Healthcare organizations should pay particular attention to the handoff. If the provider's services involve access to PHI in a manner that makes it a HIPAA business associate, appropriate agreements and safeguards are required. HHS guidance makes clear that business associates may be directly responsible for certain HIPAA obligations as well.

Source: HHS HIPAA business associate responsibilities

Security, therefore, can't be an afterthought added after a production partner is selected. It needs to be part of the production design.

3. Full outsourcing: taking production out of the revenue-cycle workload

Revenue-cycle leaders have plenty to manage without becoming experts in printers and inserters.

Under a fully outsourced model, the healthcare organization continues to determine what should be communicated and when. Patient and billing data is securely transmitted through an established workflow, while the provider handles physical production.

The result is a different operating model: data in; finished and trackable patient communications out.

That can reduce internal responsibility for production equipment, maintenance, staffing, supplies, floor space and peak-capacity planning.

It can also create a more standardized process across hospitals, practices and centralized business offices.

For patient financial communications containing PHI, security and governance remain critical. Organizations should determine whether prospective providers will function as business associates, understand how PHI is handled throughout the workflow, and put appropriate contractual protections in place.

For nonprofit hospitals, the workflow also needs to accommodate the organization's FAP and billing-and-collection processes. Section 501(r) requires reasonable efforts to determine financial-assistance eligibility before specified extraordinary collection actions.

Source: IRS Section 501(r)(6)

Outsourcing production doesn't outsource those responsibilities.

What it can outsource is the machinery and labor required to turn an approved patient communication into physical mail.

Is print helping, or slowing, your revenue cycle?

What to look for in a partner

For healthcare, security belongs near the top of the evaluation. Verify the provider's security posture and relevant certifications, and determine whether the relationship requires a Business Associate Agreement. Understand how PHI is transferred, processed, retained and accessed; how subcontractors are governed; and how incidents are handled.

Then evaluate production fundamentals: available capacity, turnaround commitments, redundancy, quality controls, reporting, document and template control, and experience with patient financial communications.

For nonprofit hospitals, make sure the production workflow can support your organization's approved FAP communications and billing-and-collections processes rather than forcing those processes to fit the vendor.

Finally, test the reporting. Don't settle for "the job was completed." Ask what you can see at the job and mailpiece level, how records can be retrieved, and how quickly your team can investigate an exception.

The goal isn't simply cheaper mail. It's a patient financial communications operation that can keep pace with the revenue cycle instead of becoming its final bottleneck.

Related reading: Explore customer success stories