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Rene Siegel dreaded trips to her mailbox. Her aging father required hospitalization on an annual basis at Cedars-Sinai Medical Center in Los Angeles. And while the clinical outcomes were generally positive, the same could not be said of the billing experience.

Each time one of the familiar white envelopes appeared, the anxiety of having her father in the hospital was replaced with annoyance at having to decipher a confusing or duplicative statement.

Siegel had difficulty understanding the source of the charges, determining what the insurance company would pay or had paid, and identifying exactly which portion of payment was her responsibility. Only after calls to hospital staff could she find the answers.

Unfortunately, Siegel's situation wasn't that unusual. Many patients and their family members were calling the hospital with questions. They were not paying their share as fast as Cedars-Sinai would have liked. And frequently, the high satisfaction that patients associated with the hospital based on their clinical experience was replaced by frustration at later dealing with the billing department.

Faced with these challenges, Cedars Sinai decided to overhaul its billing system in January 2002. Staff researched ways to adapt internal processes and technology to provide patients with enhanced timing and content of communications. Within six months of implementing its patient-focused billing program, the provider saw call volumes drop by 31 percent, improvements in patient feedback, and a significant savings in postage for billing communications.

Time for a Bill Fold?

Looking back, Cedars-Sinai can identify several catalysts for implementing the billing system change. Most pronounced were poor timing of communications, vague or incomplete messages regarding patient payment responsibility, and mailing inefficiencies.

Poor timing. Cedars-Sinai would send the patient a generic letter stating that the insurance company had been billed. The patient would then be sent a separate bill. Also, the system generated a separate bill for every month the patient had a visit. Thus, Cedars-Sinai often had to send out several statements to a patient, which confused patients and resulted in high postage. Some patients requested detailed itemizations on their bills, but these detailed itemizations tended to be too lengthy--frequently as many as 12 pages--and very hard for patients to understand.

# posted by Medical Information : 4:07 AM