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A new standard operating procedure (SOP) for the financial clearance of patients recently took effect across all UVA Health entities. What does "financial clearance" mean? It’s the process that prepares the patient and the health system for the financial aspects of an upcoming patient visit.

The new SOP helps patients better understand their financial responsibility prior to an appointment through consistent communication earlier in in the patient journey, including proactively providing estimates; connecting patients with financial counseling and/or financial assistance/Medicaid eligibility; and requesting (but not requiring) payment pre-service.

Why a financial clearance SOP?

As insurance premiums increase, along with the growth of high deductible health plans, the consumer cost of healthcare is on the rise, and with it, an increase in patient frustration and confusion. By having transparent, proactive conversations with patients about what they will owe, we can help ensure they are financially prepared for their visit and that people eligible for financial assistance are connected to those resources and supported through the respective processes.  

The SOP also improves UVA Health’s compliance with regulatory requirements under the No Surprises Act, decreases write-offs and bad debt for the health system, and aligns us with industry best practice.

So, what exactly has changed?

• Patients who meet pre-determined financial criteria (such as self-payers, uninsured patients, patients with high outstanding balances) are contacted by phone prior to their appointment to ensure they understand their estimated financial responsibility and to connect them with financial counseling and/or assistance and other support as needed.

• Payment of outstanding balances and estimated financial responsibility is requested prior to service and at registration. While payment is requested, care will not be deferred if a patient declines to pay.

• A patient’s estimated cost is provided proactively for uninsured and other patients who meet financial risk criteria. Eventually, insured patients also will receive estimates in advance. 

How will patients benefit? 

Patients will be better financially prepared for the care they are going to receive, and it’s expected that more patients qualified for financial assistance will be identified and enrolled by starting these discussions early. Upfront patient responsibility conversations also can increase overall patient satisfaction through cost transparency, patient education, and supportive service.  

How are team members impacted?

Since many team members are also UVA Health patients, it’s possible you'll get a call from a fellow team member to discuss the cost of an upcoming appointment. If you do, you’ll know they’re calling as part of this new SOP with the goals of ensuring that you know what your financial obligations are ahead of time and connecting you to supportive resources if needed. These can be sensitive and even difficult conversations, but remember that your colleagues are calling to share information and help, so please treat them accordingly.

“Giving patients more information about their financial responsibility earlier in their patient journey and helping eligible patients qualify for assistance is an important step toward improving patient access and their overall experience at UVA Health,” said Anna Blackburn, Administrator, Enterprise Patient Access. “On behalf of the Access and Revenue Cycle teams, we appreciate your support of this important new process.”

The Financial Clearance SOP applies to all outpatient services, including hospital-based services. It does not apply to Emergency Department patients, in-patients, and observation patients.