The initial conversation should lead to the right kind of help
Pre-service financial work can involve coverage questions, explaining an estimate, arranging an approved payment option, or helping a patient apply for assistance. Those needs overlap, but they are not interchangeable. I would define how staff identify the need and how they route it to trained personnel who can explain the available options under the organization’s policies.
The workflow should not require a registrar to make an assistance eligibility determination. Recognition and referral are different responsibilities from collecting supporting information and approving an application. I would document who owns each step and which situations need prompt escalation, while preserving the clinical and access decisions that belong to the care team.
I would reconcile the screening signal with actual follow-up
The first evidence request would connect flagged encounters to a counseling task, an assistance case where appropriate, patient communication, and a documented resolution. I would look for records with a signal but no task, tasks that were never assigned, and applications that stalled because the patient or team could not identify the next requirement.
I would also examine repeat contact. A patient may already have provided information that another department asks for again, or an application may be progressing outside the queue being reviewed. The sample should establish what happened across the complete workflow rather than label every open case as staff inaction.
The Epic review should distinguish cases, trackers, and tasks
In Epic, I would review the registration workflow used to signal a counseling need, the Financial Assistance case workflow, the relevant program tracker, and the workqueue or report that supports follow-up. Case status and tracker status should be interpreted according to the organization’s program design. A task marked complete does not necessarily establish an approved program or a posted financial adjustment.
I would ask for the relevant configuration, status and reason values, notification behavior, and rules that select records for staff review. CER records would be included where they drive those decisions, with context and used-by configuration. The investigation also needs examples of the patient communication and the point at which billing staff can see the result.
The handoff needs a return path to registration and billing
Counselors should be able to identify which information is missing, who is expected to provide it, and when another contact is appropriate. I would work with the team to make those states distinguishable from cases waiting on an external decision. A generic pending status gives managers very little basis for identifying whether help is needed.
Then I would establish how the outcome reaches the departments that need it. The workflow may need to update the information used in an estimate, explain an approved payment arrangement, or apply an assistance decision according to policy. I would confirm which encounters and billing entities are covered rather than assume a decision automatically applies to every hospital and professional balance.
The test should include an incomplete application
I would test a patient who requests counseling, one who begins an application but has missing information, one who already has a relevant case, and one whose situation changes before service. I would also test an approved and a denied outcome, along with a patient who cannot use the preferred digital communication channel.
The expected result should show a usable staff task, appropriate communication, preserved history, and the correct downstream visibility. I would ask counselors and billing staff to complete the scenarios together. That joint review often exposes a gap that neither team can see when it tests only its own screen.
The measures should reflect access to help and correct resolution
I would define the population of documented counseling needs and measure whether each received an appropriate next step. For assistance applications, I would separate incomplete submissions from cases with all required information awaiting a decision. Combining those intervals can hide whether the primary barrier sits in intake, patient communication, or review capacity.
| Measure | How I would use it |
|---|---|
| Successful handoff | Documented counseling needs with a traceable assigned task or confirmed existing case. |
| Time to meaningful contact | Elapsed time to a conversation or completed action that addresses the identified need, not an automated notice alone. |
| Application progression | Movement through agreed complete-information and decision milestones, with waiting reasons visible. |
| Downstream accuracy | Estimates, approved arrangements, and billing actions consistent with the final documented outcome. |
I would report patient questions, repeat document requests, and preventable billing corrections alongside financial outcomes. Assistance adjustments should not be presented as lost collections, and an increase in payment requests is not evidence that counseling improved. The objective is a reliable process that helps patients reach the appropriate resolution and gives staff a clear way to finish the work.