| Course | C815 Quality and Performance Management and Methods |
|---|---|
| Task | Task 2 |
| Paper type | Quality improvement plan |
| Length | About 1,200 words, 6 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | BS Health Information Management |
| Updated | September 2026 |
Free sample paper for C815 Task 2
Bills Patients Can Read and Calls That Get Answered: A Quality Improvement Plan to Reduce Bad Debt and Billing Complaints at a Composite Health System With Three Hospitals
Student Name
Leavitt School of Health, Western Governors University
C815: Quality and Performance Management and Methods, Task 2
Course Instructor
Month Day, Year
Bills Patients Can Read and Calls That Get Answered: A Quality Improvement Plan to Reduce Bad Debt and Billing Complaints at a Composite Health System With Three Hospitals
The Problem and Who It Affects
Tri-Valley Health is a composite system of three hospitals and 22 clinics served by one central business office. Over two years, write-offs of patient balances to bad debt have risen from $14.2 million to $18.9 million a year. In the same period, the billing call line has become the most common subject of patient complaints. The line receives about 71,000 calls a year; the average caller now waits 11 minutes for an answer, and 24% hang up before reaching anyone. On the system's patient experience survey, only 58% of respondents agreed with the statement "I understood my bill."
The problem affects several groups. Patients receive statements they cannot interpret and cannot get help with, and many carry the stress of medical debt; a national survey found that 41% of U.S. adults have some form of debt due to medical or dental bills (Lopes et al., 2022). Billing representatives handle angry callers all day, and turnover on the team reached 35% last year. The system loses revenue it is owed, and clinicians hear about billing in the exam room. Because the health information management (HIM) department supplies the codes and descriptions that appear on statements and supports charge accuracy, HIM is a partner in the solution.
Root Cause Analysis
Before choosing solutions, a team of billing, HIM, IT and patient experience staff built a fishbone diagram from 200 recent call reasons and 40 complaint letters. The causes fell into five groups.
| Category | Causes found |
|---|---|
| Process | First statements mailed before insurance finishes processing, so balances change; no cost estimate before planned services |
| Statement design | Services listed by internal codes and abbreviations; four different due dates on one page; no plain explanation of what insurance paid |
| People | Eight representatives for a system that has grown by one hospital; call volume peaks on Mondays and after statement runs |
| Technology | Payment plans can only be set up by phone; no call-back option; patient portal shows balances but not explanations |
| Policy | Financial assistance application is paper only and asks for documents many patients cannot easily obtain |
The analysis shows that the two symptoms share causes. A confusing statement produces a phone call; a phone call that is not answered produces an unpaid balance. Fixing the statement and the access points should therefore improve both measures together.
Goals and Measures
The plan sets four goals, each with a baseline, a target and a date.
| Goal | Measure | Baseline | Target |
|---|---|---|---|
| Patients understand their bills | Share agreeing "I understood my bill" on the patient experience survey | 58% | 80% within 12 months |
| Calls are answered promptly | Average speed of answer; call abandonment rate | 11 minutes; 24% | 3 minutes or less; under 8% within 6 months |
| More patients use payment plans | Share of self-pay balances over $300 on a payment plan | 12% | 25% within 9 months |
| Less revenue lost to bad debt | Annual self-pay bad debt write-offs | $18.9 million | 15% reduction within 12 months |
Data Collection
Each goal is tied to a data source that already exists or can be added at low cost. Call measures come from the phone system's automatic call distribution reports, pulled weekly. Understanding is measured through the existing survey item, supplemented by a one-question text survey sent after each billing call. Payment plan use and bad debt come from the patient accounting system and are reported monthly by the revenue cycle analyst. The HIM department will audit a random sample of 50 statements each month to confirm that service descriptions are accurate and in plain language. Complaint letters will continue to be coded by reason, so the team can see whether statement-related complaints fall. To avoid misleading comparisons, bad debt will also be tracked as a percentage of patient revenue, since total revenue may change during the year.
The Improvement Team
The executive sponsor is the vice president of revenue cycle, who controls budget and staffing. The project lead is the director of patient financial services. Members include the HIM director, who owns charge descriptions and coding accuracy; an EHR and billing systems analyst; the call center supervisor; a financial counselor; the compliance officer, who reviews statement language and collection practices; and two members of the system's patient and family advisory council, who will review every statement draft before it is tested.
Implementation Through Plan-Do-Study-Act Cycles
The plan follows the Model for Improvement: the team agrees on its aim and its measures of success, chooses changes it predicts will help, and tries each one on a small scale in a Plan-Do-Study-Act (PDSA) cycle before using it across the system (Langley et al., 2009).
Cycle one tests a redesigned statement. The new statement has one due date, lists services in plain words, shows what was billed, what insurance paid and what the patient owes in three lines, and includes a portal link and phone number for payment plans. It will be mailed for one month to 500 patients at the smallest hospital, while a comparison group receives the old statement. The team will study billing calls per 100 statements, the text survey and payments within 30 days.
Cycle two holds first statements until insurance processing is complete, removing the most common reason for confused calls. Cycle three adds online self-service payment plans and a call-back option so callers do not wait on hold, and shifts representatives' schedules to match Monday and post-statement peaks. Cycle four offers cost estimates before the 20 most common planned outpatient services and moves the financial assistance application online, with screening for eligibility at registration. Policy alone does not guarantee that assistance reaches patients: a study of state laws that expanded access to hospital financial assistance found no statistically significant reduction in medical debt in collections in the years after they took effect, and the authors pointed to implementation and enforcement challenges (Blavin et al., 2026). Tri-Valley's test will therefore measure how many eligible patients actually complete an application, not only whether the online form exists. Each cycle's results decide whether the change is adopted, adapted or abandoned before the next begins.
Tracking and Reporting Results
Each goal gets its own run chart, updated monthly, so the team can see whether changes are producing a real shift rather than random variation. The team will meet every two weeks during the testing period. The project lead will report monthly to the revenue cycle committee and quarterly to the board's quality committee, using a one-page dashboard with the four goals, the current value and the trend. When a goal is met for three consecutive months, the change will be written into standard work, and a control plan will assign an owner to watch the measure so that gains are not lost when attention moves elsewhere.
Conclusion
Tri-Valley's rising bad debt and billing complaints are two faces of one problem: patients cannot understand their bills or reach anyone who can explain them. A plan that begins with causes, sets measurable goals, tests changes on a small scale and reports results to leaders gives the system a realistic path to collecting more of what it is owed while treating patients with respect.
References
Blavin, F., Braga, B., Karpman, M., Gonzalez, D., & Kona, M. (2026). Exploring the early effects of state consumer protection policies on medical debt in collections. Health Services Research, 61(1), e70068. https://doi.org/10.1111/1475-6773.70068
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.
Lopes, L., Kearney, A., Montero, A., Hamel, L., & Brodie, M. (2022). Health care debt in the U.S.: The broad consequences of medical and dental bills. KFF. https://www.kff.org/health-costs/kff-health-care-debt-survey/
What the C815 Task 2 instructions ask
The second C815 task asks you to write a quality improvement plan. You will usually need to describe the problem, analyze root causes with a quality tool, set goals and measures, describe data collection, name the improvement team and explain the improvement method. The problem should matter to patients as well as the organization. Evaluators look for a root cause analysis that goes beyond symptoms, goals with baselines and targets, data sources that exist or can be added cheaply and a team with clear roles. A plan that jumps to solutions without analysis, or sets goals without baselines, will not meet the plan aspects. The plan should fit the system's size.
How this C815 Task 2 example is built
The plan opens with the problem, its size and the patients affected. The root cause section describes the fishbone session and its categories, then explains how the two symptoms share causes. Goals are listed with baselines, targets and dates in a table. The data collection section names each source, such as call system reports and bad debt reports. The team section assigns roles from sponsor to frontline representatives. The method section describes testing changes in small cycles, such as a redesigned statement, before spreading them. Research on medical debt and billing communication supports the plan. The goals table sits beside the data sources. Research on medical debt supports the goals.
Where the C815 Task 2 rubric puts the marks
C815 Task 2 aspects are rated competent, approaching competence or not evident. A problem aspect checks for a clear description with its impact. A root cause aspect rewards a quality tool applied with depth. A goals aspect looks for baselines, targets and dates. A data aspect asks for sources for each measure. A team aspect wants roles defined. A method aspect looks for an improvement model applied to the plan. Evaluators expect improvement science sources to be cited and notice when goals address both financial and patient experience outcomes. Plans with a run chart for each goal are easy to credit. Evaluators notice when root causes are verified with data.
C815 Task 2 help: what sends it back
Improvement plans come back most often because root causes are really symptoms, such as patients do not pay. Ask why until you reach a cause the team can change. Second, goals lack baselines. Record the current value before setting a target. Third, data sources are unnamed. Say where each measure comes from. Fourth, the team is a list of titles. Describe what each person does. Finally, test changes on a small scale before spreading them, since evaluators look for an improvement method rather than a single launch. Include patient voices, such as complaint themes, in the root cause work. Test the first change with one hospital before spreading it.
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C815 Task 2 questions, answered
Should C815 Task 2 include a fishbone diagram?
A fishbone or similar tool helps show root causes. Include it if your format allows, or describe its categories in text, as the sample does. Label each category clearly.
What goals fit a C815 improvement plan?
Specific ones with a baseline, target and date. The sample sets four goals covering bad debt, billing complaints, call answer rates and statement clarity. Each has a baseline and a date.
Is the C815 health system in the sample real?
No. Tri-Valley Health and its figures are hypothetical. The research on medical debt and the improvement methods cited in the plan are real. Its bad debt figures are illustrative.
Which improvement method fits C815 Task 2?
Plan-Do-Study-Act cycles are common because they test changes on a small scale first. The sample uses them to trial a redesigned billing statement. Report what each cycle taught the team.
Where can I find a free C815 Task 2 sample paper?
The improvement plan, goals table included, is reproduced above, annotated. Send your C815 task and problem, and your first tailored improvement plan is free. Include the problem and baseline figures you have.