July 24, 2019
As a result of high deductible health plans, practices have seen their patient receivables skyrocket over the last few years. Collecting unmet deductibles, coinsurance, and non-covered services amounts at the end of each office visit and prior to surgery are essential steps to keeping patient receivable in check. Keeping on top of unpaid balances before they get too old is also critical.
In order for these things to happen, physicians must commit to a philosophy of fee transparency and proactive collection policies, as well as empower staff to have frank discussions about money. These can be uncomfortable changes, but they are vital to a practice’s collection success.
Here are some simple and proven tips for implementing proactive collections.
1. Announce the shift to proactive collections before actually making it.
Our firm has been training staff and implementing time of service collections for more than 30 years. One thing we know for sure is that success starts at the top. All physicians must stand united and support the philosophical shift. If it isn’t conveyed as an agreed-upon “new normal,” many staff won’t embrace the change.
2. Agree to one, standard collection policy.
Change efforts are unsuccessful when each physician has his or her own collection policy. Staff needs one set of rules to follow.
Review your current financial policy and strike any language that is vague or refers to “billing after insurance pays.” As a group, develop standards for such things as amounts that will be collected at the end of each visit and prior to surgery, how to handle payment plans and options, how often you’ll send statements, what to do if patients have a financial hardship, and when to write off uncollectible patient balances to bad debt versus collections. Ask your attorney to review the policy before implementing it.
3. Get organized at the front desk.
In order for staff to collect, they must know the amount to ask for. And that varies by plan. Make a chart of your high volume services, X-rays, injections, and tests delivered in the office. Enter the contracted allowable for each of your top 20 plans to create a quick reference guide. Some practices prefer to put this information in a binder at the front desk. Others keep it on screen in a spreadsheet. And others do both. The point is to equip your team with the data they need to ask for the amounts patients owe.
4. Train schedulers to collect patient balances as part of making an appointment.
This is a simple change that makes a big difference. Once the scheduler and patient have agreed to an appointment time, if the patient has a balance, the scheduler explains: “Ms. Jones, I see there is a balance of $121.31 on your account. Why don’t we take care of that now so you don’t have to worry about it at check-in? I can take your credit card over the phone right now…”
5. Use technology to make paying you easier.
When paying a practice is convenient, more people will pay. This is especially true for patients under 40. Many check their mailbox infrequently and are likely to overlook a billing statement.
Enable the payment feature in your patient portal or offer online payments on the practice Web site. If you use an appointment reminder system, ask the vendor about options for paying outstanding balances as part of the confirmation process. Establish payment plans using automated recurring payments by credit card. Consider a pay by text solution. All of these options are faster and easier than writing a check.
6. Provide a surgery cost estimate and collect a deposit.
Pre-surgical counseling provides transparency about what the patient’s insurance will cover, and the amount they are responsible to pay out-of-pocket. A key component of implementing this system is the use of a surgery cost estimate. A surgery coordinator uses an online cost estimator or calls the payor to determine coverage rules for the recommended treatment, contracted allowables, and unmet deductible and coinsurance amounts. This is summarized on an estimate form, ideally, while the patient is in the office.
After explaining details to the patient, the surgery coordinator collects a percentage (often 50%) of the patient’s out of pocket costs as a deposit prior to surgery. The remaining percent is collected at the patient’s pre-op visit, or an automated payment plan by credit card is agreed to. The goal is to have the patient pay his or her amount in full within 90 days of the procedure date.
7. Offer patient financing.
Many patients don’t have funds freely available to pay a pre-surgical deposit. Patient financing makes it possible for them to afford their treatment.
CareCredit, for example, can be used to finance a patient’s deductible and coinsurance for surgery, physical therapy, injections, and tests. For a small service fee, the practice is paid in full and receives the funds electronically in two business days. At that point, the patient balance is off the practice’s books and CareCredit follows up directly to collect from the patient.
8. Train the staff.
It’s the rare staffer who is a “natural” at asking patients for money. Develop training materials that include scripts and talking points based on your practice’s policies. Make sure staff know how to respond to objections and questions such as:
• “I’ve been coming here for years and all I’ve had to pay was my copay.”
• “$413.00? That can’t be right. Can’t you just rebill my insurance?”
• “I can only afford half of that amount. Can Dr. Wonderful ‘forgive’ the rest?”
If you don’t have a manager or supervisor capable of staff training, hire an outside expert – it’s worth the investment. Without proper training, your team may not be effective at asking for money or handling patient objections, both of which will negatively impact collection efforts.