Making sure your Practice gets Paid

By Chris Woolstenhulme, MBRA, CMRS

Deductibles! How do you protect your practice from the risk of not being paid, while protecting your patients' finances?

It's that time of year again, you are going to notice the impact of the patient's deductibles. So how do you deal with the problem of patients having to pay out of pocket to meet their deductibles? If you don't have a policy in place to deal with this, your practice will sustain a major impact at the beginning of every year. At that point you will be playing the catch up game and scrambling to collect after the visit. You will be working harder, not smarter, which can have a significant impact on your practice.

Even those who can still afford to carry healthcare, they are finding their benefits are being cut and their out of pocket expenses are rising at an alarming rate. The impact is tremendous on Providers as well as patients. Providers must implement a "Self-Pay" policy for collections.

The deductible portion of Self-Pay is the fastest growing category and we will continue to see this increase year after year. Only after a patient meets their deductible for the year do they get to use their medical benefits. This is resulting in patients being under-insured and unable to afford the cost of healthcare.

Even if you think your "PREVENTENTIVE SERVICES" are FREE of charge, think again. The cost of these FREE services are more than likely rolled into the price of your premium. The saying "There is no such thing as a Free lunch" is very true, especially in the medical field.

While physician and pharmaceutical costs are lower in the High Deductible Health Plan (HDHP) population compared with the other groups, inpatient admissions and expenditures are significantly higher.

More and more practices are demanding and collecting the deductibles upfront for the year before the doctor will see them. No longer can the providers bill an insurance company only to have the balance turned over to the patient's responsibility, treatment is complete and you never see the patient again. Patient collections are so much more labor intensive and costly, than collecting form insurance payers, therefore; timing is crucial. Be sure you are familiar with the payers plan as several will not allow you to collect from the patient before the claim has been adjudicated.

Communication with your patient about your payment expectations is the Key Factor!

OK!... but How?

First of all be sure your patients understand what they are responsible for. Unfortunately, health care policies are often confusing and complicated, leaving patients disoriented as to what they will have to pay for when visiting your office. According to McKinsey & Company, providers can expect to collect only 50 to 70 percent of an insured patient's balance after he or she is treated.

A patient is 90% likely to pay before they see their physician, 70% likely at checkout and then it drops to 40% after they leave the medical practice.

Besides communication there are two other factors that make patients more inclined to pay:

Impose a stricter collections policy and commit to it or you will leave money uncollected. Be sure you have a clear financial policy for all new patients and be sure it is renewed annually. Let them know all of their options as early in the conversation as possible. Let patients know the medical practice accepts Visa, MasterCard, Discover, American Express, debit cards, personal checks, and cash. Remind them they can also pay over the phone.

Front Desk Roles:

At the point of initial contact or phone call, gather as much information as you can so you will be equipped when the patient arrives for his/her visit. Prior to the patient being seen it is crucial the staff finds out some essential information.

Invest the time upfront to verify if a patient owes a deductible and then skillfully ask for the money at time of service. Physician practice experts say begin by teaching your staff how to research the patient status before the visit and by preparing patients for the change.

Verify the deductible, co-pays and eligibility with every patient, using an online verification tool or directly from the payers website, if nothing else, make the phone call! Most commercial payers will give you real time information, you can chose to verify a number of patients or a single patient. Keep the information collected in your billing software or chart where it can be easily accessed. Be prepared to let the patient know what their deductible portion will be and how much they have met YTD.

Remember once the patient sees their physician, the ability to collect this money drops dramatically! Focus on time of service collections and communicating with your patients about payment expectations.

It is essential to a practice that the front desk not carry the burden of time-of-service collections alone. Everyone in the medical practice (physicians, nursing personnel, etc.) needs to be knowledgeable on the practice's self pay policies and what their role is in improving performance. This does not mean nursing personnel or technicians should not call a patient back unless they have paid their copay, deductibles and prior balances. For consistency and to keep the physicians out of the financial end of the practice along with other providers they must direct patients back to the front desk when patients ask them a question about what they owe. As you communicate each time, staff need to reference the earlier communications – "As we outlined in our financial policy...", "...during your appointment phone call..."

During this process, determine whether the patient has a deductible or co-pay and what amount is still due. Be sure to include the information on the schedule or practice management system so when the front desk is making reminder calls they can prepare the patient.

Training and confidence is crucial for the front desk staff. They must be comfortable asking for payments. Create scripts and outlines that staff can follow and conduct some role playing scenarios among the staff; this will help prepare them for different types of patient situations. Consider creating financial motivators for front end collectors or preferably for the entire front end team and evaluate collection performance based on the potential to collect vs. actual collected amounts.

Have procedures in place to address confusion from patients. For example, an elderly patient is confused about financial responsibility and is uncomfortable paying the deductible. The front desk person would attempt to explain the situation, but if that fails he would ask the administrator to place a call to the patient's family member.

The reality is not every patient is going to be willing to pay and some will not have the money to pay today. Provide them with a pre-addressed envelope so they can mail the payment to you. You can also offer discounts based on timely payment remits, perhaps even ask them if they can pay half. You must find a way to reduce the "no pay" encounters in the medical practice.

Pre-Visit:  When patients call in to schedule or re-schedule and appointment, this is a promising time to collect their deductibles and prior balances at this point in the patient experience. Collect on the phone prior to scheduling the appointment, or make them aware it is expected at the time of service as well as any past due amounts they may owe.

Patients arrival for Visit:  Patients are being seen because they are ill and don't want to worry about paying their doctor – they are concerned with getting well – but they are more motivated to pay before they see their physician. If you make payment at time of service required and fully communicate this to the patients pre-visit, then they will arrive prepared to pay. If they are not willing to pay, your financial policy should state that they will be rescheduled (this is the consequence they want to avoid...). If you don't enforce a consequence, there is less motivation to pay.

Post-Visit:  Patients and their families are so happy to be well and are not worried about paying their doctor (they are worried instead about paying the telephone or cable bill, buying groceries, etc.) .....until they need another appointment. Make paying prior balances a requirement to obtain a (non-emergent) appointment.

Prepare your patients and let them know you are bound by your contractual agreements with their insurance, but not in a threatening or demanding demeanor. Create a friendly environment while working out their payment agreement and collecting money.

Also be aware that you may see an increased patient load at the end of the year when their deductibles have been met. Some times this will require additional staff.

Staying on top of patient payments is a key to a healthy and successful practice.

Chris Woolstenhulme, MBRA, CMRS is a Certified Billing Guru (CBG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (8-5 Mountain)

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