by Wyn Staheli, Director of Research
May 13th, 2019
For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a “Patient Financial Responsibility Acknowledgment Form” to help providers with this process. Lately, the lack of pricing transparency has been in the news and even the Affordable Care Act (ACA) attempted to make things better by requiring hospitals to make their prices transparent by publishing their “chargemasters.” However, there are still problems.
Although “surprise” bills are particularly problematic when it comes to hospital bills and imaging services, they can also happen in a smaller organization. When a patient finds out that the procedure or service is not covered by their insurance, as you can imagine, they are not happy about it. Even as a practice, it is often difficult to find out what is covered by a third-party payer.
The best place to begin is to make sure you have an “Informed Financial Consent Policy” which is an official written policy. As part of your policy, you need to make sure that your office has a process which outlines anticipated procedure/item costs and helps the patient understand the role of their insurance. Medicare requires the use of an ABN for noncovered services, but you also need to have a separate form for non-Medicare patients.
A recent article in Medical Economics (see References below) emphasized the patient’s focus when it comes to healthcare services. According to the article, their top priority is affordability. You need to be able to show how your services are affordable compared to other physicians or services. As you’d expect, they also stated that convenience is also essential. Seventy percent of the patients surveyed wanted to be able to sign up for a payment plan online. If your organization is prepared to be able to offer online payments and/or payment plans, just make sure that you meet all security requirements.
Patients also look for a ‘deal’. Just keep in mind that you have to be careful with marketing to ensure that you do not violate any laws. For example, you can’t offer to waive co-insurance or deductibles for either new or established patients. Medicine isn’t like other businesses in that you have to be careful about offering any ‘inducements’.