With the rise in high-deductible health plans (HDHPs), practices must have a strategy to collect co-payments and co-insurance amounts before services are rendered, said Lovell D. Davis, MHA, CPC, director of revenue cycle management at Virginia Eye Institute in Richmond, Va. who spoke during AAPC’s HEALTHCON, April 8-11 in Orlando, Fla.
HEALTHCON offers educational sessions and networking opportunities for medical coders, billers, payer representatives, practice managers, attorneys, physicians, and other healthcare business professionals.
Why are up-front collections important? “Once the patient leaves the office, the probability of collecting any outstanding balance decreases dramatically,” said Davis
Physicians sometimes shy away from up-front collections out of fear that patients will seek care elsewhere. However, up-front collections are a critical part of maintaining practice revenue, he said.
“This is the money that’s used to maintain provider and staff salaries, purchase equipment, purchase new real estate, and more,” said Lovell. “All of this money collected through insurance and patient responsibility goes back to the practice. Every effort must be made to collect dollars owed prior to rendering services.”
Collecting patient payments up-front also reduces write-offs, saves time, and reduces operational costs related to invoicing and follow-up, he said. It can also eliminate or significantly reduce the practice’s reliance on costly collection agencies.
Lovell provided these five tips to help practices manage patient payments more effectively:
1. Create a financial policy.
Keep it simple and include clear expectations, such as:
• Acceptable forms of payment (i.e., cash, credit/debit cards, health savings accounts (HSA), health reimbursement accounts (HRA), checks, or care credit).
• No-show fees.
• Requirement that patients pay for services up-front. This includes copayments and any co-insurance that’s owed with HDHPs.
• Other important information about the financial aspects of care at your practice, such as a rule that your practice discharges patients after a certain period of nonpayment.
2. Notify patients of your financial policy.
For example, tell them over the phone when they make an appointment, include the information in a welcome letter, and post the policy prominently on your practice’s website.
3. Provide financial training to front-desk staff.
Consider creating scenario-specific scripts, such as what to say to patients when collecting copayments, cost-share amounts, or past-due balances, said Lovell.
For example, at the Virginia Eye Institute, front-desk staff call all patients two weeks prior to an upcoming appointment when there’s an outstanding balance to remind them that the practice expects payment in full when they present to see the physician. On the day of their appointment, if patients are unable to pay the full balance, staff ask for at least 50 percent of the balance. If patients are unable to pay this lesser amount, staff are trained to consult the physician to determine whether it’s urgent for the patient to be seen. For non-emergent follow-ups, staff reschedule the appointment for a time when the patient can pay.
Staff should also receive training on carrier-specific allowables and have access to an updated fee schedule for the practice, said Lovell. Patients with HSAs or HRAs may inquire about the practice’s fees for certain services, and they may request a fee schedule in writing, he said. It’s also important to provide staff with the ability to verify patient eligibility online and use cost-estimator software to estimate patient financial responsibilities.
4. Hire front-desk staff who have a billing background.
This helps ensure that staff can explain the practice’s financial policy to patients while also performing duties such as financial counseling and helping patients apply for Medicaid or other patient assistance programs, said Lovell.
5. Send timely statements.
Aim to send patient statements the day after claims are adjudicated so patients know immediately when there’s a balance owed, said Lovell, adding that this greatly enhances cashflow. “Medical practices are businesses. All businesses need adequate cashflow to operate,” he said.