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Policies and Procedures Essential for Increasing Collections


In today�s tough economy, physicians are facing an increasing challenge. Self-pay, or that portion of the healthcare dollar that is a patient�s responsibility, is becoming a larger and larger percentage of the physician�s practice every day.

In today’s tough economy, physicians are facing an increasing challenge. Self-pay, or that portion of the healthcare dollar that is a patient’s responsibility, is becoming a larger and larger percentage of the physician’s practice every day. From patients who lose their jobs and therefore their healthcare coverage, to health savings accounts (HSAs), higher co-payments, and individuals whose policies now carry a high deductible, the burden of the buck often sits squarely on the shoulders of patients.

As a result, physicians and their administrative staff now need to be diligent in their collection endeavors. “Physicians are seeing patients with a $2,500 deductible,” says Michael Lewis, director of healthcare consulting for Cowan, Gunteski & Co. “If practices are not vigilant about collecting every penny up to that point, they’re going to be losing out on a lot of money.”

Develop a process

Frank Marshall, chief operating officer for MedSynergies, explains that the best time to collect patient responsibility for healthcare services is when the patient is physically present at the practice. Once they leave the premises, he says, it’s easy to forget about the value of the service they received. The problem: How much should be collected?

“The Byzantine rules that exist in insurance on copays and deductibles, covered and non-covered services—all of those things make it almost impossible to tell how much the patient has to pay just from looking at their card,” Marshall says. “You could collect the right amount of copay for the visit, but if you’re doing a procedure, you really don’t know from the card what to collect.”

Marshall says it’s critical for physician offices to do verification of benefits early on. When a member of the office staff schedules an appointment, they should obtain the patient’s policy number, then contact the insurance carrier and explain the service being provided. How much is the patient’s copay? What’s the deductible? How much of the deductible has been met? “Then, when the patient comes in, they’ll be able to tell them that, based on their insurance, they owe X amount, and then it should be collected it at the time of service.”

Remove the physician

Lewis says that when it comes to collecting for healthcare services, the physician needs to be taken out of the equation. He explains that it’s essential for staff in the medical practice to be trained and have an understanding about the importance of collecting on all self-pay accounts. And, adds Deb Mathis, healthcare group director at Cowan, Gunteski & Co., it’s critical that those members of a physician’s staff who talk with patients about their financial obligations are comfortable doing so.

“An individual who is not comfortable asking for money should not be the person in the office interfacing with patients in that regard,” Mathis says. “It doesn’t come naturally to some people.”

Adds Mathis, it’s important to make it easy for patients to pay. For example, she points out that there are still some physician practices that do not accept credit cards. In a self-pay environment, she says, “You have to accept credit cards. People who have either no insurance or a high-deductible health plan might not be able to come up with the $80 or $100 for a visit, but they may be willing to put it on a credit card. So, you’re getting your money up front.”

Policies and procedures

Kendra Obrist, vice president of marketing for Navimedix (, says that most medical practices do not have well established patient payment policies beyond the standard to collect a $10 co-payment at the desk. It’s important, she explains, that practices understand the options available to them and define a policy that suits the way they choose to manage their finances and interact with patients.

“Physicians need to realize that they are a business, and they are going to have to develop a culture of understanding that they do have a financial relationship with their patients, as well as a health and wellness relationship,” Obrist says. “That’s the first hurdle to overcome, and I think we’re starting to see practices realize that they have to do this.”

Once a policy is established, adds Lewis, it’s imperative that practices are willing to follow through with the requirements of the policy. “Suppose your policy is that you send out three bills, and if the patient doesn’t pay them, you will send them to collection. If you never follow through on it, word gets out in the community that it doesn’t matter whether you pay this doctor or not. You have to make a commitment to the process. Otherwise, patients who are looking to be seen for nothing will know that they can come to you, and you’re basically a paper tiger.”

Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at

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