The right way to handle patient collections

Collecting from non-paying patients is vital to keeping a practice open

Nobody likes turning patients over to collections. But for a practice to survive, it’s imperative that a practice collect the money that it is owed so that it can keep the doors open and keep providing medical care to the community it serves.

When it comes to a difficult topic like collections, there are right ways and wrong ways to do it. Medical Economics spoke with Jacob Corlyon, co-founder and CEO of Capital Collection Management, to talk about the best way to handle these difficult cases.

(Editor’s note: The transcript has been edited for length and clarity.)

Medical Economics: What mistakes do practices make when it comes to collections?

Jacob Corlyon: It really comes down to a perspective issue. Perspective, when you look at collections in a medical practice, or at a hospital or surgery center level, is they're not looking at it like a revenue-generating department. It's kind of just a function that has to happen; they're not really giving it a lot of thought and attention, which it truly does need. It does take a lot of effort and education to build a staff that can engage with empathy and can provide a very good customer experience, so that you can engage with that patient in a way to educate them on the debt that's owed, and then work them through a solution of repayment. It even goes down to the collection strategy and the execution of a collection strategy. I think a lot of people are missing how detailed that process has to be from a staff perspective, so that when your staff is engaging in the conversations, whether it's in the early stage, or whether it's in late stage of that collections conversation, that the messaging is consistent across the board, that everybody knows what to say, everybody knows the programs that are available.

ME: How do you decide who to send the collections and who not to?

JC: From my perspective, consistency is key. Collections starts at billing. And honestly, it really starts before that, with the patient onboarding experience. You should be educating and talking about what that procedure is going to end up costing that patient out of pocket, what programs are available, and setting the expectation, whether it's taking some sort of down payment at the time of service, or if you offer third-party financing solutions to help cover that out-of-pocket expense. Over-communicating and educating that consumer on the front side really lends well when that account becomes in a state of collections, because they've received that messaging, they know what's available to them. Everybody would go through the same process so that everybody is treated and engaged within a consistent manner. And then when it comes to the question around who or if you should send that patient to a third-party agency, I think consistency is really key in that. You want all your patients to go through that life cycle. It starts at creating that overall strategy, and then making sure that on a consistent basis, everybody is being treated in the same manner, so that that customer spirit experience can be measured and looked at from start to finish, and that the staff can be held accountable and the agencies that are servicing those clients can be held accountable as well.

ME: You talk about consistency, are there ever exceptions that can be made? Or does it have to be across the board consistent with everyone?

JC: I'm a firm believer in consistency. The health care provider should have a well-documented financial assistance policy. If there's charity care or other programs that the medical practitioner offers, that should have coverage under there. It still needs to be consistently done. It's not saying like, I'm going to put 20 of these people through my billing and collections process, or send these 20 people to an outside agency if we work with them, but not send these 10. Everybody should go through that consistent process without exception. When you're creating this process it really takes some thought, because you want it to be people-first, you want it to be an empathetic process, but you want it to be very well thought out, so that it can be handled in a consistent manner from start to finish. The end goal is making that customer experience the best that it can be, and providing that customer with the education and the service level that they need to get that debt cleaned up and out of their minds and out of their responsibility. What we hear a lot is, outstanding debt, whether it's from a medical provider, or a bank, or financial institution, whatever that might be, it does weigh a lot on that consumer’s mind. And what we see, especially in the health care side of the equation is around surprise billing. The patient is like, OK, well, I didn't think I owed that. And then you have the additional challenge on the health care side all of the insurance nuance. It's on the provider, it's on the servicers that are working with those providers to understand it, have a consistent well-documented processing workflow, and then be able to educate that consumer and that patient all the way through the transaction to create that win-win solution to get them either back on track or get that doctor paid.

ME: It's unfortunate that patients sometimes have to be turned over to collections. Are there any tips you can share on how to collect what's owed without creating ill will?

JC: When you look at collections, and when you look at what people think about when they hear debt collection, or you’re placed in collections, or in a collections department, whether it's internal or with a servicer, it doesn't have to be a negative experience. It can be one that's very positive. We believe that through engaging with empathy, actively listening, being able to educate that patient on programs on how they come to owe the amount that you're reaching out about, that's a big thing. So be able to understand and explain to them that debt and why they owe it, and come up with a solution, whether it's having well-documented terms to create a repayment plan, or whether it's offering charity care opportunities, or whether it's offering third party patient financing solutions. You want to arm the patient and the consumer with as much knowledge as possible, with as many opportunities as possible, to make that payment. I'm a firm believer that everybody wants to repay, and it's really on, whether it's an internal collector or an external collector, to have the conversation, educate them and provide a solution so that they can repay it. And that ultimately leads to that customer experience.

ME: Is there a way to tell who's making a genuine effort to pay you and who's just trying to fool you with stories about deaths in a family or other sad stories that they try to use to avoid payment?

JC: It's something that everybody struggles with from that people side of the equation. It's very easy to get sucked into those stories, especially if it's always happening. If it's always a new story, that can kind of be a little bit of a red flag. If every time you talk to somebody, there's been something else that's happening within their life, that may be an excuse or something that they're trying to play, whether it's pulling the heartstrings or just trying to extend the time in between payments. What I think is very important as that person who's on the phone engaging with that individual is, more or less kind of changing your perspective in that conversation to not only actively listen in and engage with that individual, but really make it a genuine effort to connect, to build rapport, to offer that type of education, talk about the debt, and really try to get them to the ultimate answer, which is to say yes to a solution that works for the provider and for that consumer. You may be getting a lot of noise, but you're always working down the path of trying to get that yes at the end of the tunnel. Again, being genuine in that transaction, engaging with empathy, providing that education and really talking to that person is important, and not just say like, well, this call isn't going to be successful because I’m getting another type of story. I think it's always prudent to really engage and try to understand and then create that solution.

ME: Is there anything else that you think medical practices need to be aware of when it comes to collections?

JC: From my perspective, what I like to tell medical providers is look at the collection side of your business as a revenue-generating department. So just like you're looking at trying to acquire new patients, you want to look at how to create that great customer experience on that backside. But again, if you look at it, like a revenue-generating department, a lot of things go into that. It's actually taking the time to peel back the onion layers and look at what's actually happening and taking a little bit of an assessment of what's going on today. Then it's understanding that process and reimagining how that process works. It does take a lot of time, but you want to put in policies, procedures, workflows, training programs, educating the people that are on the phones for you, to make sure that they're well equipped to handle those conversations, to make sure they understand the insurance side of the business and how those debts actually become due and what the back-end balance is for that out of pocket costs for that consumer. That's a big question they're going to ask and those individuals need to have the training to be able to articulate that and talk around that topic with that consumer. Then you want to start dashboarding and you want to hold those individuals accountable for their performance as you would say, the sales team, because again, that is a part of that revenue-generating side of the practice. The more you recover, you are saving that revenue that was already generated. So it's vital for the medical practice, it's vital for a hospital or center to get those funds in to continue to provide excellent patient care as well as keep a practice running efficiently. So it’s training to create a consistent process, it's continuing to go back and look at that process and the people that are better doing it, just as you would any other part of the business. You want to make sure the best people are in the best seat for that individual on the bus and make sure they have what they need to be successful.