Healthcare reform is affecting more than just healthcare practitioners; it’s also impacting patients. That’s because reform efforts aren’t limited to provider-centric payment initiatives (namely, the push to adopt pay-for-performance models). Healthcare reform also has led to new trends in insurance plans. The number of patients with high-deductible health plans is rising steadily, which means patients are becoming increasingly responsible for the costs of their own care. The result: today’s patients are more invested—and actively involved—in their care decisions than ever before. But, they’re also holding more of the purse strings, which means it’s imperative that clinicians up their patient collections game. That means developing a process for ensuring you’re collecting copays and any other balances your patients owe.

The PT Patient’s Guide to Understanding Insurance - Regular BannerThe PT Patient’s Guide to Understanding Insurance - Small Banner

Getting Paid Matters

We know—you got into health care so you could help people feel better. You didn’t do it for the money. But that doesn’t change the fact that you deserve to get paid for the services you provide. You are running a business, after all. That being said, it’s crucial to collect what you’re owed—from all sources, not just payers. According to this NextGen Healthcare document, “a greater percentage of practice revenue than ever is coming from patients,” so “better performing practices are taking every step possible to minimize bad debt and optimize patient collection.” The same source cites Medical Economics as saying, “What you collect from insurance companies covers your overhead. What you collect from patients goes to your bottom line.”

Collect Upfront

NextGen also reported that a SuccessEHS study on patient accounts receivable found that only 21% of patient balances that aren’t collected at the point-of-service are ever collected. That means you can kiss goodbye 79% of the money you don’t collect upfront. That’s an awfully big number. With that in mind, here are eight tips for ensuring your patients actually pay (adapted from this source and this one):

1. Communicate Expectations

Be clear about what you expect from your patients regarding payment—and when. That means everyone on staff must know your payment policy and be able to clearly communicate it to patients at touchpoints that you deem appropriate. For example, when a patient calls to schedule his or her first appointment, whoever is doing the scheduling should inform the patient that his or her co-pay—and any other financial responsibility—will be due at the time of service.

2. Verify Eligibility

Before the patient arrives for his or her first visit, you should know the fine print on your patients’ health insurance coverage, including the required copayment (if there is one). That way, you’ll know:

    1. that the patient’s insurance covers your services, and
    2. how much—if any—financial liability falls on the patient.

Having this knowledge at the get-go can be a huge help in ensuring not only proper patient payment collection, but also clean and complete claims. And that, in turn, improves your chances of collecting payments from insurers without having to deal with rejections, denials, or appeals.

3. Estimate Cost

Once you know the patient’s insurance information, you’ll be better equipped to estimate the cost of your services—which, according to the NextGen publication, requires “calculating procedural charges, analyzing historical data, evaluating contract pricing between your organization and the payer, and applying patient insurance benefit information to establish an estimated patient financial obligation at the earliest point of contact.” While cost estimation does require some legwork, the benefits—which include improving upfront collection, boosting patient satisfaction, and minimizing days in accounts receivable—are worth it.

4. Collect Outstanding Balance When Scheduling Next Appointment

This is a good habit to get into: if a patient with an outstanding balance calls to schedule his or her next appointment, take this opportunity to collect the payment due. In fact, you also may want to consider adopting a policy indicating that your clinic will stop seeing patients with overdue balances past a certain dollar amount or date threshold. If they’re unwilling to pay—and unwilling to adhere to your collections policies—they may not be the best fit for your clinic. And if the situation continues, you may end up amassing charges that you’ll never be able to collect.

5. Save Credit Card Info on File

Establishing a credit card on file (CCOF) program can improve collection speed and cash flow. However, you should only keep patient credit card information on file if PCI guidelines–and your payer contracts—allow for it. If your practice accepts credit cards, NextGen suggests that you research the best processing rates and terms.

6. Consider Financing Options

Most patients want to pay their bills and settle their balances—if given the opportunity to do so. According to a 2009 Mckinsey survey of retail healthcare consumers (cited in the NextGen document), the number-one reason patients gave for nonpayment was a lack of financing options. Furthermore, “a 2010 MGMA study shows that 74% of better performing practices assist patients with finances, offering financial incentives to resolve balances faster.”

7. Handle Collections Internally—for as Long as Possible

The ACA International reports that medical practices recover less than $14 for every $100 owed once they turn bad debt over to third-party collection agencies. To keep more of your own money, establish a policy that addresses bad debt, and make sure patients and staff understand it. Then, enforce it.

According to Greenway Health, only 32% of patients who owe money ever receive a collection letter from the practice. Need help creating one? For the secret to collection letters that work—and two free collection letter templates—check out this post.

8. Use Technology

NextGen encourages providers to get creative with their collections methods. While staff may find asking for payment uncomfortable, technology doesn’t. Using kiosks—like those used to print boarding passes at the airport—for check-in and check-out could provide a “familiar way to improve upfront collection of patient copays and outstanding balances as well as increase check-in efficiency.” This way, patients can view their bill and pay with a credit card immediately after arriving at, or immediately before leaving, your office. (You also could use an iPad with a credit card reader attachment.)

Watch for Loopholes

According to the NextGen Healthcare article, “the Affordable Care Act (ACA) promises some positive outcomes, including allowing practices to access more specific real-time adjudication from carriers.” Eventually, this will mean more accurate patient collections. But the ACA isn’t all good for providers. Thanks to a legal loophole, insurers are required to provide patients with a three-month grace period for policy premium payments. Insurers will pay provider claims during the first month that a patient doesn’t pay his or her premiums—even if the beneficiary is eventually terminated for non-payment. However, they can withhold claims—or retroactively take back paid balances—during month two or three. If a patient ends up losing his or her coverage, providers must seek payment directly from the patients.

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