I don’t want to beat around the bush: health care—physical, occupational, and speech therapy included—is expensive. But the true cost of skyrocketing healthcare spending goes beyond out-of-pocket deductibles, because patients are allowing their health to take a backseat to other expenses. Last month, I stressed the importance of winning patients for life by marketing to them throughout the entire customer lifecycle. And I don’t want to undermine the value of keeping patients engaged throughout the entire care journey. But let’s face it: for many patients, it won’t matter how engaged they are if the cost of care is prohibitive. However, when providers make a concerted effort to help lower those financial hurdles, it not only encourages patients to take care of their health, but also creates a positive patient-provider relationship—and that ultimately fosters patient loyalty and a great reputation. With that in mind, I’ve compiled these 10 revenue cycle management (RCM) tips to help you create healthy, loyal patients:

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

1. Be upfront and transparent about patient costs.

In this post, WebPT’s Erica McDermott cites this Physician’s Practice article written by Fair Health President Robin Gelburd, which explains how the insurance industry has shifted more healthcare costs to patients by way of high-deductible health plans (HDHPs). So, it’s only reasonable that patients would want greater cost transparency; that way, they can budget accordingly. It’s on providers to offer that transparency—and it should go beyond ensuring accuracy with benefits verification. Despite the fact that patients are expected to shoulder more costs than ever before, they’re often left to dig through the muck of over-complicated health insurance rules in order to access the care they need and advocate for themselves. To be frank, the health insurance industry has failed them, and it falls to us to lend them a guiding hand.

So, what’s a rehab therapist to do? To start, we need to let go of our fear of discussing financial matters with patients. Not only does honesty and confidence in this arena instill greater patient loyalty, but also there is no one better positioned to discuss healthcare costs than the patient’s provider. Once we’ve conquered our own fear, we must determine exactly what to discuss. In this post, WebPT’s Courtney Lefferts quotes the Healthcare Financial Management Association (HFMA) as saying, “To the patient, cost is the amount payable out of pocket for healthcare services, which may include deductibles, copayments, coinsurance, amounts payable by the patient for services that are not included in the patient’s benefit design, and amounts ‘balance billed’ by out-of-network providers.”

To help providers better educate their patients on the ins and outs of insurance, we also created this free downloadable guide that you can customize to your clinic and provide to your patients.

2. Have hardship processes and payment plans in place.

It’s no secret that out-of-pocket costs prevent patients from seeking care. During our 2019 State of Rehab Therapy survey, respondents named high copays/coinsurance as the number-one barrier to care—a result that aligns with other studies on the subject. And one of the most frequently asked billing questions we come across is, “Can I waive copays or deductibles for my patients?” The short answer is “no” due to insurance contract requirements that prohibit such waivers. (More on that here.) However, to help mitigate the negative impact of high patient copays, every practice should have some kind of contingency plan in place in the event that a patient can’t pay. Having very clear criteria for when it’s appropriate to apply hardship policies or offer payment plans is crucial to avoid any perception of impropriety—or even discrimination claims.

3. Submit claims promptly to ensure patients receive statements in a timely manner.

Obviously, submitting claims on time is absolutely crucial to getting paid, and timely filing requirements are critical knowledge for any RCM expert. If you don’t submit a claim on time, there isn’t much you can do to appeal the resulting denial. That said, there may be circumstances in which you don’t meet those requirements—despite your best efforts (e.g., a patient might fail to provide his or her insurance information in a timely fashion). Even in these scenarios, you likely won’t be able to balance bill the patient (depending on your state’s laws and the payer’s rules).

So, what to do? To start, you should attempt to appeal the denied claim with the insurance payer. It's not 100% guaranteed that the payer will accept the appeal and pay the claim. But if you prove you made reasonable attempts to collect the patient's insurance information in a timely manner, there's a pretty good chance the payer will accept your appeal (as stated here). Also, documenting all communications regarding claims—including names and dates—with both patients and insurance companies is crucial to making a strong appeal.

4. Quickly resolve incorrect charges and billing errors—and deal with denials.

Additionally, make sure you’re following up with patients who have inquired about such errors in a timely fashion. As I mentioned above, if a claim was denied, most states will not allow you to balance bill the patient. That means it’s extra important to follow up on claim denials promptly. Here’s a trick for dealing with denials: there are actually several stages of the appeal process. If your appeal is rejected during the initial stage—and you feel it really should’ve been accepted—don’t take “no” for an answer. Instead, ask the payer to review your appeal. In most cases—as long as your appeal has merit—it will be accepted. Unfortunately, most providers don’t know this and end up cutting their losses too early.

5. Designate a go-to person in your clinic to field patient questions regarding billing.

Not every practice can afford to have a full-time billing person on staff, but someone in the clinic should be familiar enough with the process to provide answers to frequently asked questions—and know where to direct patients who have more complex questions. That said, everyone on staff, including therapists, should understand the claims process and how to respond when a patient asks why a service costs the amount it costs; to that end, making sure everyone in your practice understands how you set your rates is also imperative.

6. Track NPS® data to clue you in on what areas of your RCM processes need attention.

The value of tracking the patient experience—as well as your patients’ perception of you and your practice—with tools like Net Promoter Score® (NPS®) simply cannot be undersold. No matter how stellar your clinical outcomes are, when it comes time to pay the bill, a patient’s experience will usually outweigh all else from that patient’s perspective. By understanding how your patients engage in their care journey, you can identify your strengths and weaknesses as a provider. But this isn’t exclusive to the treatment process: tracking the patient experience early and often throughout the course of care can clue you in on any areas of your RCM process that may require some TLC. And because cost is such a big factor in whether or not a patient even elects to seek care, it’s easy to see why a shaky RCM process could seriously impact his or her experience during therapy.

7. Provide easy options for patients to pay their copays and deductibles at the time of service.

Furthermore, having an easy solution for accepting patient payments is a non-negotiable. Not only does having a smooth, immediate payment process improve the patient experience, but it’ll also save your front office staff the headache of using multiple systems. And of course, your staff’s happiness has a direct impact on your patients’ experience—as well as their perception of your practice.

8. Include an FAQ page on your website with common patient billing questions.

As WebPT’s Kylie McKee mentions here, more and more, patients form their first impression of you as they scroll through your clinic’s website. So, why not start things off right? In addition to including a list of accepted insurances, be sure to have an FAQ with a list of common, billing-related questions. Some good questions to include are:

  • Will my insurance cover therapy?
  • Even if my plan covers therapy, will there be any out-of-pocket costs?
  • What are my payment options?
  • Are there any discounts if I pay out-of-pocket?
  • Can I set up a payment plan?

9. Host inservices (i.e., internal training courses) with therapists, so they understand the full patient billing process.

Continuing education is a great way to show you’re not just talking the talk without walking the walk, and it’s also a solid investment in your providers. Plus, it’s important to equip providers with answers to any questions that come up in their conversations with patients. As I mentioned above, patients trust their therapist and may feel more comfortable asking him or her for this information.

10. Check all patients in and out.

Lastly, be willing to guide your patients through the entire billing process—literally. From the moment they check in to the second they leave the clinic, your patients should never be left wondering where to go or who to ask for help. During my years in private practice, we made a habit out of walking every single patient up to the front desk to check out. Not only did this ensure patients were scheduled for their next appointment—and all paid up on any outstanding charges—but it also gave patients one more chance to ask any last-minute questions. It was a warm handoff to the person who was better suited to provide details or follow through on anything my therapists may have discussed during their treatment time (e.g., additional services, supply purchases, or setting up the next appointment).

At the end of the day, your RCM process can make or break your patient’s experience. If it breaks, you risk losing that patient—along with any potential word-of-mouth referrals—to your competition. But if you make it, you can win that patient over for life—and you can take that to the bank. 

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