Increase patient collections by developing a policy for success

Oct 31, 2014, 4:00am

With high deductible health plans on the rise, patients are expected to shoulder more of the cost of healthcare; yet practices are finding it difficult to collect. In part because patients don't understand their plans; but also because staff may be unprepared to collect patient obligations.

Read Part 1: How high deductibles impact patients, practices

Read Part 3: The technology factor: Tools to help you collect

With high deductible health plans on the rise, patients are expected to shoulder more of the cost of healthcare; yet practices are finding it difficult to collect. Many patients aren’t prepared to pay their portion because they don’t understand how their high deductible plan works and may be accustomed to paying small co-pays at the time of visit. On the other hand, staff is often unprepared to collect high deductible patient portions and may have no policy in place to guide and support their efforts. 

Practices and clinics must change how they communicate about and collect patient payments in order to curtail the rising age and amount in their accounts receivable (A/R) due to the increase in patient responsibility. One of the first steps is to prepare a clear, strong patient financial policy.

By educating and preparing patients about what your practice and their insurer expects from them financially, you improve the odds of collecting in full for what you’ve already earned and contracted for. But before you can support your staff in enforcing the policy and educating your patients, you must create the policy! Here are some tips to help guide you:

  • Document your patient financial policy within your broader existing financial policy. There should be a detailed policy for internal staff’s eyes only, that guides them on steps to take and when exceptions can be made. A summary policy - the patient financial policy - should be crafted for patients to view and sign, outlining their responsibility in regard to any services not paid for by their carrier.

  • Use patient-friendly terminology to reduce confusion. A lack of understanding of what they owe is cited as one of the top four reasons for nonpayment.[1] That means you may need to explain that they could pay for “covered” services if they haven’t met their deductible.

  • Include all the basics, such as: when payment is required, how payment is accepted, when they can expect to be billed, if you will bill secondary insurance, late payment penalties, cancellation or missed appointment fees and payment.

  • Payment plans are often used to help patients pay for medical bills in a reasonably timely manner that they can manage. How payment plans are laid out should be addressed in your larger financial policy. However, offering them to those who indicate they cannot pay in full should be done at that time, instead of offering specifics in the patient financial policy.

  • Create a payment safety net by having patients on the new healthcare exchanges sign a waiver that specifies their responsibility to pay for uncovered services and have a credit card on file in that case. This will offset your risk should they fail to pay their premiums and become retroactively uninsured.

  • Always consult with your legal adviser regarding all aspects of both your internal and public self-pay policies to be sure you are complying with the law and operating within the boundaries of your payer contracts.

Once you have a strong, patient-friendly and defined self-pay financial policy, it’s important that you communicate it clearly to patients as well as educate and support your entire staff to enforce it.

Most patients want to stay in good standing with their physicians financially. Your practice can help them feel good about doing so when they are prepared and communicated to clearly by friendly, helpful practice staff. Begin with your policy, then educate patients by communicating it in several ways (e.g., website and signing at first visit) and lastly, get practice leaders and staff on board to support the goal of getting paid all that you’re owed, sooner and faster!

[1] 2008 Mckinsey consumer healthcare payment survey, quoted in “U.S. Healthcare Payments: Remedies for an Ailing System.” www.mckinsey.com Copyright 1992-2011 McKinsey & Co.