With shrinking margins, rising deductibles and copayments, and these tough economic times, it has never been more important to collect patient responsibility portions at the time of service or, in the case of procedures, in advance as a deposit. Successful time of service (TOS) collections is a collaborative effort between the physician and staff. After reading this article, please share it with staff and talk about fine tuning these efforts in your practice.

Patient Responsibility Portions

Patient Responsibility (PR) portions are co-payments, co-insurance, deductibles, and charges for uninsured and underinsured patients. Co-payments are flat dollar amounts that commonly range from $10 to $50 but can be higher. Co-insurance refers to the PR portion based on a percentage of the allowable. The most common coinsurance is 20 percent (ie 80/20 plans). Deductibles are the PR portions that get the coverage to kick in each calendar year. Deductible amounts range from $250 to $10,000 and higher. The deductible and other PR portions are the carriers’ ways of making sure the individuals are actively participating in the economic responsibilities of their healthcare, making them an integral part of the triad agreement between patients, providers and health insurance companies regardless your participation with the individual plan. Patient responsibility amounts are getting higher, becoming a much larger portion of a practice’s revenue stream.  Finally, it costs $7-10 to generate a statement that may not be paid upon receipt.  The value of the receivables diminishes the more time it goes uncollected. Collecting at the Time of Service (TOS) is much more effective in both results and cost.

Collect copayments before the visit because they are flat dollar amounts regardless of the level of service provided. Co-insurances must be collected at the point of check out because they are percentages of the allowables, which vary depending on the type, level and number of services performed during the visit. Collecting co-insurances at TOS requires having all of the payor schedules loaded into the practice management software and a streamlined, service oriented check out process.  If you have not implemented a process to collect co-insurances at TOS, it makes the most sense to start with traditional Medicare (with no secondary) patients. The Medicare allowables are readily available and typically only change once a year. As well, co-insurance amounts for Medicare are so low, that at a practice cost of $7-10 to generate and mail a statement, it can be a loss or a wash for the practice to send bills to patients for Medicare coinsurance amounts.

Pre-Procedure Deposits

The best time to collect the patient responsibility portion for a scheduled, elective procedure is before because:

• You cannot repossess the procedure;
• Need and payment are aligned; when the patient feels better, payment becomes less likely;
• Most importantly, by paying before, the patient can concentrate on recovering after, not worrying about the bill.

Research and itemize the PR portions for a procedure on a financial counseling form prior to having a conversation with the patient that culminates with the collection of the patient responsibility amount. 

Previous Balances

TOS is also the perfect time to collect on prior patient balances. Face-to-face conversations are much more likely to be successful than mailed statements or phone calls. Have staff run a schedule for the following day of clinic with outstanding patient balances. They can then identify those patients coming in for follow up who have outstanding balances and have them talk with the appropriate person before the visit with the physician.

Physician Support is Essential

The physician is in the position make the TOS collections efforts a success or a failure. Patients will ask the doctor about the bill or payment. If the physician says, “Don’t worry about the bill,” he/she undermines all efforts to secure payment. I have often joked that this is the only bit of (medical) advice your patients will follow. Do NOT say, “Don’t worry about the bill,” or “Maybe your insurance will pay,” to your patients. Instead, say, “I know you must be concerned about that, when I am finished examining you, I will introduce you to Connie Collector, who is better suited to help you on that subject.” Physicians, remove yourselves from that discussion, leave it to staff. Give staff the confidence that you support them in the patient collections efforts. Staff can convey compassion while collecting far more easily and effectively than the physician can by virtue of the different role they play in the patient’s care.

Similarly, for pre-procedure collections, the notion of a required deposit must be supported. If the physician is clearly going to do the procedure regardless deposit collection, then success will be hit-or-miss. If the physician is supportive of postponing elective procedures, this will allow the patient more time to settle the PR portion before the procedure in keeping with idea of a true deposit.

Word Choice + 10 Seconds of Silence = Successful TOS Collections

When practice staff are successful at securing TOS payments, they have achieved a delicate balance of compassion and collections – not easy.  Even employees with a knack for it, have benefited from a few pointers regarding: presentation, word choice and well placed silence. 

• Itemize and define the charges. “Your copayment for the office visit today is $25,” is much better than, “That’ll be $25.”
• Offer payment options, “We accept cash, checks and all major credit cards. How would you like to pay today?” is much more likely to succeed than, “Would you like to pay today?”
• Well placed silence is golden. After telling the patient there is an outstanding balance of $225 and saying, “We accept cash, checks and all major credit cards. How would you like to pay today?” if the patient does not pull out a wallet or pocket book, wait don’t say anything even if the silence is a little uncomfortable. More often than not, staff undermine their own collection efforts by speaking first in this situation. The patient will respond, by paying or broaching the topic of a partial payment. Wait out the silence and let the patient be the one to speak first at this point.

Jennifer A. O’Brien, MSOD, has been in practice management consulting for 24 years and is currently the executive director of Arkansas Specialty Orthopaedics in Little Rock, where fellowship trained orthopaedic subspecialists help Arkansas’ physicians help their patients. Visit us at arspecialty.com.

Tags:

Bookmark:

Facebook

Technorati

Newsvine

Google

Related: