Over the past decade, the relationship between patients and providers has become more transactional. Today most patients chose health plans that incur high deductibles, high co-pays, and fewer premiums. For example, 81 percent of covered employees in the U.S. have insurance plans with deductibles and 68 percent of covered workers have a co-pay. In smaller businesses, 63 percent of employees have a deductible of $1,000 or more, and 36 percent have a $2,000 or higher deductible. Despite these ‘predictable’ expenses, few patients adequately anticipate their out-of-pocket costs and plan their expenses accordingly. A decade ago, patient payments generated about a tenth of medical practice revenue. Between 2009 and 2015, providers witnessed a 68 percent leap in out-of-pocket payments from insured patients, creating a host of challenges for effectively collecting patient responsibility. Below mentioned suggestions in your workflow could help you to predict and collect up to 95 percent of patient responsibility without any delays.
Effectively collecting patient responsibility requires two strategies. The first strategy is, proactive front-end operations to predict and collect accurate patient responsibility at the time of service. The second strategy is, quick and error-free claim submission processes to move claims out the door as promptly and cleanly as possible so that payers will be paid quickly. As you submit claims quickly, you will receive payer response quickly and you can send patient statements in 30 days in case of any missed patient responsibility. When it comes to collecting patient responsibility portion, time is money and speed is of the essence. Only 21 percent of patient balances that remain on the books for 120 days are ever collected. In other words, 79 percent of 120-day balances go down the drain. Billing the patient within 30 days of the time of service is crucial to stay ahead of the ‘collecting within 120-day’ rule.
Ensure accurate patient demographics and insurance data: Outdated or incorrect patient demographics and insurance information can result in insurance denials. To prevent this, ask for the patient’s contact and insurance information when the appointment is made and again at check-in. Almost every payer asks you to create an account in the provider portal, you can verify patient demographics and insurance information with a few clicks.
Verify insurance coverage and benefits: For every visit, you must verify the patient’s insurance coverage and benefits. Any service provided without eligibility verification could lead to non-payment. Take out eligibility reports and review deductibles, benefits, co-payments, and other patient responsibilities. Based on the patient’s benefits and how much of their deductible has been met, estimate the extent of the patient’s financial responsibility for the visit. If required obtain necessary referrals or prior authorizations.
Communicate with the patient: Proactively communicate with your patients about services to be performed, how much will be their portion and the mode of payments. This clear communication about services and patient portion helps to build more trust towards practice. If required ask patients to talk to their insurance rep, to cross verify the total estimated cost for the service and patient responsibility.
Payment at the time of service: Remind patients about their responsibility to pay at the time of service in your auto-dialed, emailed, and mailed appointment reminders. Once the patient leaves your practice, it becomes really difficult to chase them for pending payments. More follow-ups for outstanding patient payments increase nothing but frustrations and practice expenses.
Focus on 100 percent collection: When the patient arrives or prior to the patient’s departure, your front-end staff should ask, “How would you like to pay today?” You have to set your communications and processes to collect 100 percent of patient responsibility every time.
Multiple payment methods: The greater the number of payment methods accepted, the greater the patient’s willingness and ability to pay. Options to consider include debit cards (including HSA and FSA), credit cards, cash, mobile payments, PayPal, and others.
Clean up outstanding balances: After implementing same-day payment policies, outstanding balances should not be an issue. If there was an unexpected insurance rollover and it hasn’t been paid, staff should ask how the patient would like to pay for it. You can take a printout or email a soft copy for an explanation of these outstanding balances.
Create a payment plan: If the amount due is beyond the patient’s ability to pay, create an easy-to-implement payment plan. For example, your practice management system should be able to automatically charge the patient’s debit or credit card according to an agreed-upon timeline. Many billing software allows you to save your patient’s card details and you can charge as per discussed payment plan.
The above suggestions will definitely help in effectively collecting patient responsibility at the time of service. All these suggestions are based on assumption that you have skilled and well-trained manpower to handle these revenue cycle activities. If you don’t have skilled manpower or struggling with high manpower attrition then think about outsourcing. MedicalBillersandCoders (MBC) can help you in collecting more patient responsibility within 120 days. We will share patient eligibility and benefits reports prior to patient visits and also obtain prior authorizations. Our revenue cycle experts will ensure more than 90 percent of clean claim submission, helping you collect quickly from payers also. To know more about our overall medical billing and coding services, contact us at firstname.lastname@example.org / 888-357-3226Back