With more patients opting for High Deductible Health Plans (HDHP), the total percentage of patient payments has increased significantly in the last few years. A recent survey report regarding healthcare payment patterns reveals that about 35 percent of provider revenue comes from patient pay. Timely collection of patient payments is the key to the financial sustainability of your practice.
As every patient is different, every patient payment collection offers a unique challenge. For managing such patient payment collection challenges, we shared some guidelines along with case scenarios. We discussed scenarios where a patient is unable to or doesn’t pay a co-pay or refuses to pay a bill for services provided.
Managing Patient Payments Challenges
- Obtain the patient’s signature on an appropriate HIPAA-compliant authorization prior to any procedure or treatment charged on a credit card to ensure that you can provide the credit card company with any information requested regarding the nature and scope of the service in the event of a subsequent dispute. Have a written payment plan, signed by the patient.
- Set a limit on allowable credit card charges. The limit can be a dollar amount or a percentage of the total treatment charge; for example, $3,500, $5,000, or not more than 50 percent of the procedure cost.
- Ensure your front desk staff recognizes correspondence regarding disputed credit card charges and brings it to your attention promptly. The inquiries often have a specific deadline for responding, and failure to comply with the deadline may impair your ability to collect the outstanding balance. It is necessary to make a response that is in accordance with federal and state privacy laws.
- Follow the good practice of resolving financial disputes in an amicable and professional manner when possible. Clear communication of financial responsibility is critical.
- Obtain a reference for patient credit applications. This will ultimately assist you in locating the patient if the account needs to be sent to a collection agency.
- Set a specific time limit on any adjustments or revisions to the original procedure (such as 60 or 90 days from the original procedure date). Otherwise, a patient could return years later and request a revision that was discussed when the procedure was first done.
- Identify poor payers early and deal with the problem proactively. Do not wait until the situation reaches a crisis point that jeopardizes your doctor-patient relationship and creates a risk of adverse comments on social media. Maintaining a good doctor-patient relationship may help you avoid negative comments posted online or retaliatory lawsuits for medical malpractice.
Payments Scenarios
Scenario 1: An established patient receives care but is unable to pay.
Ideally, talk with the patient first. Find out why the bill has not been paid, is there any dissatisfaction with the provided care? After your discussion, you can consider alternative financing options, including a monthly repayment plan and bill collection. You should have a written document summarizing the practice’s policy on financial matters that can be given to each patient during the initial visit.
The practice should have a policy and apply it consistently in a non-discriminatory fashion. Often, signage at the reception desk indicating that payment is expected at the time of service is an appropriate way to notify patients. When you can, remind patients that they received a copy of your policy at the time of the first visit. It makes handling such scenarios of non-payment easier.
If you decide to terminate the patient relationship for non-payment, you must follow a formal process that includes giving the patient proper notice and treating emergencies in the interim.
Scenario 2: The patient is dissatisfied with the result of an elective procedure and demands a concession (a free revisit, a refund, or a discount).
Selecting the correct patient, providing very thorough informed consent, and keeping the lines of communication open are the best ways to defend against patient dissatisfaction. If, however, a patient who is dissatisfied asks for compensation, evaluate the situation from professional liability and compliance standpoints.
In some situations, making a concession may be viewed as a courtesy gesture and maybe a positive factor in the defense of a claim. Payer-provider agreements often specify the circumstances under which a refund or waiver of some portion of a bill is permissible.
Scenario 3: Refusing to establish a doctor-patient relationship based on the patient’s inability to pay.
As long as the patient is not seeing you based on a referral from an emergency department (ED) where you were on call when the patient was seen. If that is the case, determine the hospital’s requirements as established in its medical staff bylaws and rules and regulations.
You must follow those requirements. At a minimum, it is likely you will be required to see the patient at least one time to determine status and whether the patient has an emergency medical condition that qualifies under the Emergency Medical Treatment and Labor Act.
If the patient needs emergent treatment, you will likely be required to provide care regardless of the ability to pay, although you can ask for payment or payment arrangements.
If the patient did not come to you as a result of ED, you can verify patient coverage and can refer to the policy of not accepting patients who cannot pay. Give potential patients some indication of your practice’s financial requirements when they make an initial appointment for treatment.
In addition, posting a notification on your practice website helps communicate the policy and avoid any subsequent disputes or misunderstandings. You should have a biller doing eligibility and benefits verification for every patient and communicate your decision about whether to accept an individual as your patient.
Consider including a disclaimer regarding the doctor-patient relationship on the practice website and on data collection tools i.e., preliminary healthcare and insurance questionnaires. The disclaimer should state that the practice does not deem an individual seeking treatment to be a patient until a preliminary assessment is concluded and the individual has been notified about being accepted as a patient.
Similarly, advise prospective patients at the outset that simply making an appointment or returning a completed health questionnaire does not automatically trigger the relationship. You should have an insurance coverage report for all appointments, otherwise, if the patient arrives for an appointment and you decide not to accept him or her for financial reasons, your decision may appear questionable.
Note that the scenarios and tips suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome, they are shared just as a reference for managing patient payments collection challenges. If required you can opt for our ‘eligibility and benefits verification services’ for accurate patient coverage reports to avoid such scenarios.
MedicalBillersandCoders (MBC) is a leading outsourcing medical billing company providing complete revenue cycle management services. To know more about how we can assist you for better collection of patient payments, contact us at info@medicalbillersandcoders.com/ 888-357-3226
FAQs:
1. Why is timely collection of patient payments important?
Timely collection of patient payments is crucial for the financial sustainability of your practice, especially as more revenue comes from patient pay due to High Deductible Health Plans (HDHP).
2. What are some common challenges in collecting patient payments?
Challenges include patients being unable to pay co-pays, refusing to pay bills, or financial disputes over services rendered.
3. How can practices improve patient payment collection?
Practices can enhance collections by setting clear financial policies, obtaining patient signatures for credit card authorizations, and having open communication about payment responsibilities.
4. What should I do if a patient refuses to pay?
Engage in a conversation to understand their reasons for non-payment, explore alternative financing options, and remind them of your financial policies shared at their initial visit.
5. Can I refuse treatment based on a patient’s inability to pay?
You can refuse treatment if the patient is not an emergency case or was not referred from an emergency department, but always ensure compliance with relevant regulations and ethical standards.
