Overview
Copay collection and other aspects of patient collection strategies have taken a top priority in the revenue management of practices across the United States. Over the past several years, deductibles and healthcare insurance premiums have risen dramatically. Patients are increasingly paying more out-of-pocket than ever before for their medical services. While 92% of the population had insurance in 2019, the cost to patients continued to skyrocket.
Tool: Check if your EMR has the BEST PRACTICES list for collecting payment upfront for all practices.
For practices, the collection process has to be handled expertly and efficiently. Many practices struggle with various strategies to bridge this collection gap. In the old model of billing, healthcare organizations routinely billed insurance carriers first. Billing for patients was after the visit. This model worked earlier because a bulk of the revenue cycle management was covered via insurance payments and government entities, such as Medicare. Patient payment accounted for a relatively small percentage of the yearly revenue at that time.
Patient responsibility has been on the rise for several years. From 2012 to 2017, patient payments rose by 88% in hospital revenues and this trend continues. For your practice, developing solid patient collection strategies that meet the clinics’ financial needs while catering to the patient’s budgetary requirements is essential. This has been the crux of the issue.
Many patients simply can’t afford to pay large bills upfront. While organizations are concerned about their patient’s continued care, they also need to maintain the revenue cycle management process. There are excellent strategies that your practice can employ to prioritize the patient’s needs and your RCM requirements.
Tools: Utilize eligibility feature to check benefits, refer to patient outstanding balance reports and analyze copay/deductible deficit report.
Suggest using a flat fee for patients who have deductibles, such as $50 per office visit and $100 per procedure.
Patient Collection Strategies for Your Practice
There are several considerations with patient payments. In the last year, telemedicine options have increased dramatically. Virtual visits may change your usual patient payment procedures to accommodate for the fact that the patient is not physically present to provide payment. This means more than simply switching to an online or phone payment model. Patients may still need help to manage their payments, so the practice needs to be flexible in creating options for patients in these circumstances.
Note: Provide an option for the patient to pay on the portal prior to the telemedicine visit. This improves the process for practices because it eliminates the need to follow up for payment.
There are some excellent tips from the AMA on collecting patient payments through point of care payments and billing after visit options. The following strategies can help your practice improve patient payment compliance:
Develop a flat fee payment method. For patients who have deductibles, develop a flat fee schedule so that they’re paying a portion of their responsibility in advance. A schedule might look like $50 per office visit and $100 per procedure.
Assess your revenue cycle management. This is first and foremost. In order to develop a good strategy for patient payments, you need to know how well your office is currently performing. Start with an audit of your current process. To judge the success and failure of your current process, analyze your outstanding balance along with the percentage of payments made annually.
Tools: For collecting payments upfront, check the patient’s outstanding balance at check-in/front desk, oversee patient appointment reports. Check patient aging on the dashboard, and run the patient aging report.
Open up a line of communication with patients. You can gather information by asking them questions when they arrive or via a short survey when they check into their patient portal. The best way to meet your patient’s needs is to know what they are. Practices often don’t ask direct questions about billing preferences and that makes them less likely to receive payment in a timely fashion.
Find out how your patients prefer to pay, do they understand the payment process, and whether your practice is meeting their financial counseling needs?
- Tool: Communicate with your patients proactively about their payment options.
Offer financial counsel. One problem for patients is the fact that they often don’t know what they will need to pay before the bill arrives. This can be an issue for practices, as well. There may be procedures that are necessary but not scheduled. That can change the cost of a visit dramatically. It’s important to maintain good communication with your patient to help them understand current bills and develop a payment schedule when necessary.
- Tools: Utilize the patient’s benefits print outs and come up with a payment plan
Help patients understand insurance coverage. Healthcare insurance is not always the easiest thing to understand, even for medical professionals. Imagine how confusing it is for the patients sometimes. While this may seem outside the scope of your responsibility, it’s to your practice’s benefit and your patient’s to help them understand their coverage.
- #TIP 1: Print out the eligibility details showing patients their benefits.
Make billing statements simple. The patient should easily understand their bill. Some practices make that slightly difficult and this can be hard to determine because your staff already knows what the billing means. Having an outside party look over your bill can give you a second set of eyes on whether they are easy to understand. This is especially true if patients have mentioned confusion about billing.
- #TIP 2: Check if the format and output of the patient statement can be customized.
Stay up to date with coding requirements. Medical coding changes frequently and it’s imperative that you stay up to date because the claims cannot be processed with the wrong coding. For instance, in 2021 we’ll see an update to the evaluation and management service code.
Note: Providers should revisit fee schedules annually and check if their Revenue Cycle Management can do a proposed fee schedule analysis.
Offer payment options. Patients often have different preferences for payment. It can benefit your practice to offer a variety of payment options and allow your patient to choose the most convenient.
Patient payment responsibilities are a much larger percentage of most organization’s yearly revenue than they were five years ago. As patients continue to pay a much higher amount out-of-pocket, they have also become far more frugal about their provider choices. Many patients do research for their medical treatment in the same way that they traditionally researched large consumer purchases. Excellent patient care doesn’t end at the medical treatment. Patients also need excellent resources and communication in every aspect of the process, including billing.
PrognoCIS Tools for Prompt Payment and Collections Strategy
PrognoCIS delivers tools to help your practice communicate with patients to ensure they understand their payment responsibility ultimately leading to prompt payment and collections.
- Provides Best Practices list for collecting payment upfront for all practices.
- Offers eligibility check for benefits and outstanding balance and deficit reports to show how an upfront loss in collections upfront.
- Works with Clearinghouses to provide patient estimator tools.
- Provides an option for the patient to pay on the portal prior to the telemedicine visit. This improves the workflow for practices because it eliminates the need to follow up for payment.
- Offers a collection module to collect payment upfront
- Allows you to match your office financial policy offerings.
- Patient’s benefits print outs and payment plans can be tracked in PrognoCIS.
- Customize the format and output of the patient statement
- PrognoCIS RCM can do a proposed fee schedule analysis.
3 Best Practices to Maximize Patient Collections
The inability to collect on a debt is a huge detriment to revenue. You can, however, maximize patient collections with these best practices. Online medical tools are at the forefront of managing the practice’s finances. Practice management software and patient portals are keys to tackling the debt
We live in an era of high copays and high deductibles, which unfortunately means huge medical bills for patients. When patients are unable to pay these bills, practices suffer the consequences. Let’s look at some of the data regarding healthcare collection and debt.
The Association of Credit and Collection Professionals (ACA) notes the average recovery rate of collections and debt to be about 15.3 percent by hospitals, and 21.8 percent by non-hospitals. Additionally, in 2012, hospitals reported an increase in charity and bad debt cases (5.93 percent of their total second-quarter 2014 compared to 5.09 percent in the first quarter), amounting to $45.9 billion in uncompensated care. The Medical Group Management Association (MGMA) reports a startling 60% collection rate for copays for medical practices.
Tackling the problem of medical debt is difficult because of the many approaches to resolving collection workflow. There are, however, a few best practices that can improve the patient collection percentage. PrognoCIS strives to keep its clients debt-free by offering user-friendly practice management software and expert Revenue Cycle Management (RCM) services to combat debt. Here we compile a list of best practices from our RCM billers and leading financial management groups, to help you stay debt-free.
1. Educate your patients
Education is the foundation for successful account resolution. Education means effectively communicating with patients about bills and financial agreements, prior to the time of service. Bills should be clear, concise, and in language, patients can understand. Be sure to:
- Create firm account resolution policies and make sure they are followed by both staff and patient
- Be consistent in all aspects of account resolution, from payment policies to billing disputes
- Communication between partners and associates about account resolutions to avoid mismanaging accounts
- Exercise good judgment about the best ways to communicate with patients about bills
- Start the account resolution clock when the first statement is sent to the patient
- Report back to credit bureaus when an account is resolved (in the event that an account is reported to a credit bureau)
- Consult outside sources like the Healthcare Financial Management Associate for tips on account resolution
- Understand patients are human and are prone to error. Check to see if there is an error on your side before pursuing account resolution
2. Purchase a practice management system (PMS)
Medical billing software is essential to your collection process. It enables you to electronically track bills, automate late fees, and identify patients who are behind on payments. A PMS expedites the collection process as it allows billers to multiple records from one screen.
Better yet, utilize a practice management system that is integrated with your electronic medical records (EMR). An integrated EMR/PMS system ensures accurate information to be conveyed both ways, which is essential for billers to process fees. An integrated system allows billers access to the medical record side of a system when resolving accounts—information straight from the proverbial horse’s mouth. PrognoCIS offers comprehensive practice management software in addition to an integrated EMR/PMS system.
3. Promote online payments via your patient portal
Payments should be easy and stress-free. Promote online payments via a patient portal as a way to give patients the convenience of paying through a secure connection from the comfort of home. Online payments save time and resources as you don’t have to deal with physical paperwork, and you can collect payments faster.
Not only will online payments help patient collections, but it also allows you to promote your patient portal. A patient portal is the foundation of online medical care and a gateway between provider and patient. The portal supplements the patient experience by keeping patients involved and educated, which leads to better health outcomes.
Maximizing Patient Collections is Essential to Your Practice
The growing trend of higher deductibles and copays with health insurance gives patients increased responsibility for their healthcare. As patients receive more responsibility, more pressure is put on providers to collect payments, as payments are a significant portion of revenue. By enabling best practices in the patient collection, medical practices will maximize their earning potential and keep their patient collection percentage high.
