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By Stephen W. Earnhart, RN, CRNA, MA
CEO, Earnhart & Associates, Austin, TX
More facilities are facing fallout with patient facility fees due after surgery. Many self-pay portions of surgical fees are delinquent and often end up in collection, which is a no-win situation for everyone.
We have always been an advocate for collecting the self-pay amount of the facility fee before the patient is processed. If it’s collected after surgery and when they go home, your chances of recovery diminish significantly.
With all the miserable health insurance in the marketplace, and with the potential patient cost share approaching 25% of a facility’s potential revenue — and expectations that it will continue to increase — it is time for a new approach.
Facilities must accurately calculate the patient responsibility, communicate that information to patients quickly and efficiently, and contact the patient with payment options. Most facility business office staff valiantly try to manage this, but in most cases, they simply do not have the resources and available time.
Calculating patient responsibility is complex and time-consuming. There are so many variables to consider, including payer contract terms, narrow networks and self-funded plans, tiers, the patient’s benefit plan, and the facility’s business rules regarding payment options, out-of-network and self-pay policies. It is no wonder that many facilities fall short on collection of money earned and owed.
One solution is to load your facility’s payer contracts into a cloud-based software tool that can manage any type of payer arrangement. Such a software tool should communicate directly with your patients, via email or text, to inform patients what their estimated responsibility will be for their upcoming surgery, including their unmet deductible and patient pay responsibility. Such software might even include different payment options for patients to consider before surgery.
We recently discovered such a solution. I cannot do justice to this new software in this column, but it amazed me, and we are now installing it in all our facilities. You might want to check it out and see how it can significantly help in your collections.
(Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates can be reached at 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. Email: firstname.lastname@example.org. Web: www.earnhart.com.)
Financial Disclosure: Editor Jonathan Springston, Editor Jill Drachenberg, Editorial Group Manager Terrey L. Hatcher, Author Melinda Young, Physician Editor Steven A. Gunderson, DO, FACA, DABA, CASC, Consulting Editor Mark Mayo, MS, Nurse Planner Kay Ball, RN, PhD, CNOR, FAAN, and Author Stephen W. Earnhart, RN, CRNA, MA, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.