Taking charge of patient payment woes

Assertiveness, good computer systems help

It’s another day at the office and another day of chasing down money patients owe your practice. Between scheduling patient appointments, making sure new patients fill out all the forms your practice needs to set up a patient file, scheduling surgery time for your physicians, obtaining precertification approvals from insurance companies, and pulling patient charts, your receptionist simply didn’t have time to collect copayments before each patient left the office. As a result, to collect payment, you’re tracking down every patient physicians at your practice have seen in the last month. You’re keeping your fingers crossed when they tell you the check is in the mail.

There are ways to collect payments from clients before they leave your office, practice administrators and consultants say. The keys: good billing software, stating payment expectations upfront to patients, and assigning a non-physician staff member who is assertive yet tactful when it comes to collecting payments.

On the face of it, collecting payment at the end of a patient visit seems very straightforward. A practice really only needs to do about three things right, says Richard Motley, administrator of the Hannibal Medical Clinic in Hannibal, MO.

First, the practice must communicate to the patient that he or she is responsible for the charges incurred. Second, the practice needs a billing system that can correctly identify the patient’s insurer and calculate the portion of the bill for which the patient is responsible. Third, somebody has to ask the patient for payment.

That sounds simple enough. So where do practices encounter difficulty?

Many practices drop the ball when it comes to explaining the patient’s responsibility for the tab. In many physician office waiting rooms you see a sign informing patients that payment is expected at the time service is provided. That alone is not enough.

Stress personal responsibility

When a patient arrives at the office for his initial visit, he completes a form with personal infor mation such as a medical history and insurance information. That form should also authorize assignments of insurance payments to the doctor’s office so the doctor receives the reimbursement directly, says Mel Kantz, PhD, owner of the Signal Hills, CA-based Practice Marketing and Billing consulting firm. On subsequent visits, make sure the patient has not changed insurers.

The more successful practices also require that the patient or the patient’s guardian sign a form stating that they understand that the patient is ultimately responsible for any charges incurred.

In addition to the written acknowledgement, Kantz recommends that someone at the practice take time to explain what the assignment authorization accomplishes and what it does not accomplish, Kantz says. Make sure they are clear about their financial responsibility. Many offices don’t do that. "People just know that they go to a doctor’s office, and they are expected to sign something," he says.

Some practices believe repeating the payment expectations message has a lot to do with their collections success. "I think patients need to hear three times what the payment expectations are," says Kim Pollock, RN, MBA, formerly the administrator for the 11-physician otolaryngology practice at the University of Texas Southwest in Dallas.

Her group first tells patients what’s expected at the time they make their appointments. They are reminded when the practice calls to confirm the patient’s appointment. They are reminded again when they check in for their office visit.

Adequate billing systems generally are not a problem for most practices as long as they have been upgraded recently, says Motley. Given the patient’s name and current charges, the system should be able to calculate what portion of the charges the patient must pay.

What complicates the process is a provider’s heavy involvement in managed care, says Kantz. "Managed care contracts are very different, even though they may be run by the same company. Depending on the employer group, the copayments are going to be different — $5 for this employer group, $10 for this one, $7.50 for this one," he says.

And many employers offer several plans to their workers. It’s important that a practice’s billing system be able to accommodate several plans per employer group, advises Pollock.

Once you have the right software in place, front office personnel need to stay current in processing all changes communicated by insurers. If they don’t, the practice is going to miss out on copayments. "It is all a matter of information available to the front office people, and a lot of errors are made right there," Kantz says.

Many small practices in particular find it difficult to keep up with all the insurance changes. Firms like Kantz’s can be contracted to track the changes for all area insurers, keeping a practice’s billing system current.

Most important of all, someone at the practice needs to request payment during the patient’s visit.

"Where you probably find the most egregious errors being committed is by the practitioner himself or herself in the sole practitioner office," says Kantz. For example, some providers know they should be requesting a payment at the time of the visit but simply can’t bring themselves to ask for it.

"Some of my clients who are mental health professionals see it as a contamination of their therapeutic relationship. Others simply have a difficult time without even trying to rationalize it," Kantz says.

Unless there is absolutely no way around it, you don’t want your doctors asking for money, says Motley. "They are very bad at that," he says. Physicians see themselves as healers, nurturers. "They don’t want to inflict any pain on patients by asking them to pay."

Practices that succeed in collecting payments live by these simple rules:

• Hire someone experienced in dealing with the public to collect fees. He or she must be polite and never condescending. New people are prone to errors, so try to hold onto a clerk that performs well, Motley advises.

• Train clerks to ask how patients would like to pay, not whether they would like to pay.

It takes practice for clerks to ask for payment successfully, says Pollock.

• Get copayments before the patient sees the doctor.

"If the patient is in an HMO and you know every time they see the doctor it’s $10, get it when they check in rather than when they check out," Pollock says. "If you wait [until after the physician visit], some patients have a way of finding the back door so they won’t have to make their copayment."

It’s imperative that a practice offer a variety of payment options. "We are doing more with credit cards because people are used to charging," Motley says. It also takes away the popular excuse that the patient forgot his or her checkbook.

Pollock highly recommends that fellow administrators check out a program offered by San Mateo, CA-based credit card company Visa USA. [Editor’s note: Practices interested in learning more about the Visa Health Care Program may call (800) 847-2311.] Under terms of the program, patients sign a waiver that allows a physician practice to transfer any unpaid balance to the patient’s Visa account after a specific number of days the practice chooses.

• Avoid confusion over point-of-service plans.

One of the most difficult challenges for billing clerks is collecting appropriate payments from patients who participate in a point-of-service (POS) plan. Because the POS patient may have several options available, office staff often get confused about which plan applies to a given office visit and what copayment should be collected.

The way to avoid the confusion is to implement a strict pre-registration policy at the office, says Pollock. Essentially, the practice forces a patient to choose his payment option at the time an appointment is made.

"You cannot wait until the patient gets to the door to start collecting the insurance information," says Pollock. Get the particulars of their insurance arrangements when the appointment is scheduled. When you determine that a patient has a POS plan through his or her employer, immediately ask what option the patient will use for that visit.

"Ask them at the time, ‘Will you be using the HMO option or the PPO option?’" says Pollock. Remember that pre-registration needs to happen at least 24 hours before the appointment, she says. "If the patient chooses the HMO option, you have got to make sure you have a [primary case physician] referral."

Finally, realize that no one is perfect when it comes to getting patients to part with their money at visit’s end. Some people flatly refuse and demand that you bill them. "People come up with all kinds of excuses," says Motley. But you certainly increase the likelihood of success when you ask them nicely.