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Collection is not an activity that should occur only after insurance claims are paid, say experts interviewed by Same-Day Surgery. If you want your same-day surgery program to effectively collect all monies that are due, start the collection process at the pre-registration table.
"The biggest positive impact on a same-day surgery program’s collection rate occurs at pre-registration," says Matthew J. Reat, MBA(HOM), senior consultant, Zimmerman and Associates, a Hales Corners, WI-based consulting firm. "You must have the patient’s insurance information up front in order to collect the fees you are due," he adds.
Not only do you need the name of the patient’s insurer, but you also must have checked with the insurer to verify coverage, copay, and deductible, Reat points out. The best reason to have this information early in the process is to be better able to inform patients of their payment responsibilities, he explains. "Patients who are informed at the front end are more willing to pay because they know why the charges are being passed to them and they have time to make payment arrangements," he says.
One way you can ensure patients understand their payment responsibilities is to make sure your employees understand the insurance coverage, says Reat. "I would guess that 60% of the people handling registration responsibilities don’t understand the difference between a copay and a deductible," he says. "How can they explain it to a patient if they don’t understand the terms?" he asks. In-house education that covers insurance coverage terms and definitions will help employees better inform patients, he adds. Check with one of the managed care companies with whom you contract to obtain a list of the most commonly used terms and their definitions, he suggests.
Same-day surgery programs also should be able to help patients with different payment options, says Reat. "Accepting credit cards and offering monthly payment plans are two ways a same-day surgery program can help patients pay their bills," he says.
If a patient at Valley Health Systems in Winchester, VA, is a self-paying one, the facility requires a deposit, says Ann Ryder, corporate director of patient accounts. "We do set up a six- to 12-month payment plan after the patient completes a credit application and shows proof of income," Ryder adds. A copy of a tax return for the most recent tax year is the most common way to prove income, she adds.
While the national average for same-day surgery accounts receivable is estimated at 70 days, her same-day surgery collections average between 35 and 37 days, says Ryder. Part of her success is not just the upfront work, but also a very proactive follow-up program, she says. "We allow 21 days for receipt of payment from Medicare and 30 days for receipt of payment from other insurers," she explains. Once the allowed time has elapsed, a letter is automatically generated to the insurer and the patient explaining that payment has not been received. "Patients receive a letter asking them to contact the insurer to ask them to pay," Ryder says. "This really works well, since no patient wants to be billed for money that the insurer is suppose to pay," she adds.
After this first letter goes to the insurer and the patient, Ryder waits until 40 days from the date of filing the claim to send a bill to the patient. "Because we average less than 40 days in accounts receivable, I have set our direct billing day at 40," she says. Ryder recommends that a same-day surgery manager set a number of days that serves as the trigger date for follow-up. Five days from benchmark you set for your facility or from your average days in accounts receivable is a good rule of thumb, she adds.
Benchmarks are difficult to find for ambulatory surgery, says Ryder. She suggests participating in local or state organizations that collect accounts receivable data as well as national organizations, because local organizations reflect the insurance trends of your area. "Be sure that whatever benchmarks you do use are comparing same-day surgery to same-day surgery," she adds.
For more information about collections, contact:
• Matthew J. Reat, MBA(HOM), Senior Consultant, Zimmerman and Associates, 5307 S. 92nd St., Hales Corners, WI 53130. Telephone: (800) 525-0133 or (414) 425-2189. E-mail: firstname.lastname@example.org.
• Ann Ryder, Corporate Director of Patient Accounts, Valley Health Systems, 629 Cedar Creek Grade, Winchester, VA 22604. Tele-phone: (540) 536-7654. Fax: (540) 536-7681. E-mail: email@example.com.