Improve collections with info and communication

Let patients know up front what costs will be

(Editor’s note: This is the first of a two-part series on improving business office efficiency to reduce accounts receivables and improve cash flow. This month, we look at policies and communications with patients designed to improve collections. Next month, we will look at how to staff your business office and how to make sure staff members use their time wisely.)

Imagine managing your household budget with paychecks that were two, three, or four months late. How would you pay your mortgage, buy your groceries, or feed your family?

Many same-day surgery managers find themselves in similar situations with unpaid claims that reach more than 128 days in accounts receivables. Fortunately, there are many little things that can be done before the claims become so old, say experts interviewed by Same-Day Surgery.

"We reduced our average accounts receivables days from 128 to 38 after I took this position," says Steven Wright, business office manager for Physicians Surgery Center in Daly City, CA. The dramatic turnaround came after Wright evaluated all of the systems in place to gather, document, and submit information for patient claims, he says.

An efficient business office enables you to start the collections process before the patient is ever seen in the surgery suite, Wright says. "The business office staff should begin collecting information at the time of the physician’s referral.

"In a perfect world, we would gather complete insurance information; verify coverage, copays, and deductibles; and receive complete contact information for each patient at the time of referral for every case," he says.

Because this isn’t a perfect world, Wright’s staff members collect as much information as possible from the physician’s office staff, then call the insurance companies to verify coverage and other requirements, he says. "Once we have the estimate of payment from the insurance company, we complete a form that is sent to the patient explaining the expected cost of the procedure and the expected payment from insurance. We state the amount of money that the patient will pay out of pocket and tell them that we will collect this on the day of surgery.

They also give the names and phone numbers of the business office personnel who can answer questions or make payment arrangements for the patients so staff can address any problems prior to the day of surgery, he adds.

In addition to making sure the patient understands his or her financial obligation, getting the correct information up front saves time required to submit corrected claims, says Pam Hooper, RN, administrator of Spring Hill Surgery Center in Little Rock, AR. Recognizing that information can be overlooked when staff members become rushed, Hooper had copy machines placed at the desks of admission personnel so they don’t have to gather insurance cards and other items that may need to be copied for the record, then go to another area in the office to make the copies, she says.

"This not only speeds up the process of collecting information, but we also never leave the patient sitting by themselves, wondering why they’re waiting," she adds.

In addition, you have to make sure that verification of insurance occurs in a timely and complete manner, Hooper explains. A recent performance improvement project at Spring Hill looked at the problems that result from inadequate insurance verification. "We always verify primary insurance, but we found that we often don’t follow up on secondary insurance verification," she says.

Knowing how secondary insurance will pay and under what circumstances can be another way the surgery center can improve collections and cash flow, she points out.

Stick by your policies

Be sure that if you say that your policy is to collect the coinsurance or deductible on the day of surgery, you are ready to do so, Wright says. "You can always be ready to accept a partial payment if you set up a payment plan, but you have to show that you do follow your own policies," he says.

Laurie Nichols, a consultant with Credit Control Co., a Little Rock-based medical collections agency, says, "I don’t see a lot of surgery programs that say, No. We can’t do your surgery.’"

When you don’t collect anything up front, you run the risk of not collecting anything from the patient, she says.

"It’s important that you tell the patients before the day of surgery what they are expected to pay; and if they show up for surgery with no payment or arrangements to pay, be prepared to reschedule," Nichols says. "Physicians don’t want to turn a patient away, but financially, it is a risk for the surgery center and the physician if patients believe they don’t have to pay."

One center regularly turns patients away, and there is never a patient relations problem because the center communicates its policies well before the patient arrives for surgery, Nichols explains.

When you do send a letter explaining the cost of surgery, how much insurance will pay, and what you expect the patient to pay, be sure you use words such as "estimate," Wright recommends.

"There are too many variables that can affect the length of surgery, and therefore, the cost of the procedure," he says. "Include a statement that your figures are only estimates and the final charges will be determined after the surgery is complete."

In all of your communication with patients, be sure to include a direct line to a business office employee who can answer questions and handle problems, Wright suggests. Don’t make your patients navigate a complicated voice mail system, only to have to leave a message, he says.

Also, return calls within 24 hours, Wright adds. "This is not only common courtesy, but it establishes a good relationship that will improve your chances of collecting monies you are owed," he explains.

Another key to successfully managing your claims payments is to review your accounts receivable information regularly, Wright says.

"I check the age of my accounts every day so that I can stay focused on accounts receivables even when I have a lot of other things going on," he adds. "If there’s a systemic problem, I can spot it at 45 days and take steps to correct it before it becomes a big problem."


For more information about improving business office processes, contact:

  • Pam Hooper, RN, Administrator, Spring Hill Surgery Center, 3401 Spring Hill Drive, Suite 155, North Little Rock, AR 72117. Phone: (501) 945-5800. Fax: (501) 945-5850. E-mail:
  • Laurie Nichols, Credit Control Co., 10201 W. Markham St., Suite 104, Little Rock, AR 72205. Phone: (501) 225-2050. E-mail:
  • Steven Wright, Business Office Manager, Physicians Surgery Center, 901 Campus Drive, Suite 102, Daly City, CA 94015. Phone: (650) 991-2000. Fax: (650) 755-8638. E-mail: