By Sonda Eunus, MHA
Collecting patient payments at the time
of service is one of the most daunting tasks that a medical practice’s front
office employees face on a daily basis. Asking for money may be uncomfortable
for some employees, and even more so without the right training. Additionally,
patients may get irritated when they are asked to make a payment, especially if
they are not clear on why they need to pay. It is therefore important to
communicate with the patient and inform them of the office policies for patient
payments from their first visit to your clinic. Even prior to the patient’s
first visit, the practice must make an effort to collect as much information as
possible as far as this patient’s payment method. If the patient has insurance
coverage, it is important to obtain the accurate information about their plan
as well as their policy number. The patient must be informed that this
information and the patient’s eligibility will be verified, and that if any
issues arise the patient will be notified before they come in for their visit.
When verifying coverage, whether through an electronic portal such as Availity,
on individual insurance plan websites, or by calling the insurance carrier, it
is important to note several pieces of information. First, verify whether or
not the patient has met their plan’s deductible amount, or if there is a
co-payment or co-insurance required. Additionally, check if the patient’s plan has
assigned them to another physician, and if you will need to obtain an
authorization to render services to this patient. Furthermore, if the patient
is coming from another area, your practice may be out of network with their
plan which will lead to denial of payment or a high patient share of cost.
Once the patient arrives for their
first appointment, he or she should be given the office policies document to
read, which should detail the patient payment and billing process in terms that
are simple enough for the patient to understand. The patient should be asked to
sign the office policy along with the rest of the new patient registration
paperwork. This signed document should then be scanned and entered into the
patient’s chart. This way, if the patient tries to dispute a bill or avoid a
payment down the line, this document can be proof that they have previously
acknowledged understanding of your practice’s patient billing policies. Here
are some of the points that you may want to cover in the office policies for
patients to be aware of from the start:
It is your responsibility to keep us
updated with your correct insurance information. If the insurance information
that you have provided us with is incorrect, you may be responsible for the
payment of your visit.
You are expected to pay any co-pay,
co-insurance, known non-covered services, and/or any deductible estimates at
the time of service (this should also be displayed on a sign or plaque at your
check-in window).
Patient balances that are not collected
at check-in are billed immediately on receipt of your insurance plan’s payment
and Explanation of Benefits. Your payment is due within ____ business days of
your receipt of your statement. We will send a maximum of ___ statements, and
if payment is not made the account will be transferred to a Collections Agency
and reported to credit bureaus.
If you are covered by a commercial
insurance plan that we accept, we will file a claim to your insurance carrier.
A commercial plan will always be primary to a government plan such as Medicare
or Medicaid. The secondary insurance, if any, will be billed upon receipt of
your primary insurance’s Explanation of Benefits and may pick up some or all of
your share of cost as established by your primary insurance on a case by case
basis.
Not all plans cover annual healthy
(well) physicals, sports physicals, mental health visits, etc. (should be
tailored to the specific specialty of your practice). If these services are not
covered, you will be responsible for their payment. Take some time to
familiarize yourself with your insurance plan and covered services.
It is your responsibility to know if a written referral or authorization
is required to see specialists, or whether a preauthorization is required prior
to a procedure. Please inform us if they are required.
If we are not contracted with your
insurance plan, payment in full is expected from you at the time of visit. We
will supply you with an invoice that you can submit to your insurance for
possible reimbursement (you should have a Self Pay Schedule prominently
displayed so that patients are aware of how much their visit will cost in
advance).
We accept cash, all major credit and
debit cards, or checks with a copy of a valid driver’s license. Bounced checks
will incur a Bad Check fee of $___.
Sometimes patients will ask if they can
make their payment at a later time after being seen (such as after they get
their next paycheck). If your practice allows this, it is best to ask the
patient to securely store a credit card number on file and to draft the payment
on the day that they receive their paycheck. Assure the patient that this
information will be safe and will be disposed of appropriately after the
payment has been drafted. Depending on the relationship that you have with your
patients, it is possible to make it common practice to keep credit cards on
file for all future payments as well. It is important to have an authorization
signed by the patient in the patient’s chart that allows the practice to draft
payments automatically. If, however, you are not able to secure a credit card
number for the payment, you should get the patient to sign a Financial
Responsibility form which states that the patient acknowledges the balance and
will make the payment by the agreed upon date. If the payment is not made by
the patient before this date, the patient should receive a phone call from your
office to collect the payment.
By ensuring that patients are aware of
your practice’s billing and collection policies in advance, you can
significantly increase your patient payment collection rate. Your front office
and billing employees should be adequately trained and knowledgeable enough to
clearly explain these policies to new and existing patients. Additionally,
these employees must be trained on how to ask for payment prior to checking the
patient in for their appointment, both for time of service collections as well
as for previous account balances. They should be prepared to answer questions
about what the payment is for, as well as explain previous balances. With
improved communication between your practice and its patients, as well as
appropriate staff training on patient payment collections, your practice will
be able to greatly improve your patient payment collection rate as well as
eliminate any patient confusion or conflicts that may arise in the
future.
Leading Management Solutions helps medical
practice leaders identify ways to improve operations to increase revenue,
employee engagement, and patient satisfaction. Learn more about us at www.lmshealthpro.com.
About
the Author:
Sonda Eunus is the Founder and CEO of
Leading Management Solutions, a healthcare management consulting company (www.lmshealthpro.com). Along with a team of experienced and
knowledgeable consultants, she works with healthcare practice managers to
improve practice operations, train employees, increase practice revenue, and
much more. She holds a Masters in Healthcare Management and a BA in Psychology.
