Ultimate Guide to Collecting Money from Patients

THE ULTIMATE GUIDE TO COLLECTING FROM PATIENTS

AT TIME OF VISIT

Getting Started

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THE ULTIMATE GUIDE TO COLLECTING FROM PATIENTS AT TIME OF VISIT

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5 Steps to collecting more from patients at the time of visit

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This guide provides you with the resources you need to implement better time of visit collections in your practice. You will learn the steps needed to master insurance eligibility, establish stronger financial guidelines, understand how to calculate patient costs, and even handle challenging conversations with patients.

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THE PROBLEM:Patients are unable to keep up with the increasingly

large portion of the cost of their medical care. This leaves patients frustrated, practices with higher accounts receivables, and more money that goes uncollected.

49%Providers & staff don’t know patient

responsibility at time of visit.

The collection rate goes down by 60% when the patient leaves the office.

60%62% of patients are confused and

frustrated by out-of-pocket medical costs.

62%

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larger portion of the cost of their medical care. This leaves patients frustrated, practices with higher accounts receivables, and more money that goes uncollected.

The average American has $1,766 in overdue

medical debt.About 42.9 million U.S. residents have outstanding medical debt, according to a Consumer Financial

Protection Bureau (CFPB) report.

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larger portion of the cost of their medical care. This leaves patients frustrated, practices with higher accounts receivables, and more money that goes uncollected.

You will recover just $15.77 for every $100 owed once a patient’s bad debt is due

past a certain point.

About 42.9 million U.S. residents have outstanding medical debt, according to a Consumer Financial Protection Bureau (CFPB) report.

Healthcare Insurance Plans Out-of-Pocket Costs

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$0

$1,143

$2,286

$3,429

$4,571

$5,714

$6,857

$8,000

Bronze Plan Silver Plan Gold Plan Platinum Plan

$1,680$1,770

$3,009

$6,000

$3,350$2,796

$2,316$1,731

Annual Premium Total Out of Pocket

Most common plan with lowest premiums has highest total out of pocket cost from deductibles and co-insurance.

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Bills consumers are least likely to pay if lacking funds to pay all bills

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Healthcare Bills 3rd most likely to default on payment.

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What patients are saying…

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“Our deductible is so high, we practically pay for all of our medical expenses out of pocket,” said Wendy Kaplan, 50, of Evanston, Ill.

“So our policy is really there for emergencies only, and basic wellness appointments.”

“We could not afford the deductible,” said Kevin Fanning, 59, who lives in North Texas, near Wichita Falls. “Basically I was paying for insurance I could not afford to use.”

How patients are responding to higher costs:

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1. Avoid seeking care when they need it for fear of the “aftermath” and being billed.

2. Default on their doctor bills and end up in collections.

$317,000

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On average, there are about $317,000 per year per provider in patient responsible costs.

(Co-Pay, Deductible, and Co-Insurance)

Why you need to solve your collection problems while the patient is in the office.

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On average, only 15% ($47,550) of that amount is actually collected from the patient once it is

past due.

$317,000 Per Year

$47,550

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Inte

rnal

Cos

t to

Col

lect

on

Bala

nce

$0.00

$0.25

$0.50

$0.75

$1.00

Today 30 Days 60 Days 90 days 120 days 6 months 1 Year

$0.45

$0.60

$0.73$0.80

$0.90$0.97$1.00

$0

$0

$1

$1

$1

How patient receivables lose value over time and cost more to collect.

Costs more to collect on balance than value

of the receivable.

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THE SOLUTION:

The collection rate goes down by 60% when the patient leaves the office.

60%

THE PROBLEM:

Collect more patient payments at the time of visit instead

of after they leave the office

62% of patients are confused and frustrated by out-of-pocket medical costs.

62% Educate your patients on their financial responsibility.

49%Providers & staff don’t know patient

responsibility at time of visit.

Accurately estimate patient financial responsibility

with a realistic verification process.

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By implementing an effective system of collecting all payments (co-pays, deductibles, and co-insurance) from patients at the time of service – before they walk out of the door – your practice can:

• Get more money into the practice faster • Reduce billing and back-end collection write-offs, • Improve patient satisfaction

THE BENEFITS:

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Implement your 5 step system to collect at the time of visit.

Step 1: Create clearly written financial policies.

Step 4: Collect money at the right time.

Step 2: Accurately estimate financial responsibility. Step 3: Communicate clearly with your patients.

Step 5: Make it easy to pay.

Step 1: Create Clearly Written Financial Policies.

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Establishing your financial policies.

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Communicating clearly with your patients about financial responsibilities and working openly with them to resolve outstanding balance issues establishes good expectations, better patient accountability, and higher patient satisfaction.

Patients will take a greater level of ownership in their care and treatment when they understand the costs involved.

They will respect your physicians and staff as expert partners in helping them manage the rising costs of their healthcare.

Insurance / Financial Policy Patient Agreement

INSURANCE CLAIMS/BILLINGAs a courtesy to our patients, we will file insurance claims for those insurances with which we participate. The agreement of the insurance carrier to pay for medical care is a contract be-tween you and your insurance company. Any amount not covered by your insurance company is your financial responsibility. This includes co-payment, coinsurance and deductibles.

PAYMENTPayment will be requested at the time of service for all services which are non-covered or de-termined to be patient’s responsibility, including co-payments, co-insurance and deductibles. (This is the policy of your insurance company) We will kindly reschedule your appointment if you do not have your co-payment or any past due balances.

Methods of payment accepted include cash, debit, Mastercard and Visa.

PATIENT FINANCIAL RESPONSIBILITYThe patient or their guarantor is responsible for all co-pay, coinsurance, balances and de-ductibles on the day of service.

You are ultimately responsible for payment of services provided if your insurance carrier does not pay for any reason. If we do not receive payment within 30 days, the patient will be billed.

**IT IS YOUR RESPONSIBILITY TO BE AWARE OF YOUR INSURANCE BENEFITS.**

If we are a preferred provider on your insurance plan, we will submit the claims to your insur-ance company and make every attempt to collect with the information that you provide. Howev-er, the agreement of the insurance company to pay for medical care is between you and your carrier.

**Please present your insurance card at each visit.**If you are unclear of your insurance benefits, you will need to contact your insurance carrier for clarification of coverage. If you are waiting for coverage to become effective or have no insur-ance, payment in full will be expected the day you are seen.

Delinquent accounts over 60 days will be sent to collections for processing.At which point all collection fees, contingent or not, shall be added to the patients responsibility. In the event legal action is required, the patient shall be responsible for all reasonable attorney’s fees and costs.

**All Delinquent may be shall be a month assessed late fee until paid.**

It is your responsibility to notify our office if there is a change in your insurance coverage, resi-dence, or phone number. I have read and I understand the above FINANCIAL POLICY and I agree to abide by its terms.

Printed Name:____________Signature:_______________ Date:__________

Insurance / Financial Policy Patient Agreement

INSURANCE CLAIMS/BILLINGAs a courtesy to our patients, we will file insurance claims for those insurances with which we participate. The agreement of the insurance carrier to pay for medical care is a contract be-tween you and your insurance company. Any amount not covered by your insurance company is your financial responsibility. This includes co-payment, coinsurance and deductibles.

PAYMENTPayment will be requested at the time of service for all services which are non-covered or de-termined to be patient’s responsibility, including co-payments, co-insurance and deductibles. (This is the policy of your insurance company) We will kindly reschedule your appointment if you do not have your co-payment or any past due balances.

Methods of payment accepted include cash, debit, Mastercard and Visa.

PATIENT FINANCIAL RESPONSIBILITYThe patient or their guarantor is responsible for all co-pay, coinsurance, balances and de-ductibles on the day of service.

You are ultimately responsible for payment of services provided if your insurance carrier does not pay for any reason. If we do not receive payment within 30 days, the patient will be billed.

**IT IS YOUR RESPONSIBILITY TO BE AWARE OF YOUR INSURANCE BENEFITS.**

If we are a preferred provider on your insurance plan, we will submit the claims to your insur-ance company and make every attempt to collect with the information that you provide. Howev-er, the agreement of the insurance company to pay for medical care is between you and your carrier.

**Please present your insurance card at each visit.**If you are unclear of your insurance benefits, you will need to contact your insurance carrier for clarification of coverage. If you are waiting for coverage to become effective or have no insur-ance, payment in full will be expected the day you are seen.

Delinquent accounts over 60 days will be sent to collections for processing.At which point all collection fees, contingent or not, shall be added to the patients responsibility. In the event legal action is required, the patient shall be responsible for all reasonable attorney’s fees and costs.

**All Delinquent may be shall be a month assessed late fee until paid.**

It is your responsibility to notify our office if there is a change in your insurance coverage, resi-dence, or phone number. I have read and I understand the above FINANCIAL POLICY and I agree to abide by its terms.

Printed Name:____________Signature:_______________ Date:__________

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Establishes the foundation for your financial relationship between the practice and patients.

Prevents patients from being surprised about their financial obligation.

Gives your practice some legal protection should a patient fail to pay what you are entitled to collect.

Benefits of a well written financial policy

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1. When payment is due (e.g., the date of visit, unless other arrangements have been made in advance);

2. Who is responsible for payment (self-pay patients are responsible for the entire amount of the bill; patients in health plans are responsible for any amounts not covered by their insurance);

3. The relationship to the insurance companies(make it clear that coverage is determined by patient and their insurance plan);

4. How co-pays and deductibles will be handled (co-pays are collected at each visit without exception, deductibles and co-insurance as agreed upon);

5. What forms of payment your practice accepts (e.g., personal checks, debit cards, credit cards, online payments);

6. Your practice’s policy regarding nonpayment (collection enforcement and fees).

6 Key Ingredients of a Well Written Financial Policy

How to handle the signed financial policy at the time of visit.

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1. Upon registration the check-in person should walk the new patient through the document (even if pre-filled) and verbally explain the expectations.

2. Have each patient (or guarantor) read, sign and date the document.

3. Make a copy for the patient and then add it to the patient’s chart.

If a patient says, “I didn’t know I had to pay my co-pay, or deductible” simply refer to the policy stored in his or her chart.

3 Simple Steps to an Airtight Financial Policy

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Firm guidelines

Consistent follow-through

Clear communication

WHAT TO DO IF A PATIENT CHALLENGES YOU:Be calm, be polite, refer to the payment policy, and move forward with a solution. Do not

dwell or go back and forth with the patient about what they should know.

USE THE LAST METHOD TO DEAL WITH PATIENT BILLING CHALLENGESL - LISTEN - A - APOLOGIZE - S - SOLVE T - THANK

Step 2: Accurately Estimate Financial Responsibility

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The 4 Types of Financial Responsibility

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1. Copays. They are almost always indicated as fixed amounts based upon the terms of the patient’s insurance policy.

2. Co-Insurance. If the patient’s insurance policy indicates that the insurance payer covers 90% of the cost for an office visit, the patient is responsible for the remaining 10%.

3. Remaining deductible. A deductible is a specified amount of money that must be paid before the patient’s insurance company will pay money towards a claim.

4. Self-Pay. Patients without any insurance coverage or with a plan the practice does not accept are considered Self-Pay.

**Co-insurance, co-pays, and deductibles are all forms of cost sharing. Federal and state laws prohibit clinicians from waiving cost sharing fees, doing so may violate payor contracts and is considered fraudulent.**

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Front of Card

Back of Card

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Sample Health Insurance ID Card

1. Member ID Number2. Member Name3. Group Number4. Primary Care Provider (PCP) Name and Phone Number

5. Plan Type6. Co-Pay for Visits to Primary Care Provider7. Co-Pay for Specialty Care8. Co-Pays for Emergency and Urgent Care9. Prescription Drug Plan Information

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Front of Card

Back of Card

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Sample Health Insurance ID Card

10. Health Plan Website Address11. In-Network Deductible and Coinsurance12. Out-of-Network (OON) Deductible and Coinsurance

13. Plan Contact Information14. Claim filing information

Send Billing Claims to: USA INSURANCEPO BOX 12345 | Newark NJ, 0710114

The challenge estimating financial responsibility

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The high level of complexity of patient responsibility makes it

seem like a moving target that you can’t seem to pin down.

This is true when trying to get accurate to the dollar detail about

what will be covered vs. what will be owed.

The solution is to implement a system that ESTIMATES what

the patient will owe so that you can communicate and collect

the right amount from every patient.

How to Estimate Financial Responsibility

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1. Copays. There is generally no calculation associated with copay amounts. You simply determine the type of service PCP/Specialty/ER and follow what is on the card.

2. Coinsurance. Calculations for coinsurance amounts are based upon the level of coverage that the patient’s insurance policy provides. Coinsurance calculations are based on the contracted fee schedule rate and not the practice’s retail charge.

3. Remaining deductible. Determine how much of the patient’s deductible remains unmet by verifying eligibility and benefits with the insurance company before the visit.

4. Benefits. Some services are covered entirely by the patient’s plan and others are not. This is part of the eligibility process when you contact the insurance company.

4. Self-Pay. Self-Pay or Cash Pay patients are responsible for 100% of the “cash pay” discounted amount.

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CPT CODE Visit Description Average Expected Re-imbursement Co-Pay Co-Insurance Remaining

Deductible (Not Met)Patient

Responsibility

99204 Office/Outpatient Visit, Est. $140.90 14.09

36415 In Office Blood Draw $22.50 2.25

76805OB US(transabd)

>/= 14 WKS, SNGL FETUS

$209.77 20.98

Totals: $373.17 $20.00 $37.32 $315.85 $373.17

Patient HAS NOT met deductible and remaining deductible is MORE THAN amount owed.

How to Estimate Financial Responsibility When:

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How to Estimate Financial Responsibility When:

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CPT CODE Visit Description Average Expected Re-imbursement Co-Pay Co-Insurance Remaining

Deductible (Met)Patient

Responsibility

99204 Office/Outpatient Visit, Est. $140.90

36415 In Office Blood Draw $22.50

76805OB US(transabd)

>/= 14 WKS, SNGL FETUS

$209.77

Totals: $373.17 $20.00 $37.32 $0.00 $57.32

Patient HAS MET deductible and remaining is LESS THAN amount owed.

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Figuring out Average Expected Re-imbursement

Option 1: Use the Medicare Fee Schedule Option 2: Payer Mix Analysis Report

Source: CMS website:https://www.cms.gov/apps/physician-fee-

schedule/overview.aspx

Source: Practice Management Software or

Billing Company Report

This method gives you quick and easy access to the average re-imbursements of all procedures. Since all fee schedules are based off of the medicare schedule it is reliable as an estimate.

This method gives you a more accurate estimate of what you can expect to get paid. You will have to spend the time tracking your payments (which you should be doing) to get a good set of numbers.

How to Estimate Financial Responsibility:

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https://www.cms.gov/apps/physician-fee-schedule/overview.aspx

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How to handle self-pay patients:

Self-Pay Patients should be presented with an easy to understand Cash-Pay price list of common services.

This gives them an idea of what the responsibility will be.

Payments can be collected at the beginning of the visit (preferable) or at the end after all needed services have been provided.

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How to Verify Insurance Eligibility Correctly Every Time

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• Electronic Eligibility Verification • Manual Eligibility Verification (picking up the phone)

• Verify Patients Insurance Coverage & Benefits • Determine Patient Financial Responsibility • Identify Secondary & Tertiary Payers • Confirm Assignment of Primary Care Provider for

Authorizations

Information to verify during an eligibility inquiry:

Options to perform an eligibility inquiry:


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DID YOU KNOW?

The Affordable Care Act has mandated specific guidelines for all payers to provide accurate and

timely information regarding patient financial responsibility.

(Finally!)


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1. Electronic eligibility verification / electronic data interchange (EDI)

• Practice Management Software • Clearinghouse Website • Payer Website • 3rd Party Website (AVAILITY.com / navinet.com)

2. Manual eligibility verification (pick up the phone)

Options to perform an eligibility inquiry:

http://availity.com

http://navinet.com


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http://www.availity.com/register-now-for-web-portal-access/

Availity is a free web based portal with easy to use dashboard and hundreds of payer integrations for real-time electronic eligibility verification.

3rd Party Options for Bulk Online Verification: AVAILITY

http://www.availity.com/register-now-for-web-portal-access/


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http://www.navinet.net/solutions/providers/all-payer

Navinet is a free & FEE Based web based portal with hundreds

of payer integrations for real-time electronic eligibility

verification.

3rd Party Options for Bulk Online Verification: NAVINET

http://www.navinet.net/solutions/providers/all-payer


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3rd Party Options for Bulk Online Verification: NAVINET VS. AVAILITY

Both NaviNet and Availity have easy to use portals and a simple sign-up process. The main difference is going to be the payers that are available on each and the type of information you can get.

You should sign up with both and create a process to check both portals to get insurance data on the maximum percentage of their patients.

Still, that's a big improvement over the old multiplicity of individual insurance portals, and it should get more accurate information in less time.

Step 3: Communicate Clearly with Your Patients

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How to talk about money with patients

Patients are looking to you to help them understand what to expect. Listen to them and be honest. By being transparent about their financial responsibility, you establish a more respectful relationship with them.

Start with Empathy

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How to talk about money with patientsTalking to patients about money is not easy, but can be done consistently and in a way that helps build the value of your services and improve patient satisfaction.

• Use scripts for front-office practice staff to achieve consistent messaging.

• Make sure that your practice’s written policy is consistent with any verbal representations your staff makes.

• Hold daily staff huddles to review the days financial responsibility report and cover any special circumstances before the patient arrives.

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Handling frustrated, embarrassed or angry patients:First, let the patient speak and attentively listen to him or her without interruption.

Then, address the issue with empathy, but be direct when stating that you need to work out a solution for payment (it is quite common for patients to believe their insurance is paying all of it or should be and to fault the practice if they are not).

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What to do when the patient won’t pay:First, let the patient speak and attentively listen to him or her without interruption.

Show empathy and say:

“I understand that you're upset about this. Our practice has a contractual obligation with your insurance company to collect payments at the time of service. If you are unable to make payment at this time, I am happy to re-schedule your appointment.”

Wait for the patient to respond.

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When to be flexible and when to be firm:Sometimes there are obvious circumstances that demand some flexibility. This may be the case for patients that have established already good relationships over time with the practice or they are in need of urgent care.

In these circumstances the staff should understand the protocol to check with the Practice Manager or the Physician to assess the risk to the practice and decide to see the patient knowing there is a chance that payment will not be collected,

Show empathy and say:

“I understand that you're upset about this. Our practice has a contractual obligation with your insurance company to collect payments at the time of service. Let me see if there is something we can do to accommodate you.”

Ask for the patient to be seated and to be patient. Then follow the protocol.

Then say, “Thank you, [Mr/Mrs/Ms Last Name], for your understanding.”

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Help your patients to understand their Medical Bills

Medical billing in the United States can seem like an extremely convoluted process. About 54% of Americans are confused by their medical bills, and 62% of patients are confused by out-of-pocket medical costs.**

USE a sample EOB to teach patients about their responsibility.

**According to a 2014 public opinion survey conducted by TransUnion Healthcare

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Encourage your patients to use their insurance plans portal

**According to a 2014 public opinion survey conducted by TransUnion Healthcare

Understanding Healthcare Prices: A Consumer Guide

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Step 4: Collect Money at the Right Time

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Understanding the revenue cycle.

There are 5 main stages to a patient visit. The ideal time to collect from patients is on the front end of the visit and decrease the time on the back end chasing claims and the dead-end of collections.

Pre-Visit Scheduling

Patient Check-In

Patient Visit

Patient Check-Out

Post Visit Follow - Up1 2 3 4 5

Patient Satisfaction & Collections Heat Map

Best Time To Collect Worst Time to Collect

The entire process of a patient visit, pricing, coding, claim submission, and collections is called the Revenue Cycle.

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Pre-Visit and Scheduling

1. Clearly communicate key points of financial policy and payment options to patients when scheduling.

2. Determine patient financial responsibility from insurance company.

3. Make reminder call in advance (at least 3 days) of appt. notifying of financial responsibilities.

4. Provide financial policy packet to patient before they arrive via website or email.


Patient Check-In

Patient Visit

Patient Check-Out


[FRONT OFFICE TASK CHECKLIST]

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Patient Check-In

1. Confirm patient demographics and scan insurance card (both sides to get the “send claims to” dress on the back.”

2. Walk patient through policy document and confirm signatures.

3. Review patient worksheet with financial responsibility

4. Collect co-pay and collect against deductible.

Note, Step 4 is office specific depending on specialty and needs of the office and collections may be done at check-in our check out .


Patient Check-In

Patient Visit

Patient Check-Out



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Patient Visit

1. Make patient aware of potential costs of labs, imaging, and prescriptions.

2. Remind patient to check-out to review outstanding balance and payment.


Patient Check-In

Patient Visit

Patient Check-Out


[BACK OFFICE TASK CHECKLIST]

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Patient Check-Out

1. Request co-pays, deductibles, co-insurance, and previous balances.

2. Ask if patient wants credit card info securely stored to pay future balances.

3. Request payment for existing balances or establish electronic payment plan if payment can’t be made immediately.


Patient Check-In

Patient Visit

Patient Check-Out



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Post Visit Follow-Up

1. Schedule time for billing inquiries.

2. Provide 2 follow-up calls to patients every statement cycle.

3. Collection agency management and account selection for collection agencies.


Patient Check-In

Patient Visit

Patient Check-Out



Step 5: Make it Easy to Pay

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Create incentives to pay early for larger balances• Full payment discounts for amounts over

a certain amount. • Payment plans with standardized down payments. • Financing options.

Provide multiple payment options• Credit cards / cards on-file & • Online payment options

Improving patient satisfaction.

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Patient Friendly Billing & Collections Resources

Some vendors, such as CarePayment, ClearBalance, and Simplee seek to make it easier and less confusing for patients

to pay bills.

Improving patient satisfaction.

Training Staff & Making it Stick

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Implementation Planning

How to implement successful, sustainable practice change.

1. Select a high-level champion for the change. This can be someone from the administrative staff, medical assistants, or physicians.

2. Involve all members of the team. Creating a respectful team environment where everyone’s voice is heard is important. However, that doesn’t mean that everyone on the change team will agree with everything that is said during the team’s meetings.

3. Measure the progress. Measurement gives the team a goal to work towards; showing improvement helps the team maintain enthusiasm and support for the project.