United States: Best Practices To Maximize Patient Self-Payment

Physician practices must now worry about steadily increasing patient deductibles, along with collecting traditional copayments. Deductibles as a percentage of the contracted rate increased by at least 20% across the country from 2009 to 2011, according to athenahealth. Any increase in self-pay is bad news for the physician because self-pay takes more than four times as long to collect, with a whopping 18% ultimately getting written off. Here are some best practices for making that task a little easier:

  1. Design a Formal Self-Pay Policy —  Present the policy when patients arrive at the office for their first visit. The title should be clear as to the policy's purpose (such as "Patient Responsibility for Fees"). The policy should be straightforward and simple, broad enough to apply to virtually every patient. The policy must state unequivocally that patients are responsible for fees they legitimately owe, and when those payments are expected. Explain any late payment charges or discount plan that is offered, as well as the consequence of nonpayment. You may also choose to ask patients to sign the policy as an agreement.
  2. Incorporate Self-Pay Collection into the Workflow —  Convey the importance of collecting self-pay amounts with your staff. Scripts should be provided to the front desk staff for use in asking for copays and deductibles. Identify employees who are effective in obtaining payments from patients, and look for these skills when recruiting new staff. Explore incentives or recognition opportunities to reward your staff's self-pay achievements.
  3. Deploy Available Technology —  Accept all forms of payment, such as credit or debit cards, cash, checks and HSA/FSA cards. Your patient portal should be configured to accept online payments, and contract with a live operating service to accept payments outside of business hours by telephone. Accommodate installment payment plans and automatic credit card payments. In addition, use real-time adjudication. With this technology, you can bill for service and receive a fully adjudicated response from the health plan at the time of service before the patient leaves the office. You can print out the response, displaying total and allowable charges, as well as the patient's responsibility.
  4. Obtain Information on Patient Responsibility Amounts —  Prior to the appointment, obtain up-to-date information about the patient's insurance and their share of the deductible that has been met to date. At check in, ask the patient to pay the estimated cost of services if the patient has not met his or her deductible for the plan year. Additional procedures and lab tests may incur additional charges once the patient is seen, or insurance may ultimately pay some of the costs already remitted by the patient. However, additional billing or refunding of overpayments is far less costly than attempting to bill and collect after the patient leaves the office.
  5. Use Both a Carrot and a Stick —  Offer discounts for payments made at the time of service or in cash. Impose a service charge on the bill amount if it is not paid by a certain deadline.
  6. Make Automated Calls —  Use an automated phone system to call patients before their appointments to confirm their insurance coverage and remind them that copays, deductibles and past balances are due at the time of service. Alternatively, e-mail patients before their appointments. Patients are more likely to make payments at the time of service if they know they are expected.
  7. Remind Patients of Overdue Obligations —  Call the day after the appointment if the copay or deductible was not collected. Make two reminder calls and send two reminder e-mails during each statement cycle. Configure your patient portal to show up-to-date balances and provide electronic statements and EOB summaries. Send hard copy statements once a month for at least four months.
  8. Use a Collection Agency —  Bring in a collection agency only when all collection attempts have been exhausted because the agency will keep a portion of any amount it collects. Patient accounts that are older than 120 days since the date of service should be reviewed monthly. Unless there are extenuating circumstances, pass them on to a contracted collection agency. Monitor the agency's recovery rate and customer service performance to make sure that it is getting the job done in a courteous, professional and effective manner.

Shedding Light on Patient Attitudes About Self-Payments

InstaMed (a health care payments network connecting providers, payers and patients) published the results of a nationwide survey on health care payment trends in March 2013. The data on patient attitudes toward their payment obligations is revealing:

  • Patients were responsible for an average of 20% of allowed charges in 2010. This increased to 23% in 2012.
  • 22% of patients said they did not know their payment responsibility when they left the physician's office in 2012.
  • Only 4% of patients said they received their health care bills via e-mail in 2012, with the other 96% receiving theirs via postal mail.
  • 55% of patients said they normally used online electronic means to pay a variety of monthly bills, such as utility and cable bills in 2011. This increased to 62% in 2012.
  • Online patient payments represented 8% of the gross dollar volume of all patient payments in 2010. This increased to 13% in 2012.
  • 72% of patients said they would be interested in paying their health care bills online in 2012.
  • 63% of patients said that, if they had the option of paying their health care bills via a monthly payment plan, they would use this option in 2011. This proportion increased to 71% in 2012.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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