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.
Sonda Eunus, MHA, CPB, is Founder & CEO of Leading Management Solutions. She manages a primary care pediatric practice with three locations in Marion County, FL. She holds a Masters' degree in Healthcare Management, and a BA in Psychology. Visit www.lmshealthpro.com