I have been reading several articles lately that claim facilities and practices are purchasing collection technology to improve the accounts receivables that are growing due to ever-increasing patient shares in today's healthcare payment market.  Such technologies include, but are not limited to, patient portals and mobile payment options.

You can have all the collections technology at your disposal, but the most important steps in collecting patient responsibilities do not need any technology at all. Furthermore, they don't involve patient statements.

I will be outlining steps to take to ensure your patient collections are near 100% before you even send monthly statements.  These steps can be taken by almost all provider types, almost all specialties.  Facilities and providers who see patients on an emergent basis will not always be able to follow these steps, as won't large facilities with complex services being provided, such as inpatient care.  But almost all others can.

Three-step process

Step 1:  Determine benefits and collect estimated responsbility at check-in

This is a step wherein technology can give a big assist - eligibility and patient out-of-pocket balances are often available and real-time with clearinghouse-based or payer website-based verifications of eligibility and benefits. A front desk clerk, equipped with current fee schedules and the reason for the visit, can ascertain estimated patient responsibility while the patient is checking in.  This does involve technology, but it's not new, cutting edge technology - it's been around for quite some time as many billing systems have fee schedule lookups and verification capabiliites. If the person at the front desk is not trained well enough and the technology is not sophisticated enough, the billing office may need to assist with expected codes.  In fact, it can even be the responsibility of the billing office, utilizing system notes or other in-office procedure features to communicate to the front desk the preliminary estimated patient share. Except for work-ins and urgent visits, this can be worked on the day before the day of the visit. Although it will not be instantaneous, the estimated patient responsibility can be determined even with most of the work being done manually.  The practice knows how much to expect due to their contract allowables for patients that are in-network.  The out-of-network patient always gets charged full price and is handed a receipt or superbill.

Don't forget to check beneifts, too - as anything non-covered will be collected up front.  This often involves checking payer medical policies online.  It pays to also keep a real-time reference in-office, detailing any procedures with coverage limitations with all the practice's or facility's contracted payers.

It's important to note at this point, sometimes technology works against you.  For instance, benefits determinations can be very vague or completely indistinct, depending on the website, clearinghouse, or application rendering the benifts data.  Sometimes, you just have to call to determine if a mental health visit requires preauthorization, or if a physical therapy visit will exceed policy limits, or if the payer covers botulinum toxin on a buy & bill basis or requires the patient to purchase it through a specialty pharmacy.

Step 2:  Patient is seen and services being provided are confirmed and additional moneys due are collected.

My ophthalmologist practices this efficiently.  Say I'm schedule for a mere checkup, but in the middle of the exam, he decides to do an OCT.  When that happens, I will owe more money, so he sends in a clerk with a credit card reader to collect money that is due in addition to what I already paid at checkin.  This is where technology can play a big part - since card readers are now very portable.

Step 3:  Patient checkout, where final bill is rendered and again, settlement is made when needed.

The local medical school in my area follows all three steps.  I check in for what is expected to be a 99213 visit, and I pay my bill based on that expectation.

I see the orthopedist, who decides he wants to do an x-ray.  I'm then sent to the patient financial desk to pay the difference. After the examination, I go to the check-out counter, where I am charged an additional sum since the visit ended up being a 99214.

Following these steps faithfully and consistently will result in far fewer patient statements

For most providers, following these steps faithfully and consistently will result in far fewer patient statements being mailed each month.  The only statements that should go out are:

  1. Balances due to a adverse benefit determination that was denied upon all appeals (inclduing ERISA appeals when applicable) when payer rules allow
  2. Balances due to a hardship case when agreed upon by patient and provider

Take special notice of what was NOT included in the above list:

  1. But doc, I forgot my wallet!

It's not included because these patients should be rescheduled.

If you would like some assistance with this or any other billing and collections process, please be sure to contact us.  Contact info can be found on our main page.