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    Best Practices for Proactive Patient Collections - Nicole Knight

    We are hearing that patient collections can be a struggle from estimating cost up front to collecting at time of visit. Nicole Knight provides ten best practices for developing a proactive collection plan for 2019.

    In a few weeks the calendar flips to 2019 and that means patient deductibles will reset. How prepared is your practice to collect?

    Many programs tell me that their patient balances are out of control. In my experience, it's usually because we lack proactive systems to facilitate patient collections.

    With the new year you have an opportunity to evaluate and set up these systems. Here are ten best practices to help you achieve this goal.

    1. Update your collection policy and get providers on the same page.

    "You are responsible for paying your portion of the bill" is a common but vague statement that is difficult to operationalize and enforce. Update your policy language to provide details. Focus on things such as patient education, rules about establishing payment plans, and how staff should handle patients who can't pay their balance.
    Remember the regulatory guidelines and avoid "professional courtesy."

    2. Set expectations up front.

    The biggest complaint we hear from staff when they have trouble collecting is that patients weren't told they would have to pay, so they aren't prepared to pay. Schedulers are your first touch in the collection effort. Train them to explain your policy and provide a range of fees as well as payment options. For instance: "Mr. Johnson, in addition to the visit fee, Dr. Jones may conduct a study or test during your visit. A typical fee range for most patients is $300 - $500, and we ask that you be prepared to pay your visit copay plus any unmet deductible and coinsurance..."

    3. Designate a financial counselor.

    Practices that are most successful at collecting patient balances are the ones that have a designated person available to speak privately with patients about what they owe. Ideally, this conversation is held in-person, in a private office.

    I recognize the challenges of bringing on a new FTE. But if you look at the actual dollars that this person can collect against the cost of sending out months (sometimes years) of statements, plus the amount you are currently writing off to bad debt or collections, you can justify the financial case.

    4. Equip staff with the right data.

    A first step in staff knowing the amount to collect from patients is creating a reference of fee schedules for the most common office visits procedures and testing, for your top contracted plans and Medicare. Put the information in a table or spreadsheet so staff can quickly calculate what patients owe if they have not met their deductible.

    The batch eligibility report is another great resource. It shows who is ineligible for coverage on the date of service, and often provides copay and remaining deductible information for each patient on the schedule. I suggest running batch eligibility at least two days prior to the date of service so staff can contact patients with information and options. Communicating in advance is important to overall patient satisfaction and also will assist with managing access to fill an open slot if the patient chooses to reschedule.

    5. Collect pre-procedure deposits.

    Some practices have adapted the modern practice of giving patients a written estimate of what they will owe for procedures. Many payors offer online cost estimators that calculate the patient's out of pocket responsibility based on unmet deductible, non-covered services, and coinsurance. Enter the CPT billing codes and the estimate is quickly customized for the patient.

    6. Train front desk staff how to ask for money.

    When I'm conducting an assessment of the front desk, I often hear staff say, "Are you going to pay your copay today?" and "I'm so sorry but I have to ask you to pay today."
    Training and role playing are vital to building staff confidence about asking for money. Provide scripts that help them handle objections and sensitive subjects such as what to do when a patient arrives for an appointment and can't pay.

    7. Offer multiple payment options.

    I've started hearing more and more patients ask staff whether they can set up an auto payment on their credit card to pay off the balance. Patient financing is an option that's becoming popular for patients who have $1,500+ deductibles but no room left on their credit card to pay them. Typically, the practice pays a small service fee and the balance is paid in full and off the A/R; no more statements or staff calls. And, online bill pay is a convenience that can encourage patients to pay past due balances.

    8. Offer a discount if the patient pays in full.

    To clear up large, past due balances, send patients to speak with the financial counselor, who can discuss multiple payment options that include a discount when the patient opts to pay the balance in full.

    9. Have a plan for financial hardship.

    Obviously, there will be patients who cannot afford to pay their bill. Instead of letting that money languish in the A/R, offer assistance to patients who meet certain requirements, such as a household income that is a certain threshold above the U.S. Poverty Guidelines. Consider adopting the hospital's policy for a sliding payment scale. And for those patients who are indigent or unable to pay anything, don't wait: facilitate a process for "Charity Care" instead of letting the account inflate the A/R.

    10. Set collections goals and reward success.

    Staff perform better when they know someone is monitoring their work. Set metrics for collecting a specific percentage of collectible copays each quarter or reducing patient A/R over 90 days old. When the incentive is reached, reward staff with gift certificates, pizza, or an ice cream party. If you have multiple sites, make it a friendly competition to see who collects the most, and update all teams at the end of each week to keep everyone engaged.

    Don't wait until the end of March for uncollected high deductibles and coinsurances to show up in the A/R. Be prepared and put a plan in place before the holidays so you can hit the ground running in 2019.

    Nicole Knight, LPN, CPC, CCS-P, ACS-CA, is director of Revenue Cycle Solutions at MedAxiom Consulting. Her decades of hands-on health care experience includes cardiology and neurology practice operations, clinical management, business office management, and consulting for coding and compliance. Nicole maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Coding Certification with the Board of Medical Specialty Coding. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a Lean Sigma Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA.

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