News & Information

If you have worked in billing and reimbursement, you are aware that turning patients over to a collection agency to collect on a debt should always be a last resort. Are your office policies conducive to retaining happy, paying patients or harming the word-of-mouth advertizing so important to medical providers today?

Word-of-mouth advertising is important to physicians in today's competitive market. Public relations problems can result from miscommunication between patients over billing and payment issues and can cause patients to feel that the physician is only interested in their money rather than their health.

A well-managed billing and reimbursement department can reduce misunderstandings through establishing realistic and informative payment policies as well as one-on-one conversations that educate the patient on insurance benefits, coverage and billing processes.

Attaining and maintaining current and correct patient and insurance information is only the first step to reducing the number of patients sent to collections. The following is a list of several processes you can implement to ensure prompt and correct payment for services rendered.

When patients check in for their appointment, be sure to verify their address, phone number and current insurance. Do not ask if their information has changed but rather print out their information and have them verify it and make any changes necessary at that time.

Always be sure to have a copy (front and back) of the patient's insurance card and update any co-payment amounts for office visits so this information is readily available and amounts can be collected at the time of visits easily.

Have policies on co-payments and co-insurances due at the time of each visit posted in waiting rooms and patient exam rooms.

Appointment reminder calls should include reminders that co-payments or co-insurances are due at the time of the visit. Experience has shown that the ability to remind the patient of the exact dollar amount they need to bring with them makes it more likely that the patient will be ready to pay at the time of check-in. It also allows the patient to ask and have answered any questions regarding what the payment is for.

Have multiple payment options available. This includes the obvious cash, check and credit/debit cards but additionally, health savings accounts attached to credit cards should also be made available as a payment option to those patients with them.

At least one staff member, trained to take patient payments, should be available when patients are being seen and during the lunch hour. Many times those trained to take payments are out to lunch when the patient is checking out or ready to pay and the medical assistant is not usually trained to perform this task so the payment is not collected.

Set up a policy for automatic electronic payment plans, which allow debit, credit, and e-checks to be used to pay off larger balances over a one to six month period. Payment plans allow patients to be treated and providers to be paid but they must be automatic payments so as to ensure payment in full.

Medical assistants and providers are not the best individuals to explain insurance benefits, coverage and policies to patients so billing and reimbursement personnel should be readily available to come and speak with patients before, during or after a provider visit to answer any questions or explain insurance coverage.

One of the more difficult situations to occur between patient, provider and insurance company is when the provider recommends a service or treatment that is not a covered benefit of the insurance plan and the patient incurs the expense.

Most private insurance payers will simply deny pre-authorization for a non-covered service or treatment, at which time the patient is informed of the cost and payment arrangements made for the cost of the service.

If the patient happens to be covered by Medicare, an advanced beneficiary notification (ABN) form must be explained to and signed by the patient prior to the service being performed. If this is not done correctly, when Medicare denies payment for the service the cost of it cannot be billed to the patient and must be adjusted off.

Once the insurance company pays their portion and the balance remaining is the responsibility of the patient, there are some steps you can take to collect from the patient and avoid potential problems.

Send late payment notices on brightly colored paper to grab their attention.  

Attach 'Past Due' or 'Pending Collections' stickers on statements when second statement is sent.

Add a hand-written note on the statement instructing the patient to call if they have a question about their balance or need to set up a payment plan.

Call the patient before mailing the third billing statement to see if you can work through any reasons the patient hasn't paid the balance and if a payment plan would be helpful to them.

When it has been determined that the patient has no intention of paying their balance there are two steps you can take:

Write off the balance as a bad debt. The patient must pay this bad debt balance off before being allowed to make any future appointments and then must pay any and all deductibles, co-payments and co-insurances at the time of the visit so as to avoid any more future issues with their account.

Send the account balance to a collection agency. This removes the responsibility for the account balance from the provider and all communication with the patient regarding their balance must go through the collection agency. Once the balance has been paid through the collection agency, the provider may allow the patient to be seen again but with the understanding that all deductibles, co-payments and co-insurances must be paid, in full, at the time of the appointment.

Even if you have the best policies in your practice for patient education and collecting patient balances there will always be those few patients who simply are not concerned with paying for the care they receive. Some patients simply seek free services and shamelessly use every excuse in the book for not paying.

If you establish good policies, and train your staff properly, you will have a good chance of reducing negative situations that lead to unhappy patients and unpaid balances that end up going to collections.