According to a recent study by Kaiser Family Foundation, an increasing number of insured Americans report difficulty affording health care. Are you prepared for the impact your patients’ out-of-pocket costs will have on your facility’s cash flow? Implementing patient payment policies and corresponding processes goes a long way toward effectively managing a growing financial class – patient responsibility.
Are you familiar with your ASC’s patient payment policies? Is your board supportive of those policies? Does your staff follow the policies? If you answered “no” to any of these questions, there’s work to be done. Make sure you tighten the gaps. Educate and train your staff on how to implement the policies effectively. Your efforts will be instrumental in avoiding an increase in bad debt due to uncollected account balances. You will also create a better patient experience with your ASC’s billing process.
Let’s review the components of strong patient payments policies and upfront collections.
Creating an effective collections process starts with determining when you need to receive payment from patients. Best practice is to collect co-payment and deductible portions owed by patients before or on the date of service. Post your policy at your front desk and in your waiting room. For patients who do not have insurance (self-pay), secure payment in full on or before the date of service.
Do your patient payment policies outline what should occur when patients indicate they are unable to meet the terms of those policies? If so, what steps need to be taken by facility personnel? Proactively discuss with your facility’s governing board the types of payment plans they are willing to extend to patients. Furthermore, decide what mechanisms the ASC will use when individual patient payment needs conflict with established policies.
Other things you can do to ensure successful upfront collections include:
- Providing patients with an accurate estimate of their responsibility for upcoming care – review these details with them before their date of service.
- Relaying the types of payment you accept – cash, credit cards, automatic withdrawal from bank accounts, online bill pay portal, etc. Provide as many payment avenues as possible and make it easy for patients to pay.
- Developing a well-defined policy for upfront collections. Statistics reveal patients are 90% likely to pay before their visit, 70% likely at checkout, and only 40% likely to pay after their visit.
- Training your staff to be comfortable with upfront collections – provide collections scripts, customer service training, and role playing opportunities to enhance their skills.
Before finalizing your policies, establish how you will deal with amounts that are billed to but not covered by insurance and are attributed to patient responsibility by third-party payors.
Some questions to consider are:
- How long will you wait for the insurance payment before you involve or bill the patient?
- Will you bill secondary insurance?
- Will you bill the secondary policy if this information is provided after you billed your patient?
Determine if you will bill exclusively when the secondary policy is submitted at the time of registration. Look at your statement cycle – statements issued once a month are no longer effective. Consider the frequency of your statements and the number of statements you will send before referring patient accounts to an outside collections agency.
After determining your upfront collections policies, define what past due means for your ASC. It’s surprising how many patient payment policies state past due accounts will be turned over to an outside collections service but do not adequately define the term past due. Is it one day past the due date? Is it ten days after the due date? If you state accounts will be turned over to collections, follow through. Establish a policy on how to handle scheduling of patients who were previously turned over to collections.
Consider the following:
- Will you collect all amounts owed from past dates of service before scheduling an upcoming case?
- Will you collect the patient estimate in full with no payment options due to previous collections activity?
To address the questions above, consider a legal review of your policies. This will confirm you have thoughtfully dealt with necessary items and considered how to handle any problems that may arise.
Once you have a refined policy in place, post it in your waiting room and on your website. Also, include it in your patient packets and review it in person with patients and family members. Have patients sign the policy and any corresponding payment plan agreements, then provide them with a copy. Lastly, send the agreement to your billing department to assist with collection efforts. Displaying and consistently following your patient payment policies will lead to better outcomes in your upfront collections.
In these times of rising out-of-pocket health care costs, your ASC’s patient payment policies and upfront collections practices are important to the well-being of your ASC. Review them frequently to ensure your upfront collections practices lead to an enhanced billing experience for patients and stabilization of your ASC’s revenue.
Carol Ciluffo – Vice President of Revenue Cycle Management
 The Henry J. Kaiser Family Foundation: “Data Note: Americans’ Challenges with Health Care Costs,” 2017
 McKinsey & Company: “U.S. Health Care Payments: Remedies for an Ailing System,” 2009