| There is a changing paradigm in health care, referred to as consumer-driven health plans (CDHPs), which is presenting a significant challenge to physician practices.
These are high-deductible health plans, including health savings accounts (HSAs) and health reimbursement accounts (HRAs), which shift more payment responsibility to patients. Meanwhile, more-traditional insurance plans are also increasing co-pays and deductibles. These changes can wreak havoc with revenue collections and may increase accounts receivable balances, aging, and write-offs if health care providers don’t shift their thinking and focus to collecting more at the front desk and/or checkout desk.
In the March article on front office collections we covered ways to increase co-pay collections. This article will address policies and procedures different practices are employing to collect patient deductibles and past due balances during the patient visit.
Doctor Buy-in
The first step is making the doctors aware of the financial impact that continued traditional, back-office billing of patient balances will have on the practice. Any changes in policies and procedures will require doctor buy-in and support to be effective.
Support Staff Communication
Making a dramatic change in operations can have an impact on office culture and morale. To be effective, it is critical to be sure all support staff understand how, what, and why. Having a special support staff luncheon meeting to roll out the proposed changes can be an effective way of enlisting support and fostering creative suggestions for success.
Training and Support
Be sure the front office staff members understand what is expected of them. Written policies and procedures will enhance consistency. Cross-training front-office personnel on the use of the practice management and patient registration and scheduling systems will enhance success. Reassess the current personnel to determine whether they are up to the task and what additional training they may need. Provide front office staff with details of the various CDHPs, such as point-of-service collections, methodology of patient payment, back-end billing and processing, patient deductibles, and how to obtain current patient deductible balances. Reassess current job functions to determine whether certain ones should be reassigned.
Asking patients for money puts pressure on office staff. This requires the practice to be prepared at the time of visit. Front office staff should consistently do the following:
- Preview daily appointments at least 24 hours in advance;
- Verify each patient’s insurance coverage, co-pay (if applicable), deductible amount, and allowable. If the practice-management system does not have this, check the insurer’s Web site, or contact the patient in advance of the appointment, when necessary;
- Verify any patient balance due from previous visits; and
- Know how to ask patients for money (see March article on collecting co-pays).
Patient Payment Options
CDHPs may offer one or more options for patient payment. One option provides members with integrated debit/credit cards which enable the doctor office to check patient eligibility and obtain real-time deductible balance and claims adjudication. These require special on-site equipment to be able to do so. This capability is not currently in widespread use. Others provide for no patient payment. Instead, the claim is directly submitted to the carrier which, in turn, either pays directly from the member’s HSA or, if the deductible is met, from the plan itself. The more common current methodologies are either the patient paying with a checkbook account or otherwise paying and submitting receipts to the HSA or HRA for reimbursement. Understanding how each patient’s plan works is essential for timely, efficient processing.
What Some Practices Are Doing
Although several million members are currently enrolled in CDHPs, payment and processing alternatives are still evolving.
Some practices request patients to leave credit-card information and authorization with the practice. Once it is determined what the patient owes, the practice calls and informs the patient of the amount owed before processing the credit-card payment.
In instances where the checkout clerk knows what the allowable payment is and knows that the patient deductible hasn’t been met, the patient is asked to make payment at checkout with cash, check, or credit card.
Some practices ask a patient to make a set deposit payment in anticipation that the patient will owe more, but with the understanding that the practice will refund any overpayment or leave a credit to be applied to a future visit.
For uninsured or self-pay patients, some practices are offering substantial discounts for full payment at the time of service. Practices should be cautious that this is not in violation of government or private insurer contracts. Some practices charge uninsureds a discount equivalent to the average contractual adjustments of their larger payers. Offering payment plans to uninsured and insured patients alike are likely to be utilized more in this new environment as a way to align the needs of both doctor and patient.
Inform and Educate Patients
Patients who buy high-deductible health plans often don’t know the details of their plan and may be shocked and ill-prepared to make large medical payments. Educating patients begins with patient registration and appointment scheduling. Asking questions about the plan co-payments, deductibles, and allowable amounts chargeable to the patient will help make both you and the patient aware of the patient’s payment responsibility.
The practice payment and collection policies should be in direct patient mailers, patient registration packets, waiting room handouts, and on the practice’s Web site.
Conclusion
CDHPs are becoming more prevalent, and with them come much higher patient deductibles. This will place more demands on front-office personnel to collect payments directly from patients in more non-traditional ways than doctor practices have become accustomed to doing. Preparing now will enable doctors to meet this challenge, increase practice cash flow, and reduce billing and collection costs.
James B. Calnan, CPA, is partner-in-charge of the Health Care Services Division of Meyers Brothers Kalicka, P.C. in Holyoke; (413) 536-8510. |
