Challenges in Patient Collections

By: Tammie Lunceford, CPC with Warren Averett

The implementation of the Affordable Care Act has enabled many Americans to acquire health coverage for the first time in their lives. Even those who have enjoyed long term coverage have seen changes in deductibles and co-pays over the last few years. It has always been difficult for the patient to understand their coverage but now it is even more difficult due to the vast number of plans.

Any medical entity providing service to commercially covered patients or physicians who serve the uninsured are challenged when trying to effectively collect from the patient. When working with practice managers, I often find outdated practice management systems still in place with no electronic eligibility or limited eligibility. The front office is trying to answer the phone, greet the patient, and perform various other tasks unrelated to collecting balances and co-pays. The front office staff are the most important people in the office related to efficient account set up and collection of the co-pay and balance. The ability to interpret the eligibility file and confidently educate the patient on their responsibility is very important. Physicians should realize the importance of providing the best practice management systems with best practice workflows in collection activity.

Many patients want to pay but they need options to make reasonable payments. Credit card on file or CCOF is a great option to collect efficiently, reduce statements and staff time by reducing collection calls and the generation of collection letters. Patients like credit card on file because it is paperless and it is no different than paying a bill using online banking. The practice must assure the patient the data is stored securely and their policies are effective in processing the recurring payment.

Tips to Improve Patient Collections:

▪ Prepare efficient registration process and financial policies

▪ Update and verify patient information at every encounter

▪ Perform batch and real-time electronic eligibility

▪ Track staff performance for 95% co-pay collection rate, % of balances collected

▪ Obtain benefits prior to procedure/surgery scheduling…set arrangement using CCOF

▪ Send statements twice monthly

▪ Use two collection agencies, a soft collection agency beginning at 65 days

▪ Use a financing option to transfer patient debt prior to surgery or procedures

▪ Be consistent and educate the patient regarding your policies

Medical entities can improve patient collections by assuring every step of the process is working well. It is important for the billing staff to communicate reasons for a shift to patient responsibility by reviewing the remittances and communicating with front office staff. The use of alerts or flags in the account can prepare a workflow aimed at improving patient collections.