Many medical practices have struggled to collect patient copayments and deductibles in the past.  As a result of changes in healthcare, that struggle is about to reach painful financial levels in the coming age of large patient liabilities.  Your practice must immediately improve its collections policy relative to patient balances or suffer serious consequences.

Why This Affects Your Practice

In an effort to contain the premium costs, many employers are adopting health insurance coverage requiring employees to pay much higher deductibles.  Some employers are dropping coverage altogether and sending workers to the health insurance exchanges to purchase coverage individually.  Some previously uninsured individuals are acquiring new coverage on the exchanges.  In each case, the portion of the cost of care, which must be borne by the patient, is increasing.  If an individual selects the bronze level of coverage (the lowest insurance level provided by the Exchange Marketplace), the deductible is $6,350 annually per person, $12,700 for a family.  Our clients and roundtable participants are already seeing patients who have much larger liability for their care than in the past.  In this setting the successful practices will be those who have the most diligent collection policies and have trained their staff to adhere to those policies.

Take Advantage of Collection Opportunities

Patient collections begin when the patient calls to make an appointment.  The scheduler making the appointment must access the patient balance information and inform the patient that their prior balance needs to be paid before returning to the practice.  Certainly, this pre‐collection must be done only for non‐emergency patients and cannot be done for those patients in which the practice is in a course of treatment which should not be interrupted.  These exclusions still leave many patients from whom you can, and should, collect the past balance before they return to your practice.  In the past, physicians were willing to forego the patient portion of the charge because they were content to collect the insurance portion of the charge.  In a $6,350 deductible environment, there may be no insurance portion.  When the patient is reminded of their balance, they should be transferred to a member of the collections group and given the option to pay by credit card or bank draft before being connected back to the scheduler.

For those patients who are able to make an appointment without paying in full, the reminder call is your next opportunity to collect.  The reminder calls are made by a member of the collections group and as the patient confirms their visit, the collections group explains that the balance must be paid or the appointment can be rescheduled to a time by which they can have the past balance paid.  Your practice management system will need to be able to verify coverage and patient progress toward meeting deductibles.

After these two efforts, the patient presentment is your remaining opportunity before care delivery. Check‐in staff should escort the arriving patient to a private area for discussion with a financial counselor of the practice.  If all efforts fail to collect past or current visit amounts before the physician visit, there is one remaining chance before the patient leaves and collection likelihood drops significantly.

When the exam is complete, there are often items which the patient needs to take with them, such as a prescription, drug samples, work excuse or other forms.  If the physician makes a habit of handing these items to the nurse and she delivers them to the check‐out person, that staff member has a wonderful opportunity to exchange the needed items for the patient’s payment as it is received.

For medical procedures involving special equipment, personnel or expensive medications, many practices are now asking for prepayment from the patient before booking the appointment.  If the patient then cancels or no‐shows, the practice retains the amount held as deposit.  If the patient presents, the prepayment is credited to the procedure charge.

After utilizing these opportunities to collect patient payments, all future efforts fall into the collection processes of persistence, patience and polite pursuit.  Win the collection battles when you have the greatest collection opportunity and you will have fewer balances to plead for later.