In June 2011, the Medical Group Management Association released the results of a questionnaire that ranked members' most-pressing practice-management challenges. In this edition of "Practice Makes Perfect," we'll tackle No. 11 on that list: collecting from self-pay patients or those with high-deductible health plans and/or health savings accounts.
Practice Makes Perfect: Staff training is critical in improving payment collection
Revenue-cycle management in a medical practice can be described as a series of events that begins with scheduling a patient's appointment and ends with collecting for the services. In between, billing, denial management, appeals and other related activities occur.
In an environment of stagnant or declining revenue, collecting at the front desk before or immediately after the patient visit has become more important. In fact, according to MGMA's Performance and Practices of Successful Medical Groups: 2011 Report Based on 2010 Data, 50% of better-performing medical practices reported collecting 90% to 100% of copayments at the time of service. However, because medical practices treat self-pay patients and patients with differing copyaments, deductibles and coinsurance, as well as some with HSAs, collecting from them has become much more complex.
Effective front-desk collections arise from a well-trained staff and ongoing program measurement. The old saying is "you can't manage it if you can't measure it.” One effective metric to measure is the amount of the payments in the form of checks, debit/credit cards and cash collected at the front desk on the day of service as a percentage of total charges for that day. Granted, some of these collections may be related to prior outstanding balances.
Staff training is a critical factor in effective front-desk collections. Typically, front-desk personnel are interested in checking the patient in and confirming and updating insurance coverage information. Requesting payment from patients who may have medical issues and want to visit with the doctor isn't easy and may slow the check-in process.
Make sure the staff understands the different types of insurance coverage and plans patients may have. Is the patient a self-pay patient? Do we only have to worry about collecting a copayment? Does the patient have a high-deductible health plan with a health savings account but the deductible hasn't been met yet this year? Will the patient have a coinsurance obligation that won't be known until he or she is seen by the doctor? Each of these categories may trigger a different approach to collecting on day of service. The collection process should be outlined for front-desk staff in a practice's policies and procedures manual.
For instance, the practice may decide that all copayments need to be collected at time of check-in. Some practices will take steps to find out from the insurance company in advance if a patient has met his or her deductible and base collection activities on that information. If the patient has a coinsurance payment, the practice might request prepayment of a percentage of the amount for an office visit.
Sometimes a practice will have to return a day-of-service overpayment to the patient after the claim is adjudicated by the insurance company, but in many cases, this is less expensive than prolonged follow-up billing and collection activities. Other practices avoid this problem by obtaining a credit/debit card number and a patient's authorization to charge the account once the exact payment is known.
In addition to knowing what action to take based on a patient's insurance coverage, it is also helpful to have front-desk staff practice what they should say to patients when payment is requested. An established script goes a long way toward making the staff more comfortable with asking for money.
The collection of revenue at the front desk is certainly more important and complex than ever before. Well-managed medical practices understand the different types of insurance coverage and plans their patients have. They also provide the front desk with resources and training to collect what patients owe. Revenue-cycle management becomes much more manageable when collections issues and scenarios are addressed by the practice before the patient walks in the door.
Jeffrey MilburnIndependent consultantMGMA Health Care Consulting GroupEnglewood, Colo.
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