Until recently, payers and employers managed most healthcare costs on behalf of the patient. Today the public is being primed to take on more financial responsibility for their own care, with high deductibles and co-insurance among the most notable drivers.
Provider organizations have deep experience in helping lead patients through difficult discussions about their health. The same cannot be said for communicating complex financial issues. How can providers collect more upfront, without alienating their patients? Discussions that results from this question put many patients and providers on unfamiliar – and uncomfortable – ground. But the reality is that if patient payments are not captured upfront, they probably won’t be captured at all.
New tools and strategies can simplify these interactions with clear and accurate information. Most importantly, they can instill a new sense of confidence in patients in their ability to pay for care. Just as important, these strategies will enable a unique opportunity to lead patients through a new and daunting learning curve: the real cost of care and how to pay for it.
Help patients understand what they owe
Industry best practice is to verify 98 percent of patient eligibility and benefits prior to every visit. Prior to a clinical encounter, providers should be able to assess a patient’s insurance eligibility and financial responsibility, as well as determine their ability to pay what they owe. Make pre-appointment checks part of your standard workflow, coupled with a liability estimator, so you know how much to collect from the patient. Before they walk through your front door, your patients should know about payment options and financial assistance. This includes knowing which services are covered by their insurance, what their total financial obligation is going to be, and what your organization expects to be paid for the appointment.
Make it easy to pay
A small technology investment can bring more flexibility to your collections processes, reduce your reliance on paper statements and bill collectors, and help you get paid faster. For example, most practices, hospitals, and billing services already include the option to pay by credit card, but have you considered an online payment option?
There are many vendors and services that offer an online payment portal, including clearinghouses or practice management systems that you may already be using. Importantly, look for options that allow automated monthly debits for payment plans. These will reduce your reliance on a patient initiating a payment each month.
On that note, consider offering deeper discounts for early payments. Such discounts motivate bargain shoppers and avoid payment procrastination. Additionally, discounted rates for self-pay patients in the range of 25 percent, or even sliding scale pricing based on a patient’s income, can mean the difference between getting paid a portion of usual and customary charges for services and not getting paid at all.
Set expectations early
The biggest opportunity to collect from patients is when they are standing in front of you, so make it a regular practice to ask for payment and collect at the point of service. Top-performing practices don’t just ask if a customer would like to pay today, they ask how. Are your patient access employees trained to work patient assistance programs into the conversation with patients as soon as possible? They should be – it could make the difference on whether a patient schedules treatment at all.
It can be difficult asking friends, neighbors, and hard luck cases for payment – so take time to train your team on the best way to approach a variety of payment scenarios. Then, document those scenarios and develop scripts to reference. Scripts can be both helpful and empowering, while assuring consistency for front office and patient access staff.
Consistent communication is also helpful in encouraging patients to keep current with payments. This can be aided by text messaging and emails, both of which are available in some financial clearance tools. At a broader level, engaging patients from the beginning with reliably accurate information will do more than most providers realize to establish and maintain a positive relationship with patients. And it’s a given that many of these conversations won’t be easy to have. In just one example, is the front desk prepared to tell patients they are limited to one yearly procedure – a limit they’ve already met? At these times, especially, it is crucial that patient access departments have quick access to information on different payment options.
Bonus tip: Scrub claims clean
More than ever, first pass clean claims should be a top priority. While this strategy isn’t directly related to collecting more upfront from patients, it prevents them from being surprised with bills that are higher than they were initially quoted—and that may be too high for them to pay. Beyond manual efforts like training, documentation, and periodic quality checks can support accuracy efforts, a professional claim scrubbing tool can automate claim reviews to scan for compliance with the National Correct Coding Initiative and other coding regulations and requirements—a review that, when performed manually, can be daunting for even the most experienced coders. An advanced tool will build coding rules into your practice management system, check for errors, and correct mistakes prior to claims submission to reduce denials.
It can take time to adjust your policies, practices, culture and even technology to align around new payment expectations, but improving your billing cycle is possible. If you are strapped for resources, start small and implement one or two changes at a time. Very quickly, you will see the impact on your balance sheet.
While not a complete list, it encompasses the most essential aids to help guide both the patient and the hospital through healthcare’s transition to – for better or for worse – a clinically-driven retail model. While this won’t ever become a mirror image of the traditional retail “cash and carry” model, it will need to be one where prices are every bit as transparent. Below are some of the top scenarios where patients will need guidance – and cost clarity – in this era of heightened financial responsibility.