Facilitating Collections From Patients

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For any practice, collecting fees is essential, but it can be uncomfortable and even difficult. Experts suggest the following strategies to ease the burden.

Leverage the NSA

“With the NSA [No Surprises Act], it’s all about informing people of what their out-of-pocket [cost] will be and then facilitating that collection,” said Krisi Hutson, MBA, senior director of product development at Availity. “Patient education is no longer a ‘nice to have’—it’s a mandate.”

The NSA took effect starting in 2022, and covers patients with health insurance to protect them from unexpected charges, especially as a result of unknowingly using out of network services. It also protects all patients by requiring medical practices to provide patients with a good faith estimate of cost for the services they will receive, Hutson explained. To do this, offices can use fee schedule–based estimator tools within their practice management system to provide service-specific benefits.

Hutson said independent clinicians may be unaware of one aspect of the NSA: If they are a convening provider (one who orchestrates care with other providers), they may be responsible for sharing good faith estimates for each of the providers involved in the patient’s care.

The good news is that educating patients can make it easier to collect the amount they owe, says Hutson. “The collection of patient responsibility is much less cumbersome when there is clarity and transparency,” she adds.

Timely Collections Are Better

Collect the fees for which patients are responsible as close to the time of service as possible.

“Preservice or at the point of service is best,” said Hutson. “The farther away from the care, the easier it is for patients to reprioritize their finances.” She added this may require new workflows such as verifying benefits and eligibility a few days prior to the service as well as on the date of service.

Training Staff Is Important

Up-front collections (fees taken before service has been provided) may be a significant departure from business as usual for patients. This is especially the case if a practice’s standard procedure has been to bill the insurance company first and then balance bill the patient, explained Hutson.

“Having a well-trained, confident staff is important,” she said. “Put the time into mock training scenarios. Walk them through handling objectives. Make sure they’re comfortable stating what the practice expects of patients.”

For example, when collecting the patient’s financial responsibility at check-in, staff should feel comfortable saying, “We need to collect $25. How would you like to pay—cash, check, or card?” rather than “Are you able to pay your co-payment today?”

It can also be helpful if staff understand and can explain concepts such as deductible, co-payment, coinsurance, and out-of-pocket maximum to patients.

Give Patients Written Financial Policy

Let patients know that full or partial payment is due at the time of service. Provide the written financial policy to patients at check-in and ask them to sign it. Front office staff and physicians themselves should also be prepared to answer questions such as “Why has the policy changed?” or “What if I’m not prepared to pay today?”

Clinicians need to consider what to do if the patient is not willing to pay, Hutson said, including whether they will still see the patient. “It will depend on the doctor’s philosophy,” she explained. One option is to simply say, “If you’re not comfortable paying today, we can reschedule your appointment to a time when you’ll have the financial resources to pay.”

Collection Agencies May Not Be Best Option

Collection agencies are an option but should be a last resort, advised Hutson. “If you’re going to spend extra dollars, do it on preservice collection,” she emphasized. “With collections, you’re going to spend a minimum of 35% to 45% the minute you send it out the door. If you take that money that you would lose on collections and invest in 1 or 2 financial counselors, over the course of a few years you’re going to break even—and you’re also going to improve your patient satisfaction.”

Make Payment Easy for Patients

Providing patients with multiple options to pay their bills (eg, cash, check, credit/debit card, text to pay, or email to pay) can increase the likelihood that patients will follow through with payment.

Getting Started Should Be a Priority

Experts agree that now is the time to improve the patient collections process. “Health care organizations need to compensate staff, invest in new technology, and support the services they offer to patients,” said Hutson. “Reimbursement for health care services is essential to sustaining high-quality care to the communities they serve.”

Ms Eramo is a contributing author for Medical Economics.