Time-of-Service Collections: Seven Strategies for Success

Today, patients are responsible for much larger portions of their medical bills. Copayments are on the rise, as are coinsurance and deductibles. It’s not a stretch to say that patients’ financial responsibility is the largest it’s been since medical insurance came onto the scene in the mid-20^th Century.

If you’re relying solely on your business office to respond to this trend, you won’t be successful. Your patients are your worst payers – and asking them for money long after the fact will only result in higher postage costs and ballooning accounts receivable. Engaging your front office to perform time-of-service collections is essential for financial success.

It’s an opportune time to execute these seven strategies used by medical practices that are successfully dealing with today’s reimbursement environment.

1. Set expectations. Develop a financial policy to distribute to patients when they arrive; make it available on your website, too. Hang tasteful but clear signage in the front office. Don’t beat around the bush by printing signs that say, “Our Practice Expects You to Pay Your Copayment.” Instead, be direct with signs that read, “Your Insurance Company Requires You to Pay Your Copayment.” Send the message professionally, but make it clear that you expect to receive payment at the time of service.
2. Know how to ask. There is an art to collections, and a large part is knowing how to ask for money. Instruct your staff to stop asking patients, “Would you like to pay?” Replace that request with “How would you like to pay today?” As they ask for payment, staff must make eye contact with the patient (or guarantor) and use his/her name during the conversation. Writing out the receipt while asking the question is a great tactic because it sends the message to patients that your practice expects payment.
3. Accept all forms of payment. Allow patients to pay by cash, debit or credit card. Personal checks could be an option, but consider using a check verification service if you encounter bad checks – those with insufficient funds. Look at the commission rates on credit card services to make sure you get the best deal possible from card merchants. Don’t hesitate to steer your patients to a particular form of payment. For example, you might get a better rate when patients use debit cards for amounts under $20, but a more favorable rate when patients use credit cards for amounts over $20. Of course, you should not hesitate to accept any form of payment, but it doesn’t hurt to request a particular type of payment depending on which is more advantageous to you. Most patients won’t care one way or another because it is you, not they, who sees the commission going to the card processing company.
4. Consider pre-authorized credit cards. Pre-authorized cards allow you to accept pre-payments via credit card without encountering the hassle and danger of storing the patient’s credit card information. These systems capture and store credit card information for you to use later when the claim has been adjudicated. These systems also allow you to set up payment plans securely and seamlessly.
5. Determine what to ask for. If you have a contract with an insurance company, review it to determine whether you can request the payment of the coinsurance and unmet deductible at the time of service – most likely you can. Despite the well-entrenched urban myth that circulates in the medical practice industry, most insurers do allow you to collect the patient’s coinsurance and unmet deductible at the time of service. Once you’ve identified any exceptions, ask for patient for these payments at the time of service. For coinsurance and unmet deductibles, you’ll need to know what services the patient is receiving (because allowances are based on CPT® codes). Thus, you’ll need to perform this collection activity as patients check out of your practice. Some insurers offer a web-based look-up tool to locate the correct rate. There also are software vendors specializing in contract management that can deliver this information to your staff. Alternatively, develop a spreadsheet that lists your top CPT® codes and the corresponding allowances for each code by each of your major payers. Train your check-out staff to look up the codes on this spreadsheet.
6. Collect a deposit from the uninsured. For patients who do not carry insurance, request a minimum deposit. Set the “deposit” as your full charge, a reduced flat rate, or an average of the copayment that would be expected of your commercially insured patients. You may choose to collect different deposit amounts from new patients versus established patients (typically, deposits required of new patients are higher because there is no relationship or history with your practice), but be consistent within the categories. For patients who can’t afford to pay, offer a financial hardship policy that grants discounts based on the level of hardship. The key to making this work is to take a consistent approach to charging deposits – and have a written hardship policy that you follow consistently.
7. Don’t forget the balance. Time-of-service collections include the amount owed for that particular visit – and that which is outstanding from a prior encounter. Don’t hold yourself to collecting past-due balances – ask for all balances, regardless of age. Print a statement for all patients at check out that reflects any payments they have made as well as the balance due. Giving these statements to patients at check-out is not only free (other than the cost of the paper), but it reinforces to them your expectations of getting paid. It also eliminates the excuse patients so often give to your business office: “I never received a statement.”

These days, more insured patients owe higher deductibles, copayments and coinsurance amounts. You can no longer afford to let these patients walk out the door of your practice without paying. Administrative costs and low collection rates make after-the-fact collections a losing proposition for most medical practices. Update your practice’s operations and financial policies and look for other ways to improve the revenue cycle in your practice so that you collect 100 percent of patient time-of-service payments due every day.

Elizabeth Woodcock, MBA, FACMPE, CPC, is an expert, author, speaker and trainer in practice management operations and revenue cycle management whose clients include Kareo medical billing software. She is a co-author of “The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid.” Watch a video by Elizabeth on the Top 3 Ways to Improve Your Medical Billing.