5 Ways to Improve Co-pay Collection at Medical Offices

Insurance companies are requiring patients to pay increasing amounts to their healthcare expenses through premiums and co-payments. According to the Kaiser Family Foundation, patients with healthcare coverage through their employers contribute 18 percent of the premium for single coverage and 30 percent of the premium for family coverage. 

In addition to steep healthcare premiums, paying outstanding balances at the time of care is a challenge for many patients. Patients' out-of-pocket expenses rose 11 percent in 2017, according to Transunion. And check out these staggering figures:

Out-of-pocket costs per healthcare visit

  • 49% below $500
  • 39% $501-$1,000
  • 12% were $1,000 or more

It's no wonder that one study reports nearly $16.2 billion worth of healthcare services are left unpaid each year in the United States.

With statistics like these, you can’t afford to wing it when it comes to co-pay and co-insurance collection. The following tips will go a long way in helping you create a strategic plan to improve collection of patient payments within your practice.

Maximize Technology

Conversations about financial responsibility are uncomfortable for your staff and patients. Offer solutions that allow the patient to address outstanding balances in private. Offering online options like patient payment portals and informing patients of outstanding balances prior to the appointment via text or email increase the chances of getting paid. 

Be sure your patient portal and website provides the option to pay outstanding balances. You can set up a “credit card on file” program to keep credit card information secure and available for future payments. This also allows your patient payments to be set up with automated monthly payments, which benefits both of you.

Utilize Analytics

Using analytics that are built into your billing software is a great tool to improve copayment collection.

This data can provide actual cost estimates and predict financial behaviors. For example, if your billing staff sees that a patient has incurred a hefty bill and has used a payment plan in the past, there is a good chance they will need another plan for current healthcare costs.

When your staff has access to such information, they can prompt conversations with the patient. These conversations and payment plans can keep the debt in-house. Once a debt is turned over to a third-party collections agency, the portion of payment you will receive significantly decreases. To avoid this, try using analytics and other payment methods to keep the debt under your ownership as long as possible.

Work With Patients

Most people want to pay their bills, but not everyone can pay off healthcare debt in one payment. In fact, an estimated 3 in 10 adults in the United States have had difficulty paying their medical bills in the last year. Even more worrisome, nearly 60% of those who have had trouble paying medical bills also report that it had a significant impact on their family.

Knowing that many people struggle to pay medical bills makes it crucial to work with them to find a solution. One way you can help is to provide patients with a cost-estimate for care as soon as possible. This helps them to make informed decisions about their healthcare costs. You might also want to offer a web-based pricing tool on your website that allows the patient to estimate their costs for common CPT codes performed in your practice.

Once they know the estimate, they need a plan. Offer patient payment plans for those who can’t afford to pay for out-of-pocket expenses at one time. Another option is to offer discounts for patients who are able to pay their bills in full. A 10 percent discount can be a great incentive for patients to pay at the time of service without damaging your bottom line. See 10 Ways to Help Patients When They Can't Afford Care for more information. 

Verify Insurance Coverage

It’s essential to verify insurance coverage and conduct eligibility checks before every visit. This provides your staff with the opportunity to ensure you have the correct insurance information and to review copayment responsibilities and expectations. Billing an incorrect payer can prolong the billing process and even result in unpaid coverage.

Update Your Financial Policies

One easy way to improve co-pay collection is to make sure your patients understand the expectations. This requires that you have a patient payment agreement form and written financial policy that you can share with your patients. Post a copy of your financial policy in your office or provide a copy to patients annually and with any changes. Another easy way to share this information with patients is to place a copy on your patient portal in a highly visible area.

Below are a few tips for creating a written financial policy for your practice:

  • Be clear about your expectations
  • Use patient-friendly language
  • Provide a sample fee schedule for self-pay patients
  • Offer multiple ways to accept payments
  • Offer payment plans

The reality of practicing medicine in today’s healthcare market is that you must be aware of the financial and operational best practices within your office. Use these five ways to improve your co-pay collection processes today.  And when it comes to talking to patients about fees and collections, a little empathy goes a long way.  Learn 4 Ways to Add Empathy to Your Patient Collections.


To find out how Kareo Patient Payments solutions can help boost your patient collections: 

About the Author

Melissa has been a Registered Nurse for 20 years. She has an extensive background in Nursing leadership and obtained her Master’s in Healthcare Administration in 2016...

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