Patient Collections 2.0: A Novel Approach During COVID-19 and Beyond

Collecting copayments and co-insurance amounts has always been a challenge, and during COVID-19, some would say it has become nearly impossible. Patients are not coming to the office as frequently, so there are fewer opportunities to collect unpaid balances. Telehealth also adds a layer of complexity. When patients owe a copayment or co-insurance, they must often pay it after the service has been rendered, making up-front collections difficult to say the least.

If practices want to keep their doors open, they need to rethink their collection strategy, and there is no time like the present to do so, says Tammy Tipton, owner of Appeal Solutions, Inc. in Oklahoma City, Oklahoma.

Tipton provides five tips to help practices boost their patient collections to ensure a smooth cashflow during COVID-19 and beyond.

1. Focus on insurance verification. “If patients have changed insurances, lost their jobs, or have suddenly become Medicaid-eligible, then you need to have a way of staying on top of those changes,” says Tipton. Though it may seem basic, ensure that front office staff make a photocopy of each insurance card and take the time to validate the information, she says. Be especially mindful of patients who have switched from commercial insurance to Medicaid, a payer that often requires pre-authorization and referrals for various services, she adds.

2. Offer payment plans. During the current public health crisis, patients may need flexible payment options. This includes the ability to provide automated, scheduled payments according to a pre-arranged payment plan. Explore what options are available so patients can continue to access the care they need even despite financial hardship, says Tipton.

3. Consider paperless intakes. If patients do come to the office (e.g., for vaccines, physicals, or other visits requiring a hands-on exam) rather than engage in telehealth, they may not necessarily want to touch a tablet, stylus, or keypad to check in and make a payment. Enabling them to complete paperwork and pay any outstanding balances in advance using their own mobile device not only quells anxiety, but it also boosts patient satisfaction and engagement, says Tipton.

In addition, paperless intakes enable practices to capture copayment and coinsurance amounts up front. For example, practices can require patients to complete their registration online in advance before being permitted to see their provider in person or virtually.

“It’s natural that we’re moving in this direction, and COVID-19 is making us adopt these technologies more quickly,” says Tipton.

4. Appoint someone to monitor the America’s Health Insurance Plans (AHIP) website. Many payers are currently waiving copayments and/or co-insurance amounts during the public health emergency, and the AHIP site provides a summary of payer policies. If the policy is unclear, Tipton says to contact the payer directly and ask it to clarify its position. Does the payer waive all costs, or does it only waive COVID-19-related costs? How is it handling cost-sharing for telehealth? What are the effective dates of this coverage? “You should also watch all claims very carefully to see how payers are handling them,” she adds.

5. Know your obligations under the CARES Act. If physicians accept financial support through the CARES Act Provider Relief Fund, they must meet all terms and conditions, one of which is that they aren’t able to pursue patients for any out-of-network balances, says Tipton.

The U.S. Department of Health and Human Services states the following: The Secretary has concluded that the COVID-19 public health emergency has caused many healthcare providers to have capacity constraints. As a result, patients that would ordinarily be able to choose to receive all care from in-network healthcare providers may no longer be able to receive such care in-network. Accordingly, for all care for a presumptive or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient.

“My concern, though, is that if you’re out of network, there’s probably a reason,” says Tipton. Most often, it is because the payer does not reimburse an amount the physician feels is adequate. However, when providers accept the relief funds, they need to ensure that their collection efforts align with program requirements, she adds.
Thinking ahead for Patient Colletions During COVID-19 Crisis

With patient volumes at an all-time low in many practices, now is the time to take a closer look at internal workflows. Tipton says to make the most of this time by asking these questions:

• Has our collection rate been trending in the right direction pre-pandemic?
• What is our current collection rate during COVID-19?
• Can we implement technology that will improve our collections?
• Do we need to increase internal staff or work with an external vendor?

Practices that perform these analyses and explore technology solutions will be prepared for what lies ahead—immediately post COVID-19 and beyond.

Because Kareo is committed to the success of independent medical and mental health practices and their billing company partners, we are providing a complimentary guide to help with navigating patient collections in this new era. You can access our guide, Patient Collections – a Blueprint for Success here. Our May 2020 webinar was on the same topic and you can hear the recording.

About the Author

Lisa A. Eramo, BA, MA is a freelance writer specializing in health information management, medical coding, and regulatory topics. She began her healthcare career as a...

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