Patient collections: Best practices for the front office

Starting the collections conversation

When it comes to collecting a patient payment, it helps to understand the patient’s situation. Front office staff are in a good position to begin the discussion.

In many cases, patients may be putting off medical bills because they have high-deductible health plans (HDHPs). Let’s say a patient owes $5,000 or more for a deductible. In this situation, the practice may end up as a creditor of sorts, offering multiple bill-pay options. The front office staff should be prepared to walk patients through their options, which may include:

• Pay by mail
• Pay by phone
• Easy recurring payment plans
• Card on file
• Online pay
• Mobile pay
• Financing

If patients know about the different options available to them, they may be more likely to pay.

 Now let’s dive into best practices for front office workflows.

1. Scheduling and registration

During this initial phase of the visit, the front office should collect demographic and insurance information from patients and determine their financial responsibility. The demographics entered into the system will affect payment of the claim.

• Obtain as much demographic information as possible when scheduling visits.
• Always ask patients if they have had a change in insurance, whether a new policy or change in coverage, and check for primary, secondary, and tertiary insurance.
• Also, ask about coordination of benefits (COB). This refers to the process of determining which of two or more insurance policies will have the primary responsibility of processing and paying a claim and the extent to which the other policies will contribute.

Remember, information entered on the patient’s demographics page is generated on the insurance claims.

2. Insurance eligibility verification

Insurance verification and COB involves obtaining pre-authorization and referrals, as well as updating the system with verification, authorization, and referral information.

You should verify a patient’s coverage prior to the appointment date. At least two days prior to the visit, re-run eligibility to capture the most current insurance information. Running two days prior will provide time to obtain updated information from the patient, prevent denials, and possibly reschedule the appointment if needed.

Also, follow these steps for insurance eligibility verification:

• Confirm which services are covered under the patient’s current insurance policy and whether a referral or prior authorization is needed.
• For COB, check with the other primary payer.
• Determine patient responsibility at the time of service. Communication is key — make sure patients are aware what they will owe.
• At every appointment, collect complete and current insurance information. Using a patient portal can increase efficiency and lower cost.

3. Discussion of patient financial responsibility

Prior to the visit, have a conversation with the patient about balances. During this discussion, provide a list of approximate costs for services — and be transparent! Let the patient know what to expect ahead of time.

• Inform the patient that actual costs may vary based on services provided.
• Provide payment plan options if needed — always start higher than you expect, or the “worst-case scenario,” and be prepared to negotiate.
• Share information about financial assistance programs if needed.

4. Collection of prior patient balances

If the patient has older balances, explain which services resulted in the balance. Be prepared to get specific on the dates and associated costs of services.

• As in cases where the patient has more recent balances, provide payment plan options and information about financial assistance programs.
• Be professional, polite, and compassionate. You are sharing information that is important to patients.
• On a similar note, don’t use a judgmental or accusatory tone, and don’t give excuses either.

You can help the patient resolve prior balances by offering payment plans. These plans should be clear and well-defined. For example, if a patient owes less than $100, they will be expected to pay $25 per month. If the patient owes up to $1,000, they will be expected to pay $50 per month, and so on.

5. The check-in process

During this part of the visit, patients make it known they have arrived for a visit, whether at the front desk for an in-person visit or by signing in for an online visit. The front office staff should acquire information about the patient during this part of the visit, whether it occurs in-person or online, by following these steps:

• Verify the patient’s demographic and insurance information
• Scan the patient’s insurance card(s)
• Update any changes before checking the patient in
• Complete check-in
• Collect any new and outstanding balances

6. Patient financial policy implementation

It’s helpful for practices to create and implement a financial policy they can go back to reference. The policy should cover copays, deductibles, and past due balances, along with any other pertinent financial details or guidance specific to the practice. It should include:

• Payment expectations
• Forms of payment: cash, check, money order, credit cards
• Fee implications (i.e., no show, return check)
• Payment plans
• Refund policy for patient overpayments
• Interest and/or service charges
• Discount policies
• Old balance collections
• Collection fees

Then there’s the matter of communicating the policy to the patients and making sure they’re aware of your processes. In general, the policy should be part of your daily standard operating procedures (SOPs) and referred to frequently. In terms of its tone, it should be easy to understand so it can provide the most upfront and honest information possible.

As you develop your processes, keep in mind two types of patients you may encounter: the patient who can’t afford to pay the bill, and the patient who prefers to pay after the visit or procedure is complete. In these and all cases, you should clearly state that a patient’s out-of-pocket costs must be paid up front upon check-in.

7. Monitoring accounts, collecting patient payments

Just as open conversations with patients about their balances are important, so too is keeping an eye on accounts for any missing information or necessary changes. There may be insufficient or inaccurate demographic data, for example, or missing financial data, for both new and existing patients.

• When you come across a data entry error, verify the information. Data entry errors cause not only lost revenue but incur actual costs to the practice in terms of undeliverable mail, time spent researching and correcting the error, and printing and mailing corrected statements.
• Make it a regular practice to review patient aging reports. Plan a set day of the week or month to do so. Careful review of patient balance reports will provide a clear understanding of the aging balances.
• If the patient comes in for a visit, raise awareness of the matter in a delicate, professional manner. This can help you collect the older balance.
• If needed, partner with a collection agency for bad debt accounts.

"Having the Greenway Revenue Services team is almost like having a secondary financial team, an accounting team, overlooking your audits, correlating, so everything checks out at the end of the day."

Xavier Anderson, General Manager of Valley Day & Night Clinic

A trusted advisor, partner in collections

Want to revitalize front office collections? Greenway Revenue Services brings expertise to all aspects of the revenue cycle, from the front office to the clinic to the back office.

"Having the Greenway Revenue Services team is almost like having a secondary financial team, an accounting team, overlooking your audits, correlating, so everything checks out at the end of the day," said Xavier Anderson, General Manager of Valley Day & Night Clinic.