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Rheumatology Practice Management October 2016 Vol 4 No 5 - NORM News
Anne Rowe

Mobile, AL—In a breakout session at the 2016 National Organization of Rheumatology Managers conference, Deborah Walker Keegan, PhD, FACMPE, Healthcare Business Consultant, Medical Practice Dimensions, Asheville, NC, shared 8 strategies that practice managers can use to expedite payments in today’s challenging medical reimbursement environment.

She explained that more effective strategies are necessary because high-deductible health plans are placing a significant burden on practices that must now work to simultaneously optimize revenue from payers and patients.

“The reason it is so hard is because it costs twice as much to collect from the patients than from the insurance companies,” Dr Keegan said.

Collect at the Time-of-Service

The first strategy for speeding up revenue is to collect payments at the time-of-service, Dr Keegan said. To do this successfully, managers must first determine what insurance coverage the patient has, and which services they are eligible to receive.

Next, they need to verify the patient’s responsibility (eg, copay, coinsurance, deductible) based on his or her policy. It is also necessary to determine the precise services that the patient will be receiving, as well as the payer-allowable level.

Finally, the payment must be posted and a receipt issued to ensure accurate record-keeping.

Dr Keegan shared several options that can be explored when patients do not pay the required copayment or the balance due, such as rescheduling their appointments; assessing rebilling fees; directing them to online payment options; giving them a self-addressed, stamped envelope (with a follow-up call at 4 days if payment has not been received); and involving the patient’s insurance carrier.

Analyze Inbound Calls and Improve Statements

To avoid delays in collecting revenue, Dr Keegan suggested that managers analyze inbound patient calls related to billing.

“It’s a great tool to keep track of ‘Why did they call?’ You don’t have to do this forever, but why not keep track for a couple of weeks?” she said.

In many cases, patients are not able to understand the statements they receive, which may indicate that the practice’s statements need to be redesigned. Based on the information collected during the analysis, managers can strategize ways to reduce call volume.

To determine whether a billing statement is easily understood, Dr Keegan recommended that managers ask a nonbilling colleague to read and interpret one. It is impor­tant to make sure that statements do not “encourage” delayed payments. This may happen if a statement has 30-, 60-, 90-, and 120-day buckets, because patients will often put off sending in a payment until the bill is 120 days overdue. Similarly, inclusion of a blank line for the patient’s paid amount may inadvertently encourage small or partial payments.

It is also important to include the patient’s primary and secondary insurance on the statement.

“Make it abundantly clear because that is one of the frequent questions patients will have. ‘Did you bill my secondary?’ ‘Is my secondary already reflected on here?’ ‘Are you sure I have to pay this amount?’” Dr Keegan said.

Finally, she suggested that practice managers send a statement to themselves. Oftentimes, statements are not being sent out in a timely manner.

“Really take a look and make sure your vendors are doing what you think that they are going to do,” Dr Keegan said.

Minimize Your Revenue-Collecting Process

Dr Keegan explained that sending multiple statements and letters before making an initial phone call can considerably extend the amount of time it takes for a practice to collect revenue. For example, a process that involves sending a patient 3 statements and 2 letters before attempting to contact him or her by phone may span 9 months. However, sending only 2 statements and 1 letter can reduce the process to 75 days. Dr Keegan also discussed using a scoring tool to predict the likelihood that patients will pay their bill, based on their credit history. The advantage of such a tool is that it allows practices to decide whether they want to expend a lot of time and resources trying to collect revenue from patients who are not likely to pay. However, Dr Keegan cautioned that this strategy is “highly advanced and extremely controversial.”

Use Online Payments and Billing Fees

Transitioning to online statements and bill pay may make it easier for some patients to pay their bills. Dr Keegan encouraged managers to talk to vendors, such as clearinghouses and practice management systems, to see whether they can offer support with the transition. One of the advantages of using online invoicing and payment options is that it can reduce the burden on staff members.

“You’re really saving some of the administrative infrastructure and you’re speeding up revenue to the practice,” she said. However, managers need to be aware that many patients, such as elderly people and those who are very ill, may not be comfortable making payments online. Therefore, it is important to still offer the option of receiving traditional paper statements.

“Although we want to make it easier for patients to pay, the big strategy is really making it harder for patients not to pay,” Dr Keegan stated. It is important to advise patients in advance that they may be charged additional fees if they do not pay in a timely manner; this must be clearly stated in the practice’s financial policy. These levies may include failure to pay at time-of-service fees, rebilling fees, late payment fees, statement fees, and collection vendor fees.

Align with a Partner

Managers may want to work with a collection vendor to further speed up revenue collection. This strategy can be especially helpful for practices that have a small staff.

“The quicker you get the payment from the patient, the more success you are going to have. Over time, the probability of collecting diminishes significantly,” Dr Keegan told attendees. Other partnerships to consider include small claims courts, credit partners, and attorneys that can manage high-dollar accounts.

Keep a Credit Card on File

The final strategy Dr Keegan discussed was keeping the patient’s credit card on file to guarantee payment. To successfully use this strategy, the practice must use a payment card industry–compliant gateway to authorize and securely store payment information and follow a specific series of steps. First, it is necessary to estimate the patient’s financial responsibility and collect the credit card information prior to service. It is also important to remember to obtain written consent to charge the patient’s account. Next, the practice will need to wait for the claim to be adjudicated to determine the precise amount that needs to be collected from the patient. After the credit card is charged, patients should be notified with a phone call, e-mail, or text message. Finally, a receipt is e-mailed to the patient.

In addition to speeding up the revenue collection process, other potential benefits of this strategy include minimizing patient statements, collections follow-up, and bad debt; reducing the need for collection vendors; and streamlining the processes for patient check-in and check-out and financial ­reconciliation.

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Last modified: November 1, 2016
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