With reimbursement rates constantly changing and the No Surprise Act taking effect January 1, 2022, many providers are looking at a challenging first quarter. Collecting payments has already become a large issue for clinics across the nation, but now the added complication when dealing with insurances may continue to force billers to spend more time and money on negotiating claims. Instead, clinics should consider looking into cash vs. insurance for their patients.
For those with high deductibles, paying cash upfront could actually save them money in the long-run. When paying with cash (or card) instead of billing through insurance, the clinic can estimate their services at a discount or cheaper than what it would be going by the negotiated health insurance amount. Because it does not have to go through insurance, clinics can save time and money by simply closing out the bill with the patient. Thus, many patients are surprised to find that they can pay less by being prepared to pay upfront. The risk for patients is that they will have a major medical expense and have to pay their full deductible after already paying for cash services. The risk for clinics is that patients may never pay, leaving the provider to cover the service. Insurance will pay an allowed amount and leave issues with patient non-payment to their collection agency.
Training your staff on this option will help them better accommodate patients—especially if they have already asked for payment plans or other help with paying their bills. Again, emphasize that this option should not be the replacement for health insurance. When it comes down to it, a medical crisis with expensive treatments could bankrupt a patient without insurance to help, and then you are faced with the issue of your clinic not being fully reimbursed.
Some patients use buying groups that are generally around half the price of insurance. All those on the plan are paying it into a pot, which can then be used to cover major medical and associated costs. Gathering your own research and having it on hand for patients will be a huge benefit. Find out what the plans will actually pay and what the patient balance remaining will be. If the plans pay very little but contractually adjust the remainder the clinic can come up short.
While this will not be ideal for every patient, it’s good to know there’s an alternative to negotiating with insurances. Billers should be prepared either way for the many evolutions in the industry and watching their claims to make sure they’re being paid. If your revenue cycle has been struggling to gather adequate reimbursement, then outsourcing might be the answer. Outsource Receivables Inc. helps our clients save 15% overall on what they’re currently spending on medical billing.