With the changing reality of more and more high deductible health care, having a great process that starts on that first call for an appointment and ends with payment in full is no longer optional for mid-size medical practices. Unfortunately, one critical difference between healthcare and other industries is not knowing what the patient balance will be up front. Estimating patient responsibility and educating patients on their options goes a long way to improving the revenue cycle and overall healthcare experience. Better yet, it can reduce a clinics bad debt and overall time invested in statements, phone calls and tracking payments.
While you don’t know all of the details at that first encounter you can work with what you do know. One of the most important steps is front end patient eligibility verification. ORI’s clearinghouses provide on-demand patient insurance verification. Specific information on patient co-pays, deductibles and coinsurance can be accessed almost simultaneously. In addition, clearinghouses such as Zirmed now offer patient estimation tools for medical billing. Having this information upfront is key to starting the conversation with the patient about options and requirements. For example, asking for patients to come prepared to pay their co-pay at the time of visit and letting them know their options for larger deductible balances, such as automated credit card deductions.
Ineligible patient insurance coverage is the leading cause of payer claim rejections. Traditional processes of eligibility verification can be extremely time-consuming and not always reliable. Having real-time, web based solutions allows staff to run the process at the initial appointment scheduling. Batch verification can take place a few days in advance of the appointment and on the first of the month without incurring significant staff time. These repeat eligibility check reduce the chance of unexpected insurance issues greatly. In a patient needs to check with their employer or government healthcare plan they can get the ball rolling even before their appointment!
With higher and higher deductibles, patients will be paying more out of pocket for services. A recent MGMA article noted that the best performing practice have a multitude of strategies to help their patients pay their medical bills. The findings were revealed as part of their report Performance and Practices of Successful Medical Groups: 2013 Report Based on 2012 Data. “Consumer-directed” healthcare plans are on the rise with a growth of 2 million patients since 2011 and 15% annual growth over the last few years according to America’s Health Insurance Plans, an industry trade association. In fact, the organization says that about 15.5 million patients now rely on these plans for healthcare.
The unfortunate reality of high deductible healthcare is that just because patients need to pay more this has no bearing on their ability to pay. Offering options is key. Strategies may include:
- Financial counseling with patients face-to-face
- Offering patients financial payment plans
- Providing online billing and payment portals
- Accepting multiple forms of payment including ACH check transactions
- Offering time-of-service discounts
The benefit is that patients with options will seek the care they need when they need it rather than foregoing care and then having the potential for much larger hospital bills. Outsource Receivables has ensured that options are available to clinics and the patients they serve.
Networking with peers is necessary to share these strategies. MGMA is just one resource and they are hosting a Financial Management and Payer Contracting Conference, March 2-4, in Orlando, Florida. Hmm, Florida in March…
Sharing ideas with your peers on strategies, services and products is also a great way to build your organization. Outsource Receivables has a Twitter page at @ORI_Med_Billing for just that purpose. Lastly, there are a number of reports and data that can help you see trends before learning the hard way in your practice. For example, the MGMA Performance and Practices of Successful Medical Groups: 2013 Report Based on 2012 Data survey report is compiled using data from practices around the country on profitability and cost management, A/R, collections and patient satisfaction.