Healthcare Practice Strategies – Spring 2013 - Financial Strategies: Collecting on High-Deductible Health Plans

As the cost of health insurance continues to rise, high-deductible health plans are becoming increasingly common. Here, family deductibles of $5,000+ are not uncommon.

Similar to old-fashioned indemnity plans, these plans require doing something that many practices are not set up to do any more: collect fees from the patient at the time of service.

To meet the unique demands of high-deductible health plans, you may need to modernize your practice’s financial policies. In addition to spelling out that payment is due at the time of visit, the policy should also cover these key areas:

  • Payment of deductibles, copays, co-insurance and previous balances
  • Payment related to surgery or other large-dollar charges
  • Interest or fees charged for collection and/or use of a collection agency
  • Statement process, as well as delinquency determination
  • Billing of patient’s insurance
  • Assessment of late fees and/or interest

A sample policy requiring pre-payment might include the following provisions:

“If you require a procedure, the practice will contact your insurance company to confirm eligibility and an estimate of your covered benefits. Prior to the procedure, you are required to pay in full for your estimated out-of-pocket expense related to the procedure. Such amount may be paid by credit card. Any remaining balance is due within thirty (30) days of our receipt of payment from your insurance company. This balance may be charged to the credit card you have provided to us and you will be required to sign an authorization allowing us to charge your credit card for this purpose. Any credit balance will be refunded to the responsible party within (30) days of our receipt of payment from your insurance company.”

The patient should then sign and receive a copy of the financial policy, with another copy of the signed document retained in your system. Finally, consider posting your financial policy on your practice website.

Of course, the absolute best time to collect any funds from patients is at the time of their visit. When you call to remind them of their appointment, this is your prime opportunity to discuss with the patient any copays or deductibles they will be responsible for, as well as any balances due.

Your staff should be trained to invite payment by asking patients, “How would you like to pay your bill today? Credit card, debit card, check or cash?” This clearly conveys that you expect immediate payment. In cases where a health plan does not allow you to collect at the time of service, consider asking patients for permission to charge a credit or debit card once the EOB arrives and their part of the bill is determined.

If you have a patient who balks at meeting his or her financial responsibilities, instruct front desk staff to say something like, “We’re going to have to reschedule your appointment because, according to the financial policy that you signed, you agreed to make payment prior to seeing the physician …”

Finally, in its Guide to Health Savings Accounts, the American Medical Association also suggests that practices consider establishing a fee list for their most common services and procedures so that office staff can tell patients what they might owe in advance.

Having patients fill out registration forms in advance of their visit gives staff much-needed time to verify insurance eligibility and coverage. Staff can always capture insurance information by phone, but it may be far less time-consuming if you can get patients to complete the forms on your practice website.

Then check to see if your practice management software is equipped to check eligibility on patients after you type in their insurance information. You might also ask insurers about “real-time claims adjudication,” which allows you to electronically file a claim and immediately learn what the health plan and patient will each pay.

As a result of more-aggressive efforts to collect at the time of service, you may find more patients requesting a payment plan. If you agree to a plan of four or more payments from a patient, however, you may be subject to the rules of the Fair Credit Lending Act.

If so, you’ll need to disclose in writing the terms and conditions that you’ve agreed to (similar to what you’d see on the back of your credit card statement). One option is to limit payments to only three. This way, you’ll get paid in a reasonable timeframe and not need to worry about the disclosure regulations.

The spread of consumer driven health plans could have a profound impact on how you and your staff interact with patients. All that was really important before was getting a copy of the patient’s insurance card.

Now, you’ll need to investigate further: Is this an HSA? Has the patient met the deductible? What payments need to be collected? Make sure that you’re ready for the change.

Healthcare Practice Strategies – Spring 2013 Issue 

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