Healthcare Practice Strategies - Winter 2016 - Payment Matters: The Challenge of the New 'Self-Pay' Patient


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There was a time when “self-pay” referred to uninsured patients who paid for their own care. Yet, in this era of high-deductible health plans, self pay increasingly means a patient who has insurance — but still has a substantial financial responsibility before coverage kicks in.

With patients footing more of their bills themselves, providers are often finding themselves in a new line of work: the collections business. Instead of simply verifying that patients have insurance, your staff now needs to dig much deeper and ask more questions:

  • Does the insurance card indicate a high-deductible health plan or Healthcare Savings Account?
  • Has the patient met the deductible?
  • What copay is the patient responsible for?
  • How much needs to be collected?

Timing Really Is Everything

Collecting what you’re owed from patients often hinges on timing. Human nature tells us that patients are more likely to respond to requests for payment when they know there are consequences for not responding. Consider what happens during these key stages of the patient experience:

Pre-visit: During the pre-visit phase, patients are calling in to request an appointment. They want to see their doctor. If there is a consequence at this time for not paying their deductibles and prior balances — not getting an appointment — they will have a strong motivation to pay.

Time-of-service: In the same sense, patients arrive for their appointment concerned about getting well. If the consequences of not making payment at the time of service is not seeing the doctor, this is also a strong motivation to pay.

Post-visit: A provider’s leverage for collecting payment obviously diminishes post-visit. Patients are happy to be well and not so worried about paying their bill — at least until they need to make another appointment.

What’s a Practice to Do?

Consider these best practices for collecting the often-substantial copays and deductibles that the new self-pay patient is responsible for:

Inform the patient. Better-performing practices clearly communicate payment expectations to patients. These conversations occur during appointment phone calls and are re-enforced during appointment reminders and when patients arrive for their visit.

Staff will consistently reference earlier communications (“As we discussed during your appointment phone call…” or “As you read in our financial policy…”). These conversations can also take on an educational component, helping clear up any misunderstandings patients may have regarding their insurance plans.

Verify benefits. Consider utilizing real-time eligibility tools, either through the insurer or with third-party tools. You might also consider incorporating batch eligibility tools — these serve as clearinghouses and allow for batch eligibility verification of, say, all patients scheduled for Monday.

Watch for carve-outs. In an effort to manage their medical costs, some employers are opting for plans with reduced procedure coverage. Practices that perform high-cost procedures, in particular, should determine that a procedure is covered for the patient’s condition prior to the visit. If the procedure is not covered, arrangements for a payment plan can be made and an agreed-upon portion collected at check-in.

Keep track of patients’ deductibles. Unlike copays, deductibles are a moving target. They change throughout the year. Solid processes and an on-the-ball registration team are needed to ensure that current information is in the practice management system. Knowing what amount is still due, staff can include that information in appointment reminder calls.

Collect what you’re owed. Train front-end staff in the fine art of professionally and sensitively soliciting payment from patients. Consider creating scripts and running through some role-playing so they are comfortable asking for payment. You might also devise financial incentives for meeting time-of-service collections goals. Ditto for adding collection performance to employee evaluations.

Make it easy to pay. This might include payment plans for high-deductible patients and upfront payment options like having a credit card on file. Remind patients that they can pay over the phone and consider adding an online payment option to your website or patient portal. Online payments are a natural for patients, many of whom already pay for non-healthcare services online.

Spend the Time

Meeting the high-deductible challenge requires practices to be much more proactive with patients. Spending the time on the front end verifying benefits and communicating payment expectations can go a long way toward ensuring that today’s new self-pay patient is paid up and ready to be seen.

Healthcare Practice Strategies - Winter 2016

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