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Don’t Let Your Money Walk Out The Door


Collecting the money patients owe is critical to the success of your medical practice. After all, the amount patients are required to pay is approaching 30 percent of a practice’s volume, and who can afford to let that go?

The problem is, collecting those funds can be hard or even impossible once the patient walks out the door. “In my experience, if you don’t collect at the time of the patient visit, your chances of collecting at all go down by half,” says practice management consultant Owen Dahl.

Fortunately, there’s a wide range of techniques practices can use to see that you collect the right amount from patients – while keeping customer service strong and satisfaction high.

Train Your Staff

In some practices, the office manager is the only staff member who truly understands the insurance process. That may work fine for filing claims, but it doesn’t help staff members counsel patients who don’t understand their benefits. And when patients don’t understand their bill, sometimes they won’t pay it.

”It shouldn’t just be an office manager or a biller who understands how insurance works,” says Mary Pat Whaley of Manage My Practice LLC. “Everybody should know, including physicians.”

How should a practice go about training staff on the ins and outs of insurance? One of Whaley’s physician clients took the time to teach her staff how their own health plan worked. “Now everyone there can explain benefits to patients,” Whaley says.

But what about the tricky issue of actually requesting the money? To make sure that gets done effectively, issue scripts to front-line office staffers. Using the right script can make the difference between collecting a fee and losing a patient, Dahl suggests.

For example, Dahl has staffers ask for “cash, check or charge?” rather than say “you owe us 20 dollars.” Asking the patient how they’re going to pay rather than confronting them with a balance can make a big difference in how the patient feels about the encounter. “You use scripts because you don’t want to turn the patient off,” Dahl says.

Train Your Patients

Another way to make sure your practice collects as much as possible is to educate patients on what things cost, and take care not to surprise them. This may seem obvious but far too often, practices fail in this area, consultants say.

Being upfront about fees is important – but bear in mind that slapping a fee schedule on your website won’t get the job done. After all, the amount a patient ultimately pays can vary, depending on the contract their health plan has with your office, whether they have a high-deductible plan, and whether they’re a self-pay patient.

Instead, post a statement on your website inviting high-deductible and self-pay patients to call and ask about their specific plan and benefits, recommends Susan Childs of Evolution Healthcare Consulting.

Communication can make a big difference in how prepared and cooperative patients are. For example, most practices offer a “prompt pay” discount of 25 to 50 percent off of their fee schedule if the patient pays on the spot, in cash. If you get self-pay patients to talk to you before they come in, they’ll know this, and feel more comfortable with the transaction.

“The more education patients have on self-pay and high-deductible policies, the more likely they are to pay,” Childs says. “Forewarned is forearmed, I always say.”

Clear guidance about changes in benefits is also critical. For example, your Medicare patients may come in and ask for an annual physical, not knowing that the plan no longer pays for them. If practice staffers don’t make it clear that Medicare won’t pay, “patients are going to feel duped and may leave the practice,” Whaley notes. And if they do, good luck collecting on that balance.

Automate Collections Processes

Some practices are reluctant to accept credit cards, arguing that they can’t afford to pay up to 2.5 percent of the balance when patients settle up. But this may be a short-sighted way to look at things, Dahl argues.

Other ways of collecting from patients are themselves expensive, he notes. “Nationwide, it costs an average of $8.75 for every bill you send out, when you consider the cost of overhead,” he says. “And billing services charge 6 percent.”

Practices that do accept credit cards can do more than just collect at the point of service. Whaley advises her clients to collect credit card information from patients and keep it on file. Then, if the patient agrees, the practice can charge the card for say, any balance under $50 (or whatever number the patient will accept).

Soon, practices will be able to automate their patient eligibility verification, too. Starting in January 2013, health plans will be required by the Affordable Care Act to provide a patient’s financial responsibility level electronically within 20 seconds. “When practices know right away how much the patient owes, days in A/R should decline significantly,” says Rob Tennant, senior policy advisor with the MGMA.

Be Formal About Balances

So, what if a patient can’t pay everything they owe? There’s nothing wrong with letting them pay their balance in installments, especially if they’ve been with the practice a long time.

But be businesslike about it. Far too often, practices enter into installment payment agreements on a brief chat and a handshake, Childs says.

Childs suggests that practices have a patient sign a promissory agreement when they’re making multiple payments on a balance due. “A conversation in the hallway doesn’t make it,” Childs says. “If you take it casually, they’ll take it casually.”

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Anne Zieger is a contributor to Software Advice.

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