Collecting patient due balances (including self-pay, high deductibles and health savings accounts) is in the current top 10

list of priorities for practice administrators, according to the Medical Group Management Association*. Assigning that level

of priority to just one of the many issues that you, as an administrator, must manage may seem out of the ballpark, but

your practice’s bottom line is dependent upon it.

Insurance products in the commercial and government sectors are being sold with high deductibles, often exceeding

$5,000, which was unheard just a few short years ago. Business rating firm Moody’s states, "Today's high deductibles are

tomorrow's bad debt**.‖

As a practice management consultant for more than 20 years, I couldn’t agree more. Improving collections performance

without adding unnecessary practice expense is a question I hear frequently from the physicians, managers and

administrators. The market has changed and, it’s time to reengineer our internal processes to align with today’s

reimbursement landscape.

What I tell practices that struggle with patient collections is that just hiring more staff in the business office is not sufficient;

it’s time to take action that improves your practice’s collection function from top to bottom. Read this ebook to learn

strategies for how to improve your collections success rate. Challenge yourself to implement at least one, if not all, and

start seeing tangible changes to your bottom line!

*http://www.mgma.com/practice-resources/articles/mgma-connexion/2014/july/top-10-mgma-member-challenges-and-

resources#sthash.KVHUXtBq.dpuf. July 2014.

**Daniel Steingart, an Assistant Vice President and Analyst at Moody's in the report, "US Healthcare Reform: Three Risks Reduce Credit Positives

for Not-for-Profit Hospitals." http://www.mwe.com/info/pubs/Moodys_032714.pdf. March 27, 2014.

Source: http://kff.org/health-costs/issue-brief/the-cost-of-care-with-marketplace-coverage/. Released 2/11/2015.

Asking your patients to pay is a true art form. When asking patients for

payment, be pleasant but steady in your approach. Never laugh, but offering a

warm smile is appropriate. Always look the patient in the eye and maintain eye

contact throughout the payment interaction.

While some patients will never want to pay, others are prepared to tender

payment at the time of service. Front office staff, often as instructed by

management, have a tendency to brush off patients because of the complexity

of the transaction. Our payment system is indeed complex, but it’s time to stop

making that an excuse. The bottom line: if you don’t ask, you won’t get paid.

Practice asking for money; it’s a skill that is learned, not one that comes

naturally.

Strategy #1: Ask politely, but firmly.

Install tools that can expedite the payment process. Replace old credit card

terminals tethered to the wall with streamlined devices that are easily

accessible at each workstation. Consider offering flexible payment applications

like payment plans, card on file and online payments, deployed with an

automated receipting process. To further streamline the process for your staff,

integrate the new payment tools into the daily reconciliation process.

Strategy #2: Develop workstation aids.

Physicians spend upward of $8,000 each year sending out statements. Results

are limited, with patients largely ignoring the paper notices that show up in their

mailbox. With snail mail on the decline in the U.S., many patients don’t even

check their mail on a daily basis. A more effective strategy is to transmit

statements electronically, linking an online payment system with an automated

receipting process. Your POS solution may include an e-statement option, or

you may integrate the e-statements in your patient portal. Regardless, tie

payments into your practice management system to electronically remit and to

simplify the end-of-day batch-out process.

Another huge benefit? E-statements are free—a huge cost savings over paper

statements that are transmitted through the postal system; with postage,

printing and supplies, it typically costs $.75 to send each paper statement!

Strategy #3: Transition to e-statements

Of all the businesses from which patients receive statements, healthcare

providers are the only ones who can’t take back their service. Furthermore,

patient balances carry over from month to month, without increasing or

incurring any penalties. With no sense of urgency, the patient has little

incentive to pay. Include a specific due date on the statement, and don’t make

it obvious that the payment doesn’t increase with each 30-day ―box‖ that

commonly appear on statements. Unfortunately, those boxes just highlight the

fact that the patient can wait a few more months before paying.

Strategy #4: Alter your statements

It may seem overly simplistic, but we’ve had a habit of asking patients to pay

in, say, 15 days. 15 days from when? The patient probably has a very different

date in mind than you do. Don’t leave the payment due date up to chance;

clearly list a specific due date on the statement – and follow through!

Strategy #5: Record due dates

Never miss an opportunity to request payment of a balance, whether it’s 90

days old or one hour. Eliminate the term ―past due‖ from your vernacular and

collect on all balances. Consider that patients walk into your business; if you

send out a statement later that week, the patient will hesitate to pay. Not

surprisingly, patients will think, ―I was just there; they didn’t even ask for

payment!?‖ This doesn’t bode well for you, as you’ve missed a critical

opportunity to collect payment. For patients who do not pay off their balance

before they see the physician, hand them a statement before they leave your

office.

Strategy #6: Ask for balances

Patients don’t want the amount they owe to be publicized all over the reception

area, particularly when it comes to outstanding balances. Develop a small form

to record the amount due, and pass it to the patient when asking for payment.

Or, if you’ve moved to a point-of-service solution, hand or direct the patient to

the device that will display the amount owed and provide them with flexible

payment options.

Strategy #7: Maintain privacy

Once you ask a patient for money, listen carefully. Don’t interrupt. Use the

silence to your advantage. If you take the lead, patients typically get the better

end of the deal. In a moment of panic, you may even suggest that their $1,000

balance be paid off in $5-a-month installments, leaving you with little money—

and loads of administrative costs! Once you ask for payment, stop talking and

wait for the patient to respond.

Strategy #8: Listen, listen, listen

Payment plans are important because they allow patients to pay off their

balance in regular installments, while also ensuring steady cash flow for your

practice. To set up a payment plan, start by asking the patient, ―How much

more time do you need?‖ The patient’s response will most often be a shorter

time period than you would have offered. Add any ―odd‖ amount to the first

payment. For example, for a balance of $431.78, collect $131.78 for the initial

payment, then the remaining $100 for each of the next three months. Always

collect the first payment when the payment plan is established, and request

that the patient maintain a credit card on file so that you can easily process

future payments. Always send a receipt after each payment.

Strategy #9: Institute payment plans via credit card on file

Historically, payment plans are established and then buried within the rest of

patient responsibility. To monitor these, significant staff resources are

expended to cull through accounts to determine which patients are on payment

plans and which patients are in compliance. That’s if the plans are monitored at

all…

But wait! There’s a better way! Streamline this process by creating a separate

category in your practice management system for payment plans, just as you

would for a commercial insurer. Include the category when you run

management reports about the performance of your receivables, but recognize

that payment plans must be assessed separately. Your practice has, in

essence, agreed to ―age‖ the receivables for 60, 90, 120, etc., days.

Strategy #10: Categorize payment plans

Practices send statements every 30 days, and payment plans are established

on a 30-day cycle. Why? Simply because that’s the way we’ve always done it.

But it’s time to change! As technology evolves, and we move from paper

statements to e-statements, it is important to send more notices over a shorter

period of time. How do you do this? Send statements twice a month, and

shorten your payment plan installment periods to twice-monthly, as well.

Particularly for the latter, patients will face lower payments in each installment,

and be more apt to comply with the schedule—especially if it’s an automated

payment plan that requires no action on their part to initiate each payment.

Strategy #11: Toss the 30-day cycle

Competing resources in the business office typically means that collections

gets the short stick, and that’s actually how it should be. There’s a higher return

on investment from dedicating resources to managing the insurance side of

your business. Focus your employees on transmitting claims, working edits,

handling denials, submitting appeals and contending with the nuances of the

reimbursement landscape in your local market, but don’t just ignore collections.

Contract with a third party to handle collections for you, ideally from beginning

to end. Engaging a trusted partner allows you to focus on what you’re best at –

while being assured that you capture every dollar you deserve.

Strategy #12: Outsource

Keep these 12 strategies in mind as you look for ways to boost your practice's ability to collect the revenue it is due. Patient balances

have been notoriously hard to collect, and that fact certainly doesn't bode well for the future as insurers shift more financial

responsibility for healthcare services to patients.

Collections is a complex business function but so are a lot of the things we deal with each day in a medical practice. While practices

have relied on collecting copayments from patients as they present, it’s time to take it up a notch – several notches, actually. With a

clear cut plan, greater staff awareness and a more global approach to finding collections opportunities, you’ll enjoy an increase in

cash flow. Properly managed and executed, the benefits of your efforts to revitalize collections will be time well spent.

Atlanta-based Elizabeth Woodcock is the founder and principal of Woodcock & Associates. Co-author of the best-selling book, The

Physician Billing Process: Potholes in the Road to Getting Paid, she has focused on revenue cycle management for more than 20

years. Author of more than 500 published articles, she recently completed her fifteenth book for the Medical Group Management

Association. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In

addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management

from The Wharton School of Business of the University of Pennsylvania. For more information, visit www.elizabethwoodcock.com.

About the Author

Navicure’s cloud-based healthcare claims management and patient payment solutions help healthcare organizations of all sizes

increase revenue, accelerate cash flow, and reduce costs associated with managing insurance claims and patient payments. Serving

more than 60,000 healthcare providers nationwide, Navicure’s healthcare revenue cycle management solutions automate account

receivables processes, including claims management; patient eligibility verification; remittance and denial management including

automated secondary claims filing, appeals, and posting; reporting and analysis; and patient payments collections at and near the

time of service. Navicure’s solutions are supported by its unique 3-Ring® Client Service which guarantees that a client service

representative will answer every client call in three rings or less. Navicure is the exclusive healthcare clearinghouse of the MGMA

Executive Partner network. For more information, visit www.navicure.com.

About Navicure