Patient billing and payment are significant revenue cycle management (RCM) challenges that practices and medical billing companies face. High-deductible health plans require members to make significant out-of-pocket payments before coverage starts. Last December, Modern Healthcare reported that the rise of high-deductible plans was driving health care providers to focus on collection efforts and helping patients deal with higher payment responsibilities under these plans. A study by Crowe Revenue Cycle Analytics found that lower collection rates for the “patient responsibility” share of the bills led to a decline in managed-care net revenue for both outpatient and inpatient care.
The good news is that there are certain consumer-friendly strategies that can help physician practices tackle the collection problems and bad debt posed by high deductible plans.
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- Understand patient payment responsibilities: Practices should perform insurance eligibility verification to understand patients’ eligibility for services.
- Patient education: Patients in high-deductible health plans should be educated about their financial responsibility – what their plan covers and what it does not cover – before services are provided. A best practice would be to have a financial counselor speak with them.
- Pricing transparency: In this era of consumer-driven health care, patients are shopping around based on costs and quality of care. So train your staff to answer questions on the pricing of your diagnostic and treatment options.
- Collect upfront for non-emergency procedures: Non-emergency patients in high-deductible plans can be evaluated before treatment and informed about their prospective out-of-pocket costs. It would be a practical strategy to collect upfront for non-emergency procedures. When patients enquire about the price of a service, this could be the ideal opportunity for the staff to ask them if they would like to make a co-pay or co-insurance payment.
- Offer payment flexibility: Rather than having a rigid payment structure, providers should offer payment flexibilities such as partial up-front payments, income-specific payment plans, and prompt-pay discounts. This will make it easier for patients to pay.
- Offer multiple payment modes: Patients can be offered several options to pay such as: cash, check, credit card, and credit card on file with appropriate safeguards.
- Have a financial policy: Every practice needs to have a financial policy and get every patient to sign it. Having this contract means that patients agree to comply with your rules regarding payment.
- Tell patients about the importance of regular health care: Emphasizing the importance of regular screenings and annual exams is important. Patients may not be aware that their high deductible health plan covers preventive services regardless of the deductible, including cancer screenings, diabetes testing and childhood immunizations.
- Reminders: When scheduling appointments, practice staff should have an estimate of costs ready and remind patients about payments that will be due when they arrive.
With many consumers in high-deductible health insurance plans, physicians and medical billing companies need to adopt proactive strategies to reduce patient debt and increase collections. Adopting the right measures will help practices manage cash flow more effectively.
Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.