The following is written by Carol Ciluffo, vice president of revenue cycle management for PINNACLE III.
Patient balances continue to rise due to higher co-payments, deductibles and co-insurance, making efforts to collect patient payments up-front all the more critical. Becoming proactive about patient financial responsibility can significantly shorten the payment resolution cycle.
In an ideal situation –– submission of a clean claim and prompt processing of that claim by the payor –– the reimbursement arrives about 15-30 days after the date of service. Upon completion of a properly processed claim, the facility generates a statement to notify patients of their remaining financial responsibility.
But in many cases –– particularly when the patient has to pay a significant part of the bill –– actually being paid in full can take even longer than the 60-90 day limit that some ASCs set. To positively impact self pay balances and avoid becoming a long-term creditor, ASCs may want to use the following strategies.
- Pre-verify patient insurance benefits, specifically noting deductibles, co-pays and co-insurance parameters as well as the portions already met in each of these areas.
- Collect co-pays and deductibles on the date of service, before the scheduled procedure.
- Ask for payment in full.
- Don't fall into the trap of allowing a long-term payment plan, such as $10 a month on a $500 bill. The ASC can easily become the patient's banker or loan officer of choice.
- Establish hard-and-fast guidelines for patients' payment plans and make sure staff members consistently follow them.
- Accept credit card payments and offer alternative payment services, such as CareCredit.
- Use a secure, online payment portal.
- Accelerate the statement process. There are several ways to do this. For example, shorten the statement cycle by sending them out every 15 days, or ask for payment in full in the initial statement, with one final notice generated 30 days later.
Failure to manage patient balances can result in a high percentage of A/R attributable to self-pay and having to follow up with more patient accounts than you can afford to contact.
Impact of an up-front collections policy
To illustrate the impact of your ASC's up-front collections stance, consider the following three scenarios.
- ASC A does not perform up-front, self-pay collections. As a result, 37 percent of the facility's outstanding A/R is attributable to patient balances.
- ASC B employs an active up-front collections policy, with staff members consistently observing the outlined parameters. As a result, patient A/R balances represent only 7.25 percent of the total outstanding A/R.
- ASC C adopts an aggressive up-front policy for self-pay collections. The A/R balance attributed to patients' balance is -7.5 percent. In this scenario, the facility would rather process patient refunds than spend time chasing patients for money owed.
You do the math. Ensuring your patients are informed about their financial responsibility and actively working with them to secure payment at the time of service can significantly impact your ASC's cash flow.
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