1. Devise a defined collections policy. It's crucial for surgery centers to have a defined collections policy that patients understand even before they arrive at the surgery center. If the patient knows what their responsibilities are and when payment is due, the ASC is more likely to collect, said Jim Devitt, an expert in healthcare revenue cycle management.
"The ASC should have a written set of policies and procedures about handling the account from cradle to death," he said. "There are some people coming in with $5,000 deductibles and you must have a policy from the minute they walk through the door on how you are going to handle collections."
Place importance on working with the patients for quick and easy payments. "It can be done in a nice way that keeps it clear and simple for the patients," he said. "Define what is acceptable and what is past due. You may see some practices that keep billing statements 10 months after services are delivered, and that's a problem. Focus on patient responsibilities and the actionable steps you will take to collect."
In the policy, define how many written notices or letters patients will receive, how returned mail is handled and when statements are due. If you are too busy to manage the revenue cycle and go after delinquent patients, consider outsourcing these services.
2. Determine likeliness to pay ahead of time. If possible, determining before services are rendered which patients who cannot confirm full payment up front are likely to pay you and which are not, said Bob Richardson, president of ExtendCredit.com, a company that simplifies in-house finance plans for healthcare providers. It's not an exact science, but surgery centers can use several mechanisms, such as credit reports or proof of employment, to get an estimate.
Talk openly with patients about finances to gauge their willingness to pay. You'll have some patients who will pay for a large portion of the procedure up front and are amenable to setting up a payment plan, while other patients might insist on a low down payment and monthly fee. Combined with a poor credit assessment, these patients might present a much higher collection risk.
"If a person is saying, 'I don't know if I can afford the bill,' then have a conversation about using a payment plan they can afford," Mr. Richardson said. "Negotiate a little for a monthly payment plan amount that's reasonable to you and to them."
3. Help the patient understand how his or her insurance coverage works. Payment misunderstandings are often caused by a patient's lack of knowledge about his or her insurance. "Most misunderstandings deal with a change in insurance, and we spend a lot of time educating the patients about what their insurance covers," said Rhonda Fort, director of business operations at Practice Partners. She recommends spending some time asking the patient basic questions about their insurance coverage to determine how much they understand. If the patient is unaware of a co-pay or recently changed deductible, the bill will come as more of a surprise, which will decrease the likelihood of collecting in full.
ASCOA Vice President of Finance Cathy Meredith recommends connecting the patient with their insurance company if the ASC doesn't have time to educate each patient. "If a patient is having a difficult time understanding their coverage and really believes they do not owe the amount [you're billing them for], you can encourage the patient to call the insurance company and ask questions," she said. "In [rare circumstances], you can set up a conference call, and get on the line with the patient and the insurance company so the patient can hear the same information [from two sources]."
4. Allow for flexibility. Payment plans are easy if everyone pays you on time, Mr. Richardson said. The work starts when missed payments need to be collected. To help patients stay current with their payment plan, allow for occasional flexibility in the plan's repayment.
If a patient has another unexpected expense and misses a monthly payment, many systems will try to catch the patient up the next month, but realistically the patient won't have twice as much money when the next month rolls around.
"If this is not habitual behavior, skip the payment, moving the payment to the end of the loan term," he said. "Show the person in good standing, and work with them to get back on track for payments they said they could afford."
Mr. Richardson also recommends taking proactive steps to set patients up for success, such as using auto debit from their bank accounts and scheduling their payments around paydays and rent schedules. "We focus on the, 'How do you help the person who wants to pay you when life happens?' while making sure you get paid,'" he said.
5. Use a third-party payment plan. Not every patient will be able to pay for an expensive procedure up front, and your facility shouldn't have to turn away those patients. In that case, you can use a third-party payment plan through companies like Chase or GE's CareCredit that will approve or deny patients based on their credit rating. If a patient is approved by the payment plan, he or she can make regular payments for the procedure, and any failure to pay is generally absorbed by the payment plan, said Rob Morris, vice president of marketing and new business development for GE Capital's CareCredit.
These payment plans generally function like dedicated healthcare credit cards that can only be used for healthcare charges. A patient can apply at the center by entering several pieces of personal information, and the payment plan company automatically approves or declines the patient based on how likely or able they are to pay. The third-party payment plan means a third-party company assesses a patient's ability to pay and absorbs the loss, creating less financial hassle for your center.
An ASC should only resort to its last option — billing the patient after the procedure — if the patient arrives on the day of surgery and cannot pay and a day-of-service cancellation would create animosity between the surgeon and the center, he said. In that case, ASCs should research how to receive the highest possible payment from post-discharge collections.
6. Train staff in money collection. Staff members at the surgery center should have special training to understand the rules and regulations of payment collection. If a mistake is made, the ASC must admit to it and work with the patients to make it right.
"The worst thing that could happen is the ASC tries to twist the mistake so fault falls on the patient," Mr. Devitt said. "If you make a mistake, admit it and correct it. Otherwise they could write a negative review on social media websites. Keep your patients happy and you'll drive increased patient volume."
If you are unable to collect from the patient, bring in a third party experienced at collecting this type of debt. "For some patient debtors, as soon as the third party is implemented, they will pay," he said. "Sometimes people become very savvy in how to deal with payments and they know their credit won't be hit until they see the third party involved."
Third party contractors may accept a flat rate for working on the claims or take around 33 percent of collections.
7. Decide whether aggressive collections will hurt patient relationships. Physician offices, like other businesses, may be hesitant to pursue patients aggressively if they want to maintain a longstanding relationship with the patient. If the patient feels the office is being too pushy, they may decide to go elsewhere for treatment. However, patient collections in ASCs are slightly different; because many patients are one-time customers at the ASC, surgery centers can be more aggressive with non-paying patients without losing their customer base, Mr. Morris said. Without being rude, surgery center staff members should call patients consistently and consider submitting them to a collections agency once phone calls have proven unsuccessful.
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"The ASC should have a written set of policies and procedures about handling the account from cradle to death," he said. "There are some people coming in with $5,000 deductibles and you must have a policy from the minute they walk through the door on how you are going to handle collections."
Place importance on working with the patients for quick and easy payments. "It can be done in a nice way that keeps it clear and simple for the patients," he said. "Define what is acceptable and what is past due. You may see some practices that keep billing statements 10 months after services are delivered, and that's a problem. Focus on patient responsibilities and the actionable steps you will take to collect."
In the policy, define how many written notices or letters patients will receive, how returned mail is handled and when statements are due. If you are too busy to manage the revenue cycle and go after delinquent patients, consider outsourcing these services.
2. Determine likeliness to pay ahead of time. If possible, determining before services are rendered which patients who cannot confirm full payment up front are likely to pay you and which are not, said Bob Richardson, president of ExtendCredit.com, a company that simplifies in-house finance plans for healthcare providers. It's not an exact science, but surgery centers can use several mechanisms, such as credit reports or proof of employment, to get an estimate.
Talk openly with patients about finances to gauge their willingness to pay. You'll have some patients who will pay for a large portion of the procedure up front and are amenable to setting up a payment plan, while other patients might insist on a low down payment and monthly fee. Combined with a poor credit assessment, these patients might present a much higher collection risk.
"If a person is saying, 'I don't know if I can afford the bill,' then have a conversation about using a payment plan they can afford," Mr. Richardson said. "Negotiate a little for a monthly payment plan amount that's reasonable to you and to them."
3. Help the patient understand how his or her insurance coverage works. Payment misunderstandings are often caused by a patient's lack of knowledge about his or her insurance. "Most misunderstandings deal with a change in insurance, and we spend a lot of time educating the patients about what their insurance covers," said Rhonda Fort, director of business operations at Practice Partners. She recommends spending some time asking the patient basic questions about their insurance coverage to determine how much they understand. If the patient is unaware of a co-pay or recently changed deductible, the bill will come as more of a surprise, which will decrease the likelihood of collecting in full.
ASCOA Vice President of Finance Cathy Meredith recommends connecting the patient with their insurance company if the ASC doesn't have time to educate each patient. "If a patient is having a difficult time understanding their coverage and really believes they do not owe the amount [you're billing them for], you can encourage the patient to call the insurance company and ask questions," she said. "In [rare circumstances], you can set up a conference call, and get on the line with the patient and the insurance company so the patient can hear the same information [from two sources]."
4. Allow for flexibility. Payment plans are easy if everyone pays you on time, Mr. Richardson said. The work starts when missed payments need to be collected. To help patients stay current with their payment plan, allow for occasional flexibility in the plan's repayment.
If a patient has another unexpected expense and misses a monthly payment, many systems will try to catch the patient up the next month, but realistically the patient won't have twice as much money when the next month rolls around.
"If this is not habitual behavior, skip the payment, moving the payment to the end of the loan term," he said. "Show the person in good standing, and work with them to get back on track for payments they said they could afford."
Mr. Richardson also recommends taking proactive steps to set patients up for success, such as using auto debit from their bank accounts and scheduling their payments around paydays and rent schedules. "We focus on the, 'How do you help the person who wants to pay you when life happens?' while making sure you get paid,'" he said.
5. Use a third-party payment plan. Not every patient will be able to pay for an expensive procedure up front, and your facility shouldn't have to turn away those patients. In that case, you can use a third-party payment plan through companies like Chase or GE's CareCredit that will approve or deny patients based on their credit rating. If a patient is approved by the payment plan, he or she can make regular payments for the procedure, and any failure to pay is generally absorbed by the payment plan, said Rob Morris, vice president of marketing and new business development for GE Capital's CareCredit.
These payment plans generally function like dedicated healthcare credit cards that can only be used for healthcare charges. A patient can apply at the center by entering several pieces of personal information, and the payment plan company automatically approves or declines the patient based on how likely or able they are to pay. The third-party payment plan means a third-party company assesses a patient's ability to pay and absorbs the loss, creating less financial hassle for your center.
An ASC should only resort to its last option — billing the patient after the procedure — if the patient arrives on the day of surgery and cannot pay and a day-of-service cancellation would create animosity between the surgeon and the center, he said. In that case, ASCs should research how to receive the highest possible payment from post-discharge collections.
6. Train staff in money collection. Staff members at the surgery center should have special training to understand the rules and regulations of payment collection. If a mistake is made, the ASC must admit to it and work with the patients to make it right.
"The worst thing that could happen is the ASC tries to twist the mistake so fault falls on the patient," Mr. Devitt said. "If you make a mistake, admit it and correct it. Otherwise they could write a negative review on social media websites. Keep your patients happy and you'll drive increased patient volume."
If you are unable to collect from the patient, bring in a third party experienced at collecting this type of debt. "For some patient debtors, as soon as the third party is implemented, they will pay," he said. "Sometimes people become very savvy in how to deal with payments and they know their credit won't be hit until they see the third party involved."
Third party contractors may accept a flat rate for working on the claims or take around 33 percent of collections.
7. Decide whether aggressive collections will hurt patient relationships. Physician offices, like other businesses, may be hesitant to pursue patients aggressively if they want to maintain a longstanding relationship with the patient. If the patient feels the office is being too pushy, they may decide to go elsewhere for treatment. However, patient collections in ASCs are slightly different; because many patients are one-time customers at the ASC, surgery centers can be more aggressive with non-paying patients without losing their customer base, Mr. Morris said. Without being rude, surgery center staff members should call patients consistently and consider submitting them to a collections agency once phone calls have proven unsuccessful.
More Articles on Coding, Billing and Collections:
14 Recent Medicare, Medicaid Issues — Medicare ACOs, SGR & More
Former President Bill Clinton Calls for Healthcare Cost Transparency
19 Pioneer ACOs Want CMS to Delay Pay-for-Performance Obligations