In our previous article on how to improve upfront collections, the first in this two-part series, we discussed the need for accurate and timely preauthorization. The second phase — patient financial counseling — is just as important.
There are two primary reasons for patient financial counseling:
- The patient's right to be fully informed of their financial responsibility prior to the day of the procedure so they can plan payment accordingly.
- The ASC's need to be properly compensated for the services provided.
The second part in this series provides eight suggested steps to assist you in obtaining upfront collection of a patient's financial obligation.
1. It is the responsibility of the patient financial counselor to be aware of the ASC's financial policies, including those that cover the following:
- collections prior to service
- collection of deductibles and co-payments
- Medicaid
- commercial insurance (HMO/PPO)
- workers' compensation
- liability (auto/litigation/lien)
- secondary insurance
- cosmetic procedures/self-pay
- charitable consideration
- non-covered procedures
The patient financial counselor must also be knowledgeable regarding the types of payment accepted by the ASC (e.g., credit cards, cash, money order, cashier's check, personal check).
2. After receipt of information regarding third-party coverage from the insurance verification specialist, contact the patient (or responsible party, if the patient is a minor) at least three days but preferably one week prior to the date of procedure. This conversation is to inform them of their financial responsibility and respond to any questions regarding the patient's insurance coverage as determined during insurance verification for the scheduled procedure.
It is important to include the following points in this conversation with the patient:
- Identify yourself, the surgery center, the date of the procedure and the name of the provider.
- Check accuracy of the patient's insurance carrier, plan holder, employer (if applicable), identification number and group number.
- If treatment is for an injury, ask if the cause of the injury is due to work, automobile or another kind of accident.
- Ask if patient has any other insurance.
- Inform the patient that the carrier has advised that the procedure is covered and the amounts due by the patient for deductible and/or copay.
- Advise that these amounts are due on the day of surgery and what types of payment the ASC accepts.
- Inform the patient that verification of benefits with their insurance carrier is not a guarantee of payment. The ASC will file the claim with the insurance company for them.
- After the carrier pays the claim, the patient will be responsible for co-insurance amount and will be billed at that time.
- Advise the patient that they will also receive bills from the anesthesiologist and their provider. If applicable, an additional bill may be received from the laboratory/pathology.
In some instances, third-party payers may require additional information from the patient (e.g., second opinion, proof of full-time student status). If so, in addition to the points listed above, advise the patient of the additional insurance carrier requirements and collect the necessary information at that time.
3. Depending on the ASC's policy for cosmetic, non-covered or self-pay procedures, the patient should be made aware that payment in full is required on the day of the procedure.
4. Again, depending on the ASC's policies, if a patient refuses or cannot afford full payment on the date of service, a promissory note should be signed, and the following payment plans offered, listed in the order of the ASC's preference:
- 50 percent at admission and payment of the remaining 50 percent in 30 days.
- 50 percent at admission, 25 percent in 30 days and 25 percent in 60 days.
- 33 percent at admission and 33 percent in 30 days, with the final balance in 60 days.
- 25 percent at admission, and the remaining balance paid in six equal monthly installments (six months total). If the patient is unable to pay 25 percent at the time of admission, consult with administrator to determine amount needed to be collected to cover case cost and then divide balance equally over six months.
A recurring credit card payment may also be accepted for promissory note terms. If the patient selects this method of making monthly payments, complete both the appropriate promissory note and recurring credit card payment form.
5. If the patient claims inability to make payment of any kind, refer the account to the business office manager/administrator to determine if the patient meets the criteria for charitable consideration. The patient should provide all information requested in the charitable consideration policy to be considered for this assistance.
6. Upon the patient's arrival on the date of service, the patient financial counselor or designee should meet with the patient and have them complete all necessary paperwork, copy the patient's insurance card and identification, collect the agreed upon payment and provide a receipt for any payment. If applicable, have the patient sign the appropriate promissory note.
Provide the patient with a copy of any consent forms, release of information forms and assignment of benefits forms they sign as well as a copy of the promissory note, if applicable. They should also receive instruction on how to contact if they have further questions about their insurance or payments due.
7. Scan or copy the promissory note, insurance card (front and back) and patient's identification. If copied, forward to the billing office.
8. Any other payment arrangements must be made with the written approval of the administrator. No patient should be denied care without approval of the administrator or designee.
Be Vigilant
Collecting upfront payment for services is becoming increasingly important as third-party payer deductibles and co-pays continue to increase and their payment for services decrease. The financial health of your ASC is dependent on being paid the full amount allowable for services provided, which includes not only payment from the insurer but the patient's portion as well.
Providing appropriate, adequate and timely financial counseling for the patient is an important and critical part of patient care. Patients understanding their financial responsibility and, if necessary, having time to plan to meet that obligation is key to improving their satisfaction.
Caryl Serbin, RN, BSN, LHRM, is president and founder of Serbin Medical Billing, an ASC revenue cycle management company. Serbin Medical Billing's primary objectives are to provide the best coding, billing and accounts receivable management services available to ambulatory surgery centers (hospital joint-venture, corporate-owned or independent) and anesthesia providers. Ms. Serbin has been a leader in the ASC industry for 30 years. She was the founder of the first ASC-specific billing company.