As the payor trend toward increasing deductibles, co-pays and co-insurance continues, greater pressure is on ASCs to collect what have become large dollar amounts from the patient.
Failure to capture this higher patient balances could turn a profitable procedure into one that loses money for the center. The following recommendations can help boost your collections success rate.
1. Provide detailed patient financial counseling. After communicating with the third-party payor to determine the patient's financial responsibility, contact the patient as far in advance of the procedure date as possible to allow the patient time to plan to cover costs. It's important that you are aware of any contract or state restrictions that prevent up-front collection of fees. Provide the patient with the deductible amount still owed, any co-pay and an estimate of how much co-insurance could be owed. Make sure to advise them that the final amount may differ from the estimate due to possible changes in the procedure(s) performed by the provider. Explain clearly how much the patient owes and how much should be paid before surgery.
It often falls to the ASC to educate patients on their contractual coverage. Informing the patient about their portion of the fee helps eliminate confusion and prepare them for meeting their responsibility.
2. Ensure provider's office and the ASC are sending the same message. Providers often tell their patients that they don't have to worry about payment until after the procedure is performed. This may work well for the provider as they see the patient for postoperative visits and have more opportunities to collect their fee. However, the ASC usually has only one face-to-face contact with the patient. This makes it crucial to prepare the patient to pay for the ASC's fee on the day of surgery. Discuss the ASC's financial policies and procedures with the provider's office so they understand the need for their support in providing the patient with accurate information.
3. Collect the patient's total estimated amount due on the day of the procedure, if feasible. Due to the large deductibles and co-insurance on many third-party payor policies, the patient's out-of-pocket expense may be quite high, often more than the insurance company owes. ASCs cannot afford to allow patients to leave the ASC following their procedure without having covered their expenses or determining a payment plan as failing to do so and then trying to collect can prove difficult and time consuming.
That's one of the reasons why it's imperative that ASCs…
4. Provide several options for payment. ASCs should offer several ways for patients to meet their financial responsibility. The most obvious ways to pay are cash or credit card. Since these are the simplest and quickest solutions, it is worthwhile for ASCs to participate with the most used credit cards (MasterCard, Visa, Discover and American Express).
5. Set up a payment plan. As patient financial responsibility has grown, payment plans have become more commonplace in ASCs. If the patient is unable to pay the full amount of their estimated financial responsibility up front, a short-term payment plan (i.e., 90 days or less) may be a viable option.
On the day of surgery, require a pre-determined down payment that covers at least the direct costs of the procedure. Arrange automatic monthly payments to be charged to the patient's credit card or deducted from a bank account and have them sign the necessary documents to allow these charges or deductions.
6. Offer information about healthcare credit services. There are several available, so research which one(s) offers the best fit for your patients and the ASC. Like accepting credit cards, this option charges a usage fee to the ASC, but it also helps eliminate the expense of collection efforts. Providers are paid the full amount owed, minus a fee, and the patient pays the healthcare credit company through a payment plan. This option is available to patients who meet the service provider's requirements, such as income, job security and credit history.
7. Consider a direct payment plan. Some ASCs choose to offer patients a payment plan where the patient regularly pays the facility directly (again preferably no longer than 90 days). Know that enforcing these plans can prove difficult and time consuming. If you go this route, ask the patient to sign a promissory note and inform them that there is a pre-determined down payment that will be collected prior to surgery. Thereafter, regular monthly payments are due on a specified date in a specified amount.
8. Send regular patient statements. Since the amount collected up front is just an estimate, there may be additional monies owed by the patient. Send the initial statement as soon as the remaining patient responsibility is established (i.e. all third-party payor payments received and appropriate adjustments made). After the initial statement is sent, follow-up statements should be sent at least every 30 days. After three statements with no response, a phone call to the patient is appropriate prior to engaging outside collection agency efforts.
Don't Overlook Patient Responsibility
During collection efforts, patient balances are often overlooked as they may not be a high dollar amount, or as high as most claim balances. However, any amount not collected in a timely manner negatively affects your accounts receivable total and aging. Assign a business office staff member the responsibility of ensuring that patient payment plans and remaining balances are regularly worked until completely collected and audit their progress regularly.
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.