By Lewis Custer, Senior Vice President, Administration, National Medical Billing Services
With the continued shift of financial liability from the third-party payers to patients, it is critical to have effective, efficient and consistent processes and procedures for patient registration and intake. The back-end processes to remediate patient demographic errors, incorrect insurance information and collecting the patient’s portion of the financial responsibility are increasing in expense (e.g., postage, supplies and labor for a patient statement process) and the back-end rework processes are only moderately effective. Therefore, it is financially prudent to make every effort to capture accurate and complete patient demographic and insurance information and to collect the patient’s financial responsibility, prior to, or on the date that services are rendered.
The following are recommended steps that may be taken and services that may be purchased to prevent claim denials, mitigate rework and improve patient payment collections:
1: Establish a proactive patient pre-registration process to:
• Capture and confirm patient demographic and insurance information
• Complete patient registration forms (e.g., assignment of benefits form, acknowledgement of financial responsibility form, etc.)
• Provide information regarding appointment scheduling rules and the consequences of missing an appointment.
2: Consider purchasing a real-time eligibility verification tool that will allow access to:
• The patient’s benefits
• The patient’s benefit limitations
• The patient’s out-of-pocket financial responsibility
Further, there are a number of third-party suppliers and billing software companies that offer integrated real-time eligibility verification services for a fee.
3: Consider purchasing encrypted patient portal services that allows patients to:
• Provide and maintain demographic and insurance information electronically
• Make payments electronically
• Communicate with clinicians and staff members electronically
4: For patients who may either have a deductible or are responsible to pay a coinsurance for scheduled medical services, consider implementing a patient financial responsibility estimation process to collect all, or most, of the patient’s portion of the financial responsibility prior to, or on, the date-of-service. There are a number of third-party suppliers that offer patient financial responsibility estimation tools and services that vary in complexity and accuracy.
5: If collecting the patient’s portion of the financial responsibility during the pre-registration or registration processes is not desired or possible, it may be beneficial to offer as many payment options as possible to patients. Payment options and benefits might include:
• Reoccurring payment plans with limitations on the length of the plan and with minimum required payments allow for large patient balances to be separated into manageable and controlled amounts
• Adding a required promissory note that the patient must sign increases the patient’s accountability, the overall effectiveness and the consequences of not complying with the plan
• Allowing patients to pay using all forms of major credit cards or Automatic Clearinghouse (ACH) payments offers more flexibility to patients
• Medical loans through organizations like Care Credit will provide an additional payment option and flexibility for patients versus financial hardship processes that lead to adjusting off a portion or the entire patient balance