The patient collection process has moved beyond simply collecting patient co-payments and sending billing statements. In today’s healthcare environment, providers and their office staff are faced with the daunting challenge of reframing business practice to help maximize reimbursement from not only health insurers but from patients as well. A TransUnion Healthcare analysis uncovered that patient responsibility or patient out-of-pocket expenses rose on average 11% in 2017; a trend that does not appear to be slowing. With this heightened focus on patient collections, let us explore ways to positively impact the patient experience through the use of new technology, discuss consumer protections and the barriers they add to collections, and review other best practices that will help you maximize your revenue.
Both consumers and healthcare providers are battling the sustained presence of high-deductible health plans. Consumers are faced with the higher out-of-pocket expenses while providers are tasked with collecting higher copays. In 2017, patient responsibility made up nearly 30% of income for practices indicating that the patient is now one of the major payors in the healthcare space.
With this type of marketplace presence, it is important for providers to understand that the revenue cycle has a direct impact on the patient’s overall experience. A positive or negative experience related to the cost of care received and subsequent medical billing has an impact on the patient’s perception of care received. Why is that? The billing process is often the first interaction the patient has with the facility and is often the last. According to research from Fierce Healthcare, patient satisfaction ratings fall by an average of more than 30 percent from post-discharge through the billing process. In the event there are significant issues with the post-care billing, one would expect the satisfaction rating to fall even further, therefore collecting patient responsibility at time of service will allow patients to focus solely on their recovery after care without continued financial burden. Additionally, in 2017, TransUnion reported that 68% of consumers were unable to pay their financial responsibility after services were provided and they expect the percentage of patients not paying their medical bills in full to rise to 95% by the year 2020. Because of this, collecting patient responsibility at time of service is essential to increase your cash flow and decrease the administrative burden associated with back-end collection costs.
Already this year, we’ve watched the almost continuous barrage of headlines regarding healthcare technology; the expansion of telehealth, wearable health tracking devices, and cloud-based services amongst others. Technology is incorporated in all areas of healthcare and revenue cycle is no exception. Consumers want convenient access to healthcare and a streamlined process. As a result, providers are looking for ways to implement new technologies that promise to promote accuracy and efficiency while positively impacting the patient experience.
To help providers collect these higher patient responsibilities, many practices are implementing automated tools that can evaluate patient benefits and eligibility and produce accurate time of service quotes. Having this information will better prepare front office staff and set proper expectations for the consumer. This type of technology implementation helps to streamline the time of service collections process while ensuring that patients arrive prepared with a full understanding of their responsibilities. These estimates also offer the providers and office staff the supportive and accurate information they need to discuss personal and customized financial responsibility with their patients, fostering a positive relationship between the provider and the consumer. Automation of this type can also help to reduce patient phone calls, improve patient satisfaction, and decrease administrative burden associated with collections. Often, these technologies are integrated with the practice management system or EHR which eliminates inefficiencies and helps to reduce demographic and insurance capture error; a common cause for claim rejection or denial. When a claim is rejected due to error or denied due to documentation, it is the provider who suffers as this creates a delay in claim adjudication and subsequent payment for service.
While you are meeting the challenges of collecting patient financial responsibility it is also important to remain knowledgeable about associated state regulations. In the event you are unable to collect full patient responsibility at the time of service, be sure to review your state’s statute of limitation on consumer debts to ensure that you are compliant with collection practices and timeframes. Individual state regulation dictates specific time frames during which you have the right to attempt to collect debt from a consumer. These limitations vary significantly across all states and may also include qualifying criteria; therefore, it is important to understand what your back-office collection practices may include.
The concept of balance billing or surprise billing has been making headlines over the past few years because of growing concern from healthcare consumers and government officials. As a result, states are continuing to focus on the implementation or expansion of balance billing or surprise billing legislation. Though the concept of balance billing and the legislation associated is not new, many states are expanding their efforts to include greater consumer protections. These laws are the result of the ever-increasing presence of high-deductible health plans post-Affordable Care Act implementation. As a result, a patient may find that they have large and unexpected medical bills after treatment at an in-network facility by an out-of-network provider. States have long been making changes to legislation to protect consumers in these scenarios, which are often difficult to anticipate. From 2016 to 2017, at least 89 bills have been introduced in 28 states on the issue, with nearly every state in the country addressing some form of consumer protection related to balance or surprise billing. Understanding how your state regulates balance billing will help your facility remain compliant as you manage your revenue cycle.
Though the use of automated tools and knowledge of collection practices will foster positive patient-provider relations and improve revenue, they are not the only options available to providers. There are other best practices that span many avenues. Facility or physician practice collection policies should be provided both directly to the patient and posted publicly in the office space with the goal of educating the consumer about collection practices. With growing efforts surrounding price transparency, patients are now educated consumers who expect to have open conversation about costs for healthcare services with their providers.
Payment plan and financing options are other great services to have available to patients. Not only do these options make the process of receiving care more efficient and seamless for the consumer, they also decrease the amount of time and resources needed to follow back-end collections. Payment plan and financing options also allow the practice to engage the patient in their financial planning and supports a collaborative effort to find a payment plan that is customized for the patient but that also meets the providers requirements. Maintaining a credit card on file can also help to ensure that you are able to charge payment in a timely fashion either as a one-time payment or as part of a payment plan. This will decrease the patient days in accounts receivable and increase cash flow while adding an additional level of convenience for the patient.
Because the patient is now one of the major payors in the healthcare space, providers and practices alike must pay even greater attention to the patient experience and patient satisfaction expanding patient advocacy beyond clinical care. No longer is the patient experience only about the time the patient spends in your office or facility. Patient responsibility, collection practices, medical billing and the encounters associated with these areas have a profound impact on how the patient views their experience and the care they receive. Improving time of service collection practices with policy disclosure and use of new technologies will help you improve your cash flow. Remaining current and knowledgeable on state and federal regulations that govern collection practices will help you maximize your revenue while remaining compliant.
Written by Kylie Kaczor MSN-RN, CASC, CMPE, CPHRM, ACHE, CPCO, CLSSBB, Vice President, Clinical and Regulatory Affairs
Source: Becker’s ASC Review
This post was first published September 5, 2018 and was updated July 29, 2020.