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Optimizing Patient Collections in the ACA Era

Optimizing Patient Collections in the ACA Era

For the 50 years leading up to the enactment of the Affordable Care Act of 2009, total healthcare spending grew by more than 800 percent in the United States, ultimately accounting for nearly 20 percent of the nation’s economy by the end of the last decade, according to the consulting firm McKinsey and Company.

Bending this cost curve was a primary goal of the ACA, which included numerous provisions designed to slow healthcare spending by encouraging patients and providers to make more prudent choices about treatment. For doctors and health systems, this means transitioning away from a fee-for-service model to one that emphasizes outcomes. Individuals, too, are adjusting to a new system of higher premiums, deductibles, and co-payments—all purposely designed by healthcare policymakers to slow spending by forcing patients to have more “skin in the game” when visiting the doctor’s office.

While the transition towards value-based care remains a work in progress, the era of increased patient responsibility is already well underway.

Today, the average deductible for an employer-based plan is $1,318, more than twice what it was a decade ago, according to The Henry J. Kaiser Family Foundation’s “2015 Employer Health Benefits Survey.” The foundation’s study also shows that individuals covered under employer-based plans now are paying a larger portion of their surgery bills than they were just a few years ago: Between 2011-15, the percentage of employer-based plans with coinsurance increased by nearly 20 percent. This undoubtedly is a big reason why the overall costs for uncompensated care in the United States remain much higher than they were a decade ago, even though a smaller percentage of the population is uninsured.

But with patients responsible for covering more of their healthcare costs, ambulatory surgery centers and other providers are stuck in the middle, responsible for collecting more out-of-pocket expenses directly from patients. This greater cost sharing requires providers to rethink how they have collected money from patients, who historically have not prioritized medical bills over other typical monthly expenses. The following best practices will help optimize patient payments at your facility:

Policies, processes, and education

Providers are making big strides in improving their bottom lines by implementing strict financial policies, especially at the point of service (POS). According to a 2015 Advisory Board Company survey, the average U.S. hospital more than doubled its POS collections between 2010-14, from $700,000 to $1.8 million per year—a positive development, but one that must continue to improve in the era of increased patient responsibility.

With that in mind, financial policies should be simple and consistent and applied uniformly. All staff and physicians should be educated on the rules and held accountable for applying them. Similarly, patients should be made aware of all policies and required to sign documents indicating they’ve been informed at the POS.

Patients should be alerted about their financial obligations prior to and on the day of their procedures via automated phone calls, emails, and text messages. Payments then should be collected upfront from patients before the procedure is performed. Patients should be offered a variety of convenient options for paying deductibles and coinsurance, including cash, credit card, check and health savings account. Self-pay patients also should be offered discounts for upfront cash payments at the time of service.

With patients fully informed of a facility’s financial policies, front-desk staff should also schedule appointments six to eight weeks out, if possible. At the time of scheduling, benefits also should be verified with the payer, a step that should be repeated on the day of service. Also, staff should be well-versed in the various types of carriers, as well as the requisite forms and policies for self-pay patients, workers’ compensation claims, motor vehicle accidents and other typical cases.

Technology, follow-up, and collections

Once primarily a paper-focused industry, healthcare is taking a crash course in 21st-century electronic billing and payment practices. The reason is simple: Consumers demand it. According to a 2015 PricewaterhouseCoopers survey, 20 percent of consumers “did not find bills simple to pay,” a sentiment that jumps to more than 30 percent when answered by those with self-reported fair or poor health, i.e., those most likely to utilize healthcare services.

Investing in an HIPAA-secure online patient payment portal can help facilities move the needle in this area. These systems allow patients to provide and maintain demographic insurance information, make secure payments online, view bills, develop payment plans, utilize price transparency tools, and view payment history—all on their phones, tablets, and laptops.

But technology alone can’t solve all payment issues. Patients should be called on or before the day of service and reminded of their obligations. Statements also should regularly be sent and two reminder calls, emails or text messages should be made per statement cycle. In addition, 24-hour call center services can provide patients with the added convenience to pay their bills over the phone at any time.

If patients fail to pay after numerous attempts to collect outstanding payments, overdue notices should be sent—but only if your facility intends on following through on the implied threat. And once all options have been exhausted, collections agencies can help facilities recoup payments on delinquent accounts. These services, however, typically only pay pennies on the dollar for bad medical debt, which underscores the importance of fully leveraging processes, training, and technology to collect as much of a patient’s financial responsibility as early in the revenue cycle as possible.

Written by Nader Samii, CEO, National Medical Billing Services

Source: Becker’s ASC Review

This post was first published July 1, 2016 and was updated July 29, 2020.

Nader Samii, National Medical, Revenue Cycle Management, RCM, ACA, Affordable Care Act,



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