Many surgery centers attempt to collect the patient portion of a payment for services performed at a surgery center after the patient has left the ASC. This is clearly a recipe for bad debt, says Lindsay Miller, vice president of internal auditing.
“Our experience has shown that expected collections decline dramatically once a patient leaves the ASC,” she says. “In fact, if a patient doesn’t pay within 28 days, your likelihood of getting paid at all reduces to below 10 percent.”
Further exacerbating the problem, “many of the surgery centers around the nation are taking virtually any case they can get and are rarely checking benefits or determining whether the patient can pay their co-pay, co-insurance or deductible,” says Ms. Miller, whose company provides billing, coding and collections for ASCs in over 25 states across the country. “Many of these facilities are hurting for cases, but taking on some of these cases without doing the necessary homework in advance can negatively affect self-pay accounts receivable as well as cash per case if the facility is seeing a lot of patients with poor in- or out-of-network coverage.”
Ms. Miller says the most effective way to minimize the amount that needs to be collected from ASC patients is to have the front desk staff collect and verify insurance card and demographic information, perform pre-certifications without assuming that the procedures are covered and collect the co-pay and co-insurance at the time of service. It is also critical, she says, to have knowledgeable, professional and highly diligent financial counselors who are willing and able to call patients in advance and let them know their financial responsibility before they even enter the ASC for their procedure.
“While we fully acknowledge that it can be challenging to do this in all situations, we are staunch advocates of having centers put such policies and procedures in place and do their best to follow them,” Ms. Miller says.
New technologies can also be used to significantly improve the likelihood of success in the patient pay arena, such as automating the calculation of patient responsibility so the front desk staff has access to that information when requesting payment, she says. National Medical incorporates online insurance verification, for example, and advises clients to offer various options for payment, ranging from patient payment portals that provide electronic statements and the ability to pay online or over the phone with checks, credit cards or debit cards. “There are also wonderful financing programs that can be quite attractive to patients,” Ms. Miller says.
One organization that provides such a financing program is GE Capital, through its CareCredit product. Rob Morris, vice president of marketing and new business development for CareCredit – GE Capital, says CareCredit allows patients to pay their facility fee over time in monthly installments, while the ASC receives its payment in two business days.
Having a patient financing program in place can remove the awkwardness an ASC faces when billing the patient following treatment. ASCs are sometimes thrust into a difficult position with their physicians if a patient comes on the day of a scheduled surgery and has not brought the necessary payment, Mr. Morris says. If an ASC refuses to provide services to such a patient, it risks angering the surgeon, who will have shown up for nothing and may consider moving to another center. “ASCs cannot afford to alienate their surgeons,” he says.
Mr. Morris says he has encountered ASCs that have accumulated hundreds of thousands of dollars in patient A/R they are unlikely to ever collect. A financing program can eliminate this A/R, increase cash flow and save money that would have been spent on staff and materials for collection efforts, he says.
In the case of CareCredit, regardless of whether the patient eventually pays, the ASC receives its payment. There are a variety of no- and low-interest payment plans. The ASC pays a processing fee on the type of payment plan chosen.
Offering extended payment plans through third-party programs can also enhance patient relationships, Mr. Morris says, because they allow the ASC to avoid potentially contentious situations with patients.
With healthcare reform likely to result in more patients entering the healthcare system, and with the burden of payment increasingly shifting toward the patients, it is critical for ASCs to have a well-thought-out plan in place to handle patient payments. With patient pay increasing toward 20 percent of the total A/R for many ASCs around the nation, this will become one of the most critical items in determining the level of profitability for surgery centers in the coming years, Ms. Miller says.
Ref. Becker’s Healthcare
This post was first published June 2, 2010 and was updated July 29, 2020.