Insurance plans have increased the amount of the visit that the patient is responsible for paying when a patient visits a pediatric practice. It is interesting how before 40 years ago, it was common for patients to pay the entire bill to their pediatrician and they would submit their receipts to the insurance company for reimbursement of some of the visit. The model changed in the 1990s as managed care and the HMO became popular with the small copay to the patient and the insurance company paying most of the cost. Since the Affordable Care Act and increased costs to health plans, health plans help employers and individuals reduce their monthly insurance plan cost by increasing patient co-pays and deductibles. This means it is more important today for pediatric practices to measure overall collection rate (combined Insurance and Patient payments). Five steps that can help improve patients collections are:
- Train and Monitor Consistency of Front Desk Team
The front end of the revenue cycle is the front desk team at the pediatric practice. The front desk team usually has strong knowledge of the families that visit the practice. They should be trained on confirming demographics, checking insurance eligibility, and collecting copays as well as any patient amount due. Either the practice administrator or one of the physician partners should monitor and provide feedback on each front desk team member’s consistency in this position. The front desk team members should also be familiar with the current practice financial policies.
- Update Practice Financial Policies
Each pediatric practice should maintain a financial policy that includes information related to collecting co-pays and patient statements. The guarantor for the patient is responsible to understand their insurance and provide up to date and accurate insurance information. Most patients do not understand insurance plans and often forget to actively communicate a change in their medical insurance. For this reason, it is important that the front desk team members ask on each visit if the insurance information has changed. The best practice is for the front desk team to review the actual insurance information on file.
- Patient Statements
After an insurance claim is sent to the payer, the biller should receive a confirmation of the amount paid by the insurance and the amount due to the patient. Based on the information sent back, the medical biller might send out a first patient statement. This statement shows the billed amount, the contract rate, what was paid by the insurance, and what is due from the patient. If the practice accepts credit cards, this information should be included on the patient statement.
- Collection Calls
Some guarantors receive the patient statement and either forget to pay or avoid paying the statement. Reminder collection calls are a good way to increase the payment rate of patient statements that have not been paid. Collection calls take time and cost money so check to see if your billing company includes this as part of their service.
- Payment Plans
Some guarantors are only able to pay a portion of a bill. The practice should have a payment plan policy that describes some options for the medical billing team to present to the patient as far as payment plans. A young family might not be able to afford a $295 patient statement but could afford to pay $100 up front then $50/month until paid. While payment plans take time, they are an important tool to improve the collection rate in a flexible way. Managing payment plans take time and cost money so check to confirm your billing company includes this as part of their service.
While there are many aspects to patient collections, the five steps listed above provide some framework on how to optimize the patient collection aspect at a pediatric medical practice.