The medical world has seen a dramatic increase in the amount that patients are due at the time of service. As evidenced through national surveys like the 2015 survey by the Kaiser Family Foundation on employer health benefits, out-of-pocket costs for patients has increased by 230% in the past 10 years. This trend looks to be continuing. Therefore, collecting from patients has become vital to the financial health of medical practices.
Here at PracticeForces, as we serve medical practices, we have witnessed this upward trend in patient responsibility firsthand. With patient due amounts accounting for 30% of practice incomes, what we do as billing operations has an enormous impact on a practice's financial performance. Our clients depend on our innovative approach and best practices when dealing with patient collections.
By following strict guidelines, best practices, and by educating the practices we serve on collection procedures, we have been able to improve our own collection efforts, and achieve a 99% collection rate for the past 2 years.
On average, this leads to a 20% revenue increase per client, with spikes of 60-70% yearly revenue increase when billing is in a much better, cleaner state. For example, this recent half-yearly analysis of our services for an established provider of in-home medical care services and physician house calls shows that, after taking over from their previous billers, in just over 6 months we achieved a 158% payment increase, and significantly reduced their outstanding A/R.
With this in mind, we wanted to share with you a few secrets that will help your patient collection activities. For more in-depth information, refer to this article by HBMA.
Concerning Provider-Payor Contracts:
- Patient co-pays are required to be collected at the time of service.
- Billing companies can educate practices to ensure compliance.
- Patient balances must be collected.
- Payor is entitled to terminate the agreement and deny re-negotiation if no collection efforts are made for patient balances. This can be viewed as a contract breach.
- Medicare requires collection efforts for all Medicare patient balances.
- Provisions regarding patient co-pay and deductible reductions or write-offs must be followed explicitly.
- All requirements must be met before providing discounts.
We have also found the following best practices to drastically improve patient collections:
- Adhere strictly to the medical practice's financial policy.
- If a practice does not have a policy, the billing company should educate them on the importance and value of having a developed policy for patients to follow. Speak to us if this is of interest.
- Be consistent.
- Always follow the payor contract and practice's financial policy with every patient collection procedure.
- Compress Statement Cycles.
- Send bills as soon as possible, because collection percentages drop dramatically after 30 days.
- Document every interaction.
- The key is to have a paper trail for every interaction. Work with your biller to establish good documentation habits.
As the patient responsibility portion of the medical bill continues to rise, practices depend on billing companies to achieve high rates of patient collections. To achieve this, we as billing companies must ensure compliance with the provider-payor contracts and the practice's financial policy.
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