More and more patients may have insurance now than they did 5 or 10 years ago, but that does not necessarily mean fewer are paying for services out of their own pockets. In recent years, deductibles and co-pays have risen quickly, even among employer-sponsored plans. So how can practices help improve collections of fees for service? Experts offer tips on ways to bring more money into the practice.

Good policy

Making sure practices receive money they are owed begins with having a good financial policy that is communicated to patients, said David Zetter, founder of Zetter Healthcare Management Services in Mechanicsburg, PA. He recommends having patients sign off on a policy every other year so they are up to date on the practice’s guidelines.

Physician offices should have strict guidelines for handling self-pay patients with an option for a prompt-pay discount if possible, said Michelle Colaberardino, director of physician practice services for Revenue Cycle Solutions, LLC, headquartered in Pittsburgh.

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Another policy to consider is how many statements will be sent to patients if they do not pay. Zetter recommends sending only 1, because “if they ignore it, they will ignore others.” Then if they don’t pay within 30 days, he suggests sending the bill to collection. And if your state allows it, require patients to pay collection fees.

The policy should also cover any payment plans a practice offers. Colaberardino recommends basing payment terms on the amount owed, lengthening the time to pay it off for larger bills, like 3 months for bills under $500 and 6 months for bills $1,500 or more.

If a plan stretches payments out over too much time, physicians can end up being considered a lender by federal or state regulations, Zetter said. “Any practice needs to be very cognizant of what the laws are in their state,” he said. “They need to know how long they can let payments go on a certain balance or bill.”

Office changes

Small measures can be taken in the office to improve collections. First, staff should be trained to collect co-pays at the time of service or patients do not see the doctor, Zetter said. “If a patient has a co-pay of $20, they need to ask, ‘How would you like to handle that today?’” he said. “They shouldn’t ask, ‘Would you like to pay it?’ It just takes some training.”

Staff should also be trained to verify insurance every time a patient visits. A co-pay is listed on most insurance cards, but if patients have an old card, that may be out of date. A real-time verification should tell what a co-pay is, so it can be collected at the time of the visit.

Likewise, if a patient with a balance on his or her bill comes in for an appointment, the front desk should make an attempt to collect at that point. He recommends that all staff members who have patient contact receive instruction on how they can take part in the collections effort and how to communicate so they do not feel uncomfortable asking patients for money.

If patients cannot pay the entire bill at the time of service, use the electronic medical record (EMR) to generate a bill to give to them before they leave the office. By doing this, patients will already have an idea of what is currently due, Colaberardino said. Some EMR systems can send a bill as a soon as a balance becomes due. This may provide better results and be more cost effective than sending statements out weekly or monthly.

“Don’t wait,” she said. “Statements could be going out every day. This keeps the money flowing in.”

Use credit

A practice that Zetter recommends to most of his clients is keeping patients’ credit card information on file. “I have a couple of providers that mandate that they have credit or debit on account or they don’t see patients,” he said. “They have hardly any [accounts receivable]; the only problems they have now are collections with insurance.”

But taking patients’ credit information and keeping it locked in a file somewhere is a huge risk, he said. He recommends working with gateway vendors that keep the information in their system and is responsible for keeping it safe. When a patient signs off on a payment plan, office staff can simply go into the system each month and charge the flat amount until it is paid off. A vendor then sends a receipt to the patient each month alerting them the amount has been debited.

Gateway groups typically charge a monthly fee, Zetter said, the money spent comes back to an office 10-fold by increasing collections and reducing staff time on the efforts.

Colaberardino is less a fan of having credit card information on file because of the potential for theft of the information. It is beneficial for a practice to gather this information, she said, but patients tend to be skeptical of the process. Many individuals do not want to give the practice the ability to deduct money from their accounts automatically. To do this, staff members need to assure patients their information will be secure.

“You have to educate them and let them know the process is going to help provide services in a more efficient manner and allow staff to dedicate less time here and more time on other important jobs,” Zetter said.

Tammy Worth is a freelance medical journalist based in Blue Springs, MO.