Improve patient collections through billing transparency

everythingpossible/Adobe Stock

An overwhelming majority (92 percent) of patients want to know their payment responsibility prior to visit. This statistic, from InstaMed’s seventh Trends in Healthcare Payments Report, highlights the recent shift in patient financial engagement.

Patients have become consumers who seek transparency and flexibility when paying for healthcare expenditures. However, medical groups are lagging when it comes to meeting consumer expectations of identifying, and collecting, out-of-pocket liability.

Technology solutions are beginning to make accurate patient estimates a scalable solution to not only identify but help medical groups engage in best practices for collections.

Patient cost identification should focus on more than running patient eligibility and returning back copays, deductibles and coinsurance levels. An accurate estimate factors in specific procedure codes that apply to a patient encounter as well as processing logic of the specific payer to get to an actual allowable rate - in addition to the standard check for eligibility and benefits.

The number of insured patients using high-deductible health plans (HDHP) has exploded over the last decade, to the tune of nearly 400 percent growth. The almost 22 million U.S. residents using these HDHPs create expanding patient responsibility balances and will be vital to control and limit write-offs and bad debt

When it comes to communicating patient estimates, practices need a mechanism to assist in disseminating this often-complex information to patients. Research suggests that 74 percent of patients are confused by their explanation of benefits (EOBs). Therefore, structure your patient access teams and materials to be consultative in nature so that patients actually understand the rationale behind their liability.

By educating patients on their liability, your practice will see improved patient collections as well as a better patient satisfaction score since there will be fewer large surprise balances. Given that 73 percent of practices take longer that 30 days to collect balances, accelerating this timeline can have a direct impact on your practice’s financial performance.

Here are 5 steps your practice can take to assist in patient responsibility collections:

• Review the layout of your patient estimate or patient statement. If it doesn’t make sense to you, it definitely won’t make sense to patients.

• Focus on verifying insurance benefits in advance of the visit so you can be aware of HDHPs or even patients with inactive coverage. Leverage electronic verification wherever possible.

• At a minimum, be prepared with the insurance allowables for your most common procedure codes. Although having a system in place to automatically help with this is much more efficient, knowing what your insurance allows is a step in the right direction.

• Work with your patient access department, physicians and healthcare providers to ensure all parties are in alignment prior to discussing estimated costs with a patient.

• Change scripting at point-of-service or during pre-registration to make patients aware of possible liability and even suggest collecting payment in full, down payments or establishing payment plans, prior to the patient’s visit with their physician or healthcare provider.

The financial experience is becoming more impactful on overall patient engagement. Medical groups that continue to strive towards transparency will yield better patient financial performance, improved patient experience and healthier patient relationships. Though regulation may be passed to force medical groups to improve cost and care transparency, strive to be ahead of the curve. If you do, you will see improvements across the patient spectrum.

Andrew Harding is the vice president of customer success at Rivet, a software company helping physicians and healthcare providers intelligently and accurately collect money faster from payers and patients. Prior to Rivet, he was a revenue cycle consultant helping hospitals and physician practices optimize their collections. He can be reached at andrew@rivethealth.com or at www.rivethealth.com.