Beware of the Insured Patient!

Lea Chatham February 11th, 2013

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By: Rochelle Glassman, President & CEO, United Physician Services

With today’s high deductible plans, it is wise to view every patient who has commercial insurance (HMO, PPO and POS, etc.) as a self-paying customer. Why? Now that January 1 has come and gone, many patients’ deductibles have been reset leaving the first bulk of healthcare services paid by the patient. If the average office visit costs $199 and a patient as a $5,000 deductible, it is safe to assume that the charges for the first 25 visits will be paid out-of-pocket. Most patients do not meet their deductible unless they have high-dollar procedures, surgery, or a hospital admission.

Patients who are on Medicare and do not have supplemental (secondary) insurance also are responsible for 20% of the cost services provided. Have you thought about this and is your practice prepared for this reality?

If we aren’t careful, high percentages of insured patients can create a false sense of normalcy for our revenue cycle. We fall into the trap of believing the party responsible for paying the practice is the insurance company. Well, with high deductibles, we’d be making the wrong assumption. To avoid falling into this trap, here are a few precautions you and your staff can put in place today!

  1. Prior to the patient visit. Confirm with the patient on the phone or through a patient portal that their insurance plan remains the same. Update any change of information in your practice management system.
  2. Verify “every” patients’ insurance and benefit package prior to the patient visit. If you have a software system in place that checks eligibility for you, please use it. If not, it is worthwhile to use the payers’ websites to check, especially for new patients.
  3. Patient notification. If the new deductibles begin in January, alert the patient of what remains of their deductible prior to the appointment, and explain that payment will be due at time of service. The payment will be counted toward the deductible and will need to be paid by them, not the insurance company. Notifying the patient in advance does not open the patient to surprises at the time of the visit. This should limit the number of patients who do not pay at the time of service with the excuse that they did not know that they had not met their deductible.
  4. Collect the deductible before the patient leaves your office. Pre-collecting the deductible or a portion of the deductible before the patient visit or at the check-out counter is a great way to avoid the costly and risky process of trying to bill the patient after they have left our office. If the patient cannot afford the entire payment ask for a minimum of 50% and then request that the patient allow you to make a deposit on their credit or debit card for the balance to be applied to their account either at the time the EOB is posted or after an agreed to date no longer than 30 days.

Taking a deposit on an account via credit card is becoming more common in healthcare as it is no longer cost effective to send out patient statements for small dollar amounts. Many practices automatically write off balances under $10.00, this could add up to be a significant dollar amount over 1 year. If for example you write off $10.00 for 250 patients that would be $2,500.00.

For patients having expensive procedures or tests (over $500.00) who cannot afford to pay the in full at the time of service or within 30 days, it is important to have them agree to a payment plan before the service is provided. Again, the patient should approve monthly payments to be applied to their credit card until the balance is paid.

Like car insurance, healthcare insurance today is often geared to pay for medical emergencies. Those patients requiring only primary care services rarely meet their annual deductibles.

How can you learn about more innovative ways like this to improve collections? Join me on February 20 to hearabout other strategies to increase revenue and shorter your revenue cycle. Register here.

rochelle glassman discussees innovative strategies for increasing collections

About the Author
Rochelle Glassman is a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

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