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Pain Point Series: Is Your Center Consistent When Collecting Patient Payments?

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You can’t follow an ASC-focused blog, magazine, or trade organization without constantly hearing about the struggles of collecting patient payments. While the topic is widely discussed, it seems there is relatively little consensus throughout the industry. We won’t pretend to know what is best for your Ambulatory Surgery Center or patient population, but we will certainly recommend you have a Patient Pay Policy in place and that your center follows it consistently. A well-thought out policy eliminates ambiguity for your staff and promotes a feeling of fairness among your patient population. And best yet? ASCs with written and enforced Patient Pay Policies have much better collection outcomes than those who don’t.

If you have a policy that is outdated or not well adhered to, or you don’t have a policy at all – you’ve come to the right place! Below we will outline some key points to consider as you draft, or update, your Patient Pay Policies and Practices.

Do you want to collect any patient responsibility up front? If so, how much? If your patient population consists largely of privately-insured individuals, it’s probably best to collect (at least) a portion of the estimated patient responsibility prior to the procedure. In order to do this effectively, you’ll need to build out an effective process for calculating the estimated patient responsibility prior to the procedure. It’s impossible to know exactly what will take place during a procedure before it is underway, but patients have little patience for a large variance between the estimated and actual procedure cost. In order to best combat this, it is important to communicate the nature of the estimate in detail along with the estimate.

Conversely, if your patients are largely publicly-insured, and patient balances remain relatively low, it may be most cost effective to forgo costly estimates and instead, collect after the procedure.

What payment plans are you willing to accept? Be sure to include specific guidelines outlining what payment plans you will accept in your Patient Pay Policy. Recently, we’ve seen increased use of a tiered payment plan, based on the patient’s total bill. This method appears to be highly effective at reducing self-pay Days in A/R. Here’s an example of a tiered payment plan:

 Patient Pay Balance

  Maximum Length of Payment Plan Approved

 $1 - $150

 2 months

 $151 - $500

 3 months

 $501 - $1,500

  6 months

 $1,501 +

 9 months

**Note: It’s always a good idea to start by suggesting a shorter-term payment plan, even if the patient has a larger balance. You can always increase the length up to the maximum-approved length if needed.

Regardless of the length of the payment plans you are willing to approve and incorporate into your Patient Pay Policy, the most important step is to ensure all care providers and management personnel are in agreement of the payment terms. Ensuring this agreement prior to publishing/enacting your policy will ensure you have the necessary support to apply the policy consistently to your patient population.

What criteria will you use to decide when to send patient balances to a collection agency? As with the other aspects of your Patient Pay Policy, we believe there are several correct answers here. Each center should make this decision based upon their: ability to follow up on failed payment plans/unpaid balances, cash flow requirements, and their overall patient balances and patient population. Some common criteria we see used is:

  • Patient has received 3 statements, 1 phone call, and has not returned correspondence or made payments in accordance with an approved payment plan
  • Patient has set up a payment plan but has failed to meet the obligations of the payment plan 2 months in a row

We hope this information is helpful in creating or updating your Patient Pay Policy. As always, we are happy to be an ongoing resource for you and your center. If you have further questions or need some advice, contact one of our knowledgeable sales consultants by completing the form below.

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