Practice Management Alert

Medicare is especially tough on offices that don't collect

Medical offices that have the least amount of trouble with collections typically have set policies and procedures (P&P) in place that let staff know what is expected of them, experts say.

-It has been our experience that this is the foundation for a successful practice. Staff perform much more productively when they know what the company policies are and are trained in a way that they can feel confident in their approach,- says Robyn Lee of Lee-Brooks Consulting in Chicago.

When setting P&P for copayments, the office should be sure to put the proper staff in place for the task. -A practice should not ask staff to perform a task that they are not comfortable performing and are not trained to perform,- Lee says. -If there is no alternative and the practice must ask a staff member who is uncomfortable with this task, then there should be time spent mentoring, coaching and continual support for staff.-

Medicare Can Punish Offices With Pay Cuts

Medical offices must make it clear to patients up front that all required copayments will be collected. If you don't try to collect every copay that your carrier contracts require, you could be in for severe penalties. This risk is magnified in medical offices that see a lot of Medicare patients, because CMS comes down hard on offices that don't collect all copays, Lee says. -If you do not attempt to collect copays and Medicare finds out, they will reduce the physician's reimbursement. Instead of reimbursing the physician at 80 percent with a 20 percent copay, Medicare will reimburse at 60 percent with the patient owing 20 percent,- Lee says. 

All that risk means you must have solid copayment P&P that the entire office is committed to upholding. If your copayment collection is not running very smoothly, you may also want to consider shifting the responsibility to the billing department, Lee says.

Consider Moving Copay to Billing Department

Many medical offices have their receptionists collect copayments from patients when they check in. However, this may create problems if the receptionist is not properly trained on collection techniques.

-It has also been our experience that most of the time, receptionists are not the appropriate individuals to ask for payment,- Lee says.

Receptionists who collect copays may also take longer to process the patients, which could cause problems -at the window when there is a waiting room full of other patients,- Lee says.

Solution: If the front window is getting clogged up by problems with copay collection, you may consider having someone from your billing department collect the money. -Hopefully this is in the -inner office,- away from other patients, and the function is performed by billing staff,- she says.

Benefits: If the patient has a question on her bill, she can ask a biller about the charges more easily than she could a receptionist.

Also, billers typically have more experience than receptionists with collection techniques, which are vital to securing payment from certain patients.