Practice Management Alert

"It takes a village" applies not only to rearing children but to your collection process as well.

The billing department employees are not the only ones responsible for collecting payments from patients. Every staff member in the office should do her part to get patients to pay fully and promptly for healthcare. But not every staff member knows what she can do to help the collections process, and the billing department can help - by educating the entire office on how each department and every member has an integral role in the collections process.

As most medical offices know, effective bill collection begins with clear communication with patients. Employees are responsible for telling patients what to do and what to expect. Communication is something that needs to happen at many different points of contact, and there are several ways to recruit various staff members to work with patients to facilitate payment. Billing experts offer the following policies and processes to help you make the most of your time with patients.

The first step toward effective practice-patient communication is to make sure everyone in the office understands her role in collecting bills. Every practice should have financial and billing policies. Working from these policies, managers should educate employees with written guidelines that outline the payment-collection responsibilities for each job description, says Lori Foley, CMA, CMM, a senior physician practice management consultant with Gates Moore & Co. in Atlanta.

The billing department also needs to teach employees how to ask for payment, Foley adds. She finds untrained employees often empathize with the patients and don't want to ask them for money. Because patients come to your practice when they're not feeling well, untrained employees can feel uncomfortable bringing up financial issues with them, she says. Don't tell your receptionist or check-out clerk to just "Ask for the money," Foley warns  tell them how to ask. "Would you like to pay today?" gets less money from patients than "How would you like to pay today?"

Once employees know they're responsible for participating in payment collection, managers need to hold them accountable for those activities, Foley stresses. If employees aren't following through on talking to patients about money, managers should work with those employees to get them up to speed.

"Communication really starts from the very first contact with the patient," says Adrienne Rabinowitz, CPC, billing manager at Western Monmouth Orthopedic Associates in Freehold, N.J. When a new patient calls to schedule an appointment, the scheduler needs to determine how the patient will pay for the services. Ask: Is the patient insured, and what type of insurance is it? The scheduler should note whether the patient has workers' compensation, personal injury protection (PIP) from a motor vehicle accident, commercial health insurance or Medicare, Medicaid or some other government coverage.

If the patient has health insurance, the scheduler must confirm that the practice participates with this plan. Most practices use a grid or keep a list of current contracts with payers for this purpose.

The scheduler should ask new patients to arrive 15 minutes early to read and fill out paperwork. The scheduler should forewarn the patient that copayments are collected at the time of service and indicate what forms of payment the office accepts, Foley recommends. This information lets the patient know what to expect when she arrives. When schedulers consistently inform patients about paying at the time of service, other staff members feel more comfortable following through with collecting the payment.

For a return patient, schedulers should confirm the insurance coverage, address and telephone number. It's much easier to find out if a patient has changed insurance plans when he arrives for treatment than on the phone months later after the insurance company denies the claim.

If the patient is uninsured, Rabinowitz recommends determining how much the patient may be charged for anticipated services. Billers or a billing manager  not schedulers  should make this estimate, she cautions. So make sure your scheduler knows whom to ask for an estimate.

Depending on your practice type, you may have time after making an appointment to verify a patient's insurance information. Foley admits that most practices don't think this step is worth all the extra staff time it takes; it usually requires another full-time employee to do all the verifying that's needed.

But even though there's a financial cost, "the benefits outweigh that cost," she says. And you end up with lower collectables, she adds. Plus, verification gives you a chance to ask the patient about any problems when he or she arrives for the appointment.

At check-in, make a copy of any new insurance cards. Have new patients read and sign a financial policy that outlines the way your practice bills for services.

"Some practices are moving toward collecting copayments when the patient arrives," Foley says. If you choose to collect at check-in, make sure copayments are collected consistently.

Check-in is the only guaranteed time for face-to-face contact with the patient. Though most patients appropriately check out, others may duck that step to avoid paying bills. For that reason, office staff should address patients who have balances due when they arrive. You may want the receptionist to request payment, or you may want to designate an employee to speak privately with the patient after he checks in.

Once the patient has left the office, it's "very important to take a consistent monthly approach to the process of collecting funds," insists Ross Rohde, MBA, MSW, practice manager at a 45-doctor multispecialty practice in Atlanta. At Neonatology Associates, Rohde uses the rule of threes: three financial statements, three letters, three calls. After that, it's time to consider sending the account to a collection agency, he says.

His practice sends three financial statements to patients who owe money. If the bill goes unpaid, statements are followed up by three letters that request payment. Last, a staff member calls the patient three times to discuss payment options and learn more about the patient's situation. It's important to keep the same billing employee on the account to provide consistency, Rohde says.

If the rule of threes doesn't work, Rohde uses a collection agency to seek payment from the patient. He finds that just one letter from a collection agency usually succeeds in getting the patient to pay the bill. But Rohde urges billers not to use empty threats about collection agencies, because following through on what you say to patients is important.

Instead, communicate what you know you can follow through on. That way, patients can rely on the information you deliver. You want to prepare them for what is going to happen, nothing more, nothing less. "The more you tell them, the more they know what to expect," Foley reasons. Communicating consistently with the patient about her financial responsibility for receiving care can make collection easier at all parts of the process.