Practice Management Alert

You get more flies with sugar than vinegar. That old adage works well for a billing office that's trying to get reluctant patients to pay. You're more likely to see deserved payment if you don't immediately repel patients with antagonistic claims.

In other words, don't be a bulldog. You should pursue collections aggressively, but experts agree: Hounding patients for money isn't very effective. You should instead methodically offer difficult patients the opportunity to pay or to explain why they can't pay.

Any in-house collections process should involve both letters and phone calls. How often you write or call a patient should be determined by your staffing resources and the average amount of delinquent accounts you encounter.

When you write to a patient about a delinquent account, provide a remittance slip and a return envelope to ease a patient's effort to pay, says Ross Rohde, MBA, MSW, a practice manager at a 45-doctor multispecialty practice in Atlanta. Using a remittance format puts your bill on par with other bills the patient is receiving. Patients who are insured often don't think about medical bills in the same way they do a phone bill, and following a traditional format will urge the patient to take the bill seriously.

Consider using a return-receipt method for mailing these bills so you know the patient is actually receiving them.

If your attempts by mail to secure payment fail, billing staff members should call the patient to inquire about the account. Experts agree that taking the appropriate tone on the phone improves your ability to collect from the patient.

On the first call, ask the patient whether he or she understands the bill, says Victoria Jackson, administrator and chief executive officer of Southern Orange County Pediatric Associates, who spoke at a recent Coding Institute teleconference. Be ready to answer questions, she advises. You should be able to tell the patient what the bill is for and what his or her insurance paid.

When you're doing in-house collections, don't forget that the patient is in control. Working with the patient is often the only way to ensure you will receive payment, and that means starting out on the right foot.

Jackson advises billers to call patients when they are likely to be home. The best time is usually in the early evening. Listen for cues that your call is coming at a bad time for the patient, and ask if there is a better time to call.

The first call should open a dialog with the patient. If possible, you want to secure payment. However, barring that, the call can give you a clearer idea of why you haven't received payment so far. If the patient insists the insurance company paid improperly, offer to double-check with the insurance company, Jackson says. However, you should only check with the insurance company once, she adds. From then on, it's the patient's responsibility to work out any problems with the insurance company, she says.

If the patient doesn't claim that the insurance company made a mistake, then the staff member should get the patient to acknowledge that he or she owes the practice money, Rohde says. "The best thing to do is work with them and say, 'Look, I'm here to help you resolve this debt,' " he argues. You want to collaborate with patients to come up with a way for them to pay the debt.

The more you can hear where patients are coming from, the more you can work with them, Rohde says. The first step is listening, he says. At first, you might hear complaints and antagonistic remarks, but stay professional, he urges. After the venting, a patient may start to tell you what problems he or she faces. If not, a little prodding might help, he says. Tell the patient you might be able to work out a payment plan if he can tell you a little bit about his financial situation, he says. "People appreciate somebody who is willing to work with them even though it has to do with their own debt," Rohde adds.

In addition to a payment plan, you can suggest splitting the payment between a credit card and a check, Rohde says.

It's important to note whether the patient faces financial hardship. Consider offering these patients some type of discount or waive a percentage of their balance, Foley says. If you do discuss financial hardship with a patient, document the conversation to protect yourself from any governmental or third-party investigation, experts agree. Your compliance program should include guidance about waiving fees based on financial hardship.

In developing a payment plan, keep it reasonable, says Lori Foley, CMA, CMM, a senior consultant in Atlanta with Gates Moore and Co. "Five dollars a year for the next 20 years is just not good," she quips. Give the patient the ability to pay over time, but ensure the practice is recovering the money in a timely manner, she says.

If you reach an agreement on the phone, Jackson recommends that you repeat the agreement at the end of the conversation or that you have the patient repeat the agreement. This repetition ensures that you and the patient have the same understanding of what you discussed.