Practice Management Alert

If you-re having trouble getting patients to pay their copays at appointment time, you-re not alone. Many practices struggle with when and how to collect copays to ensure they capture proper reimbursement from patients. This is even more important lately, as the copayments grow larger and are often even higher than the amount you receive from the third-party payer.

Incorporate these three expert tips into your copay collection practices now to ensure your office isn't chasing down those unpaid copays later.

The first step in collecting a patient's copay is deciding whether your practice collects the fee during check-in or check-out. You need to decide what works best for your office and your patients.

Collection experts recommend implementing a financial policy that requires patients to pay the copay at check-in time.

"Nowadays, most offices collect the copays prior to a patient being seen," says Edwina Sprow, CPC, owner of Sprow Consulting Services based in Phoenix. When your office implements a change in office procedure and policies, you should realize that some patients will be upset with the reception personnel. However, most people have come to expect to pay their copays at the check-in window prior to seeing the provider, Sprow adds.

Tip: If a patient complains about your office requiring payment before the service, experts suggest you remind him that the copay is an obligation under his insurance contract. You can even remind the patient that the grocery store, for example, doesn't allow him to consume goods before paying for them, and medical care is no different.

Another plus: Asking for the copay at check-in also means that patients -- who may have intended to pay -- haven't yet encountered any delays or backups that might make them less inclined to pay the office, and they aren't getting a service they haven't paid for.

You should clearly inform patients about your financial policies, including your copay policy and any additional fees your practice charges for non-payment at the time of service. A sign at the front desk is a simple way to do this, experts say.

"Our sign says that there will be a $10 charge if the copay isn't made at the time of service," says Angela Gottbreht, CMC, CCP, biller and coder for the Ankle and Foot Clinic of Everett in Washington. "Once the patient is charged that one time, that usually fixes the problem."

Spell it out: Your written financial policy should include any copay penalty information the patient needs to know. "We have a financial policy that explains the extra charge for copays not paid at the time of service," Gottbreht says. Having patients sign the financial policy indicating that they received a copy of it is a good idea. Then keep a signed copy in the patient's chart, and give another copy to the patient.

"We have recently been seeing an increase in pa-tients who -forgot their wallet,- " says Jordan McInerney, practice manager of Asheville Medicine and Pediatrics in North Carolina. To alleviate some of the problem, McInerney created a letter to send to these patients "explaining to them that the next time they fail to pay their copay at their visit, they will not be seen by the doctor." You should also remind patients to bring their copayment with them when you make appointment reminder calls.

When all else fails, your practice has the right to refuse to see the patient if he doesn't pay his copay, as long as he is not there for emergent care. "Patients have a contractual agreement with their insurance carrier to pay copays at the time of service, and it is perfectly OK to refuse to see them," says Joyce A. Shea, a consultant with Practice Management Consultants in Baltimore. This is another reason to collect the copay before rendering the service, because if you collect after the service, you don't have this option available.

"No matter how many signs you post, ultimately it is up to your front desk to refuse to see the patients if they do not have their copay with them," Shea says. "Of course they should be educated to this and how to sensitively turn the patient away and still maintain good relations for the physician's office."

Good practice: One way to measure the front desk's success in copay collection is to use an adjustment code that is specific to writing off balances related to uncollected copayments. If you write off the copay after billing the patient, even if it goes to collection, write off that balance to a special code, such as "copay not collected." Then, add up the amounts you-re writing off to that special adjustment code, and report it monthly to the front desk or whoever is responsible for the copay collection. Through measurement and goal setting, your practice will find that copay collection will improve.