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ACA changes create fresh collecting challenges for urology practices


If you’re in private practice, your profits will be directly affected by how your staff can manage and adapt to ACA-related coverage changes.

The Affordable Care Act has affected the health insurance of many of your patients. ACA mandates that most health plans cover a wider variety of services that were previously not covered-birth control and maternity and psychiatric care, just to name a few. While some of your patients’ plans will be “grandfathered” and exempt from some of these coverage requirements, many patients will struggle to understand how their new coverage has changed. If you’re in private practice, your profits will be directly affected by how your staff can manage and adapt to these changes.

Widening coverage puts squeeze on patients

While insurers have been forced to widen their coverage in terms of the types of services covered, they have done so by increasing premiums, co-pays, and deductibles. (The popular press contains countless anecdotes.) Your patients who have had the same large employer for many years will be the least affected because their plans are likely grandfathered; patients who haven’t enjoyed the same job stability (eg, self-employed or employed but economically stressed patients) will find themselves responsible for a greater proportion of your fees than ever before.

NBC News cited sources “deeply involved in the Affordable Care Act” estimating that 50% to 75% of the 14 million self-insured will have their current plan canceled. Those whose plans are canceled are being offered one of the similar “compliant” plans with considerably higher premiums and/or higher co-pays and deductibles.

For practices with lax collection practices, these changes can prove catastrophic. Starting on Jan. 1, 2014, new plans with higher and freshly reset deductibles mean greater demands on-and challenges to-your practice to collect fees directly from patients.

Non-standardized collection practices are a frequent problem, particularly in smaller offices. Physician-owners, management, and front office staff need to be unified and focused on collecting every cent due from the patient at the time services are provided. To the extent it’s practical to inform patients of their financial responsibility prior to their arrival in your office, so much the better. Above all, your patients must not think of their physician as a credit-extending institution!

Ask to maintain credit card on file

Asking patients for permission to maintain a credit card on file can help speed the checkout process, to the benefit of your patients and staff. We still see practices asking patients if they prefer to be billed-a terrible error since the practice will expend resources chasing many dollars destined to go uncollected.

Another poor practice that is disallowed by your payer contracts, but still not uncommon, is the ad hoc waiving of co-payments by physicians. Patients quickly learn how to “game” the system. Questions of financial responsibility should never be addressed by the physician, but referred to the appropriate administrative staff. If your front desk staff is collecting as it should, your practice may see considerably more cash.


Embezzlement: All-too-common source of losses

Poor collection practices aren’t the only contributor to losses in your practice. Embezzlement is all too common, and financial controls need to be solid all the way around.

As an example, our firm recently helped a practice recover from a practice manager who exploited a lag in the deposit schedule to steal cash. The manager substituted checks from a later day for the same dollar value-an ingenious and costly scam that cost the practice many thousands. The same practice had a safe full of cash stolen (it wasn’t bolted to the floor) with the practice manager and janitorial crew as prime suspects!

If it’s been a while, consider whether your internal systems might benefit from an objective assessment from an outside firm.

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