Some urology practices have the edge over their colleagues when it comes to getting paid for what they do.
However, I am amazed at how many practices fail to clarify their financial expectations. This makes it confusing for patients and difficult for staff to consistently collect what is owed, not only from the insurance companies, but from the patients as well. Employers are passing a larger portion of medical expenses on to the patient and if you aren't careful, your practice will be left holding the bag.
Developing written financial policies is a process that unifies the practice and improves consistency when it comes to the many steps involved in collecting revenue. The policies are also used to obtain a commitment to follow these guidelines and develop training tools to help the staff enforce the policies. This article shows you how to establish written policies for both your office staff and your patients.
Patient and insurance data requirements. If staff is expected to check eligibility, obtain authorizations and check on benefits and coverage limits before the patient comes into the office. Put it in writing.
Charge capture and reporting. It is important to set time parameters for doctors to document charges and for the staff to submit charges to the insurance company and statements to the patients.
Payment requirements. Establish what is due when and what the staff's responsibility is in communicating with and collecting from the patient. For example, do you want existing balances to be reviewed by the scheduler when making an appointment, and is it her responsibility to ask the patient to be prepared to pay this balance on arrival for his visit? If there are exceptions, what are they?
Payment tools. This includes analyzing your current patient statement to make sure it is user friendly. If you get a lot of phone calls after statements are sent, it's a sure sign that your statement needs to be revamped. It needs to be clear so patients understand what they owe and what amount is pending insurance payment. It's also important to have effective dunning messages so the patient understands your expectations.
Make it easy for patients to pay by accepting debit and credit cards for mail-in and in-office payments. Also determine what types of payment plans are acceptable so collectors have the tools to negotiate a payment arrangement that keeps the risk at a minimum.
Collection guidelines and procedures. Clarify collection follow-up procedures for third-party payers and patients.
It's also important to determine when an account should be turned over to collection, and specify who has that authority. You want to be clear about who will review the account and make the final decision to ensure the practice's interests are protected. In some cases, it may be better to write off a small balance than to agitate a disgruntled patient.
Make sure that all the doctors are on board with the policies and that they don't compromise staff's ability to enforce them. I've been in more than one urology practice where the staff laments the fact that patients will bypass the system and discuss finances with the doctor. Dr. Goodguy tells the patient not to worry about a payment, and the staff becomes powerless. It's critical that the physician stay out of the way by simply referring the patient back to staff (eg, "Amanda handles our billing. Whatever she works out with you is fine with me."). Remember, your staff wants to do the job right and ensure that the money is collected and in the bank.
Develop a policy for patients
Once you have finalized the policy, you'll need to develop a modified, abbreviated written policy for patients and discuss how you will introduce it to them. Here are a few ideas:
I suggest holding staff meetings to clarify each employee's role in collections. After all, the revenue chain involves everyone in the office. Staff can discuss nuances and have their questions answered. Everyone will better understand the mechanics required to ensure that you're paid for what you do. Role playing can be very effective in learning how to deal with the difficult patient.
Implementing new financial policies is critical for a practice and requires proper planning, training, support, communication, and a commitment, but it's well worth the effort.
Judy Capko is a health care consultant and the author of Secrets of the Best Run Practices. She can be reached at 805-499-9203 or firstname.lastname@example.org