Collecting patient-pay balances at the time of service is far from a favorite front-end function. It is, however, an essential responsibility for effective revenue management.
The good news is that requesting payment from patients at the time of service no longer comes as a surprise to patients. As healthcare costs have escalated within recent years, so has the practice of sharing the cost of that care with consumers, through higher premiums, co-payments, deductibles or other co-insurance requirements within healthcare plans. “It is easier to collect now... They [patients] are expecting you to ask,” according to Physician News, May 2000.
Requesting payment without compromising the surgery center’s patient-focused culture requires effort. The staff needs to learn to become more comfortable asking for payment. Most front-end members have difficulty asking for payment, especially in advance of services. In the past, most front-end staff had been responsible for meeting, greeting and directing patient flow without regard for payment. Back-office employees were expected to collect payments. Now, it is more important than ever to work as a team and to improve the up-front financial outcome.
Managers need to provide front-end staff with the tools and training necessary to confidently and competently discuss payment issues with patients. Customer service training should include the fundamentals such as how to smile, make eye contact and answer questions. Specific dialogues should be practiced, such as asking, “How do you want to pay today: cash, check or credit card?” Scripts should be provided, as staff members are usually very sensitive to the patients, and pre-scripted dialogue may make them more comfortable speaking to the patient about co-pays and deductibles.
Everyone in the center should become accountable for the direct financial impact. Nurses need to know that they can ensure that charge entry slips include all of the services provided in the surgery center. Physicians can help secure payment by supporting their staff and upholding the facility’s collection and financial policies.
The role of the front office is important in the financial success of your surgery center. As managed-care concepts have dominated the healthcare market and health savings accounts with high deductibles have come into effect, the role of the front office has expanded from simply scheduling patient surgeries, answering the telephones and pulling charts. Their responsibilities now include obtaining accurate patient and insurance information, collecting co-pays and deductible amounts, issuing and or receiving referrals, pre-certifying certain surgical procedures, and capturing and coding facility services. It is imperative for the staff to have defined job roles that incorporate financial functions.
There are six essential roles or functions in the front office. These are the office manager, scheduler, receptionist, cashier, patient account representative and biller/collecter. Since many surgery centers are confronted with budgetary restrictions that limit the number of support staff that can be employed, most of these functions have to be combined into one or two job descriptions.
Some of the functions of the front office staff include the following:
Office Manager: This is the lead supervisory role, which encompasses all activities in the front office. Not only does this individual ensure that everyone is carrying their job responsibilities, she/he has to know how to perform all of the other roles including patient and staff education.
Receptionist/Cashier: This is typically the first person the patient will interact with during their visit and must set the tone for the patient’s entire experience. This individual must understand the patients’ financial and demographic information, which is required for billing. He or she is responsible for answering the phone and collecting the co-pays and deductibles at the time of service. It is critical that he or she has a list of patients who will have co-pays or deductibles.
Scheduler/Patient Account Rep.: This individual must know the correct method of scheduling patients for each doctor so that their time is efficiently used. It is extremely important that he or she know the various insurance plans the center participates with. He or she is also responsible for verifying benefits and telling the patient in advance what their financial responsibilities are. Most patients are not educated on the type of insurance they have. They also must educate the patient about their plan.
Insurance/Biller/Collector: They are responsible for entering the charges in the system, making sure all services are billed on a timely basis with correct coding, as well as paid accurately. She or he will be responsible for follow-up on insurance claims and working denials and rejections and working self-pay accounts. The office manager will assist this individual with his or her job functions.
You can now see how important it is for everyone to be accountable for their job responsibilities and work as a team to increase and maintain the revenue.
Don’t forget that self-pay accounts are surging as more and more people are uninsured or underinsured, or face increased cost sharing under their health plans. To ensure receiving full payment for services, you should be working to establish patient financial obligations and collect appropriate payments before rather than after the services have been rendered.
Many offices lose money by not collecting all of the money that is due to them from the patient responsibilities. Some do it by choice, others because they don’t have a system in place for tracking their patient billing. They don’t even realize that the patients aren’t paying the portion they owe.
In either case, it is important to know what can get you into trouble. With Medicare, it is illegal to not bill the patient for their portion, whether it is the deductible or the coinsurance. It is also illegal to bill for more than Medicare allows you to, so you must be sure you understand what the patient’s obligations are. If Medicare discovers that you are billing Medicare for services, but not billing the patients for their responsibility, you can be charged with Medicare fraud.
With commercial insurances, there is normally a clause within your contract that you sign that states you will bill patients for all co-pays and/or any other patient responsibility. If the insurance carrier discovers that you are not collecting from the patients, they may consider it a violation of your contract and terminate your participation. They usually will not go any further than terminating a contract unless they discover other violations going on as well.
Some doctors have a difficult time asking their patients for their co-pays and deductibles. These insurance regulations provide a firm basis for them to stand on.
Training the staff is the key to making all of this happen and is very important to their job functions. The critical areas for training your staff include:
- Helping staff understand your managed care contracts and all the nuances that are associated with them, including the senior HMO contracts.
- Understanding basic benefits concepts so that they can accurately calculate what the patient responsibility is and navigating the insurance companies’ Web sites for information on the patient.
In summary, emphasizing the revenue side is critical to our centers. Being consistent among our staff and sensitive to the patient will lead to better customer service. It is still a challenge, though, even if you are doing all of the right things to get the patient to pay up-front. Tracking your cash collections up-front compared to the charges for the week will help you measure your results.
Joyce L. Jones, CPC, CPC-H, CCS-P, CPC-ASC, is director of business operations at AMSURG and has more than 30 years of experience in the medical industry. She is an approved PMCC instructor for the American Academy of Professional Coders (AAPC) and a past member of the AAPC’s National Advisory Board. The AAPC provides credentials to medical coders in physician offices, hospitals and outpatient centers.