In health care, as in most industries, people are more likely to comply if they know what to expect. With the majority of employer benefit plans renewing on Jan 1, many patients’ benefits changed and deductibles went back to zero. Health care providers have always ensured they maximize revenue with proper insurance billing. But what about patient pay? According to the McKinsey study, patient pay is 15-30% of accounts receivable. Are you doing everything you can to capture as much revenue as possible? Two words: Pre-visit Planning.
It Starts with Scheduling:
When setting the date, time and reason for the visit, you should confirm all patient demographics, obtain current insurance carrier name, group number and member ID number. Then, instruct the patient of what to bring to their appointment and alert them if a co-pay will be expected at the point of service. You can also indicate they can expect a reminder prior to their appointment.
Know Their Benefits:
Most health plans offer free online access to benefits and eligibility information; or your clearinghouse may offer an automated way to search this for a list of patients. It is important for you (and the patient) to be aware of what insurance will pay vs. what the patient will pay.
If you cannot advise how much a service will cost a patient, it is difficult to maximize your patient collections. Mine your billing system to identify the most common reasons patients are seen and the corresponding procedure codes used for those visits. This data can be used to develop an estimate by matching the procedure codes to the health plan allowed amount and by applying the patient’s benefit level.
This is a great way to reduce no-shows, but it is also helpful to clarify expectations. If you have substantial volume, you may wish to subscribe to an automated service for reminder calls (many offer features to have patient ‘press 1 to confirm or 2 to cancel’ type of options). Some services offer secure email and text options also. You may wish to include verbiage that indicates your expectation for the patient to pay at the point of sale. This takes away check-in surprises and increases you revenue collection.
By preparing patients for their visit, you can improve collections by 20-40% and reduce your overhead for re-work.