BILL PAY Patients should know what they owe and how they'll settle up before arriving for surgery.

If your facility is like ours, you're seeing a growing number of patients who must reach deep into their pockets to pay for a significant portion of their surgical care. Around 70% of our patients have insurance plans that put them on the hook to cover deductibles of at least $2,000. Those high out-of-pocket expenses make it difficult for us to walk the fine line between running a surgical business that must collect what it's owed and providing compassionate care to patients who need to undergo surgery. Here's how our business office strikes the perfect balance.

Know the contracts
Each member of our business office staff understands patients' insurance plans better than the patients themselves. We upload the terms of the contracts into our billing software, which we audit twice per year to ensure the correct payment rates are generated when we input CPT codes. We train our staff on the calculations used to determine payment rates and patients' co-pays. When we contact patients a week before surgery to inform them of their financial responsibilities, we can have an informed discussion about the benefits. It also helps that we assign staff certain specialties so they gain a clinical perspective.

We view ourselves as benefits coordinators. Patients want to know how we calculated their deductibles, so we're prepared to go over the math with them during the insurance verification phone call. We look up the procedure's CPT code to determine our facility's contracted rate. We'll then disclose to a patient that we submit a bill for $14,000 to the insurer, which pays us $4,000. Of that $4,000, the patient might be responsible for a $2,000 deductible. Their plan might cover 80% of the remaining $2,000, so they owe an additional $400.

One of 2 things will happen. The patient will tell you that he'll bring the deductible on the day of surgery or inform you that he can't afford it. Patients sometimes reveal very personal details about their financial situations, so it's important for us to hear why they might not be able to afford their surgery and empathize with their predicaments.

PHONE A FRIEND Lend a sympathetic ear to patients as they work through concerns about their portion of the bill.

In-house payment plan
We offer an in-house payment plan to patients who can't afford their deductibles. We first ask them how much they're able to pay — our goal is to collect as much as possible up front. We have them name a number, because we might underestimate what they can afford. We then arrange a payment plan for the outstanding balance.

Our payment plan is zero-interest on the condition that we set up a bi-weekly or monthly auto draft from a patient's bank account, bank card or credit card until the debt is paid off. Patients appreciate that arrangement. So do we. Our staff doesn't have to call hundreds of patients per month to check on the money we're owed.

A patient's cost share can change after we put a payment plan in place based on a host of variables — the insurer adjusts how much it'll reimburse, previous medical care had already chipped away at the deductible, the surgeon performed additional repairs during the procedure or used more hardware than we estimated — that result in our having to reimburse the patient or collect more than we already have.

When we have to adjust the auto draft payment plan if they owe an additional amount, we contact patients to inform them of the new balance. If we don't hear back from them within 37 days (a deadline established by our former management company that's proven effective) to either set up a new payment plan or pay in full, we send the account to a collection agency.

To avoid sending outstanding balances out for collection, we take 20% off of the bill for patients who pay promptly (around the same percentage the collection agency takes). The early-pay discount sometimes helps us resolve outstanding balances.

Healthcare credit card
If patients balk at setting up a payment plan, perhaps they'll opt to work with a third-party lending company to finance their out-of-pocket expenses. We used to partner with a company that offers a healthcare financing credit card. (The company works exclusively with surgery centers, and a hospital recently bought our ASC.) The arrangement worked out great. Patients appreciated having the option available to pay for their care and the company immediately paid us what the patient owed, minus 10%. That cut was worth receiving payment on the day of surgery and not having to worry about collecting from patients.

Offering the credit card came with additional responsibilities. We had to relay the legal disclaimers on behalf of the lending company and make sure patients understood 3 things: their payment options, that a third party offered the card and how the card's interest rate worked. Once patients signed off on those elements, the choice to use the card was completely theirs. The lending company provided a payment calculator that let patients input the amount they owed and set the payment terms to determine which scenario worked best for them. Many patients opted for a fixed-rate loan amortized over 12, 24, 48 or 64 months. The interest-free option sounded appealing in theory, but it didn't look good on paper when patients entered in the amount they'd have to pay per month to settle the balance within the 12-month interest-free period. After a year, interest would kick in — at a very high rate and from the original purchase date — on the outstanding balance. We made sure patients were fully aware of that caveat, and that paying the minimum monthly payment would not pay off the entire loan in time to make it interest-free. OSM