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Coding & Billing: Collecting Co-pays on the Day of Surgery
6 keys to an effective patient collections program.
Prerna Gupta
Publish Date: June 2, 2016   |  Tags:   Financial Management
patient payments PAID IN FULL Strive to collect 100% of patient payments on the day of surgery to limit your exposure to bad debt.

Are you collecting every dime of what patients owe on the day of surgery? If you're not doing so before patients go back to the OR, you're likely leaving significant money on the table.

In this era of high-deductible health plans that are forcing beneficiaries to cover higher co-pays and deductibles of $1,000 or more, patient collections can account for 20% to up to 40% of revenue for surgical facilities, according to some estimates. Yet collecting from patients on the day of surgery is not an easy task. Patients often assume that once they pay their premium, there won't be any additional charges for their surgical care. What typically happens when you send these patients a statement after treatment with a patient balance on it? That's right, they often ignore the debt, and hope you — and it — will go away. Here are some strategies to get patients to pay up in full and on time.

Stay ahead of the game. Don't get stuck in a cycle where your billing office has to play a game of catch-up to collect patient payments. Instead, have the front office do the legwork before a patient undergoes surgery, verifying insurance benefits and calculating what patients owe days in advance. Be sure at least one member of the front-office staff is properly trained on how to verify patients' insurance. Once these staffers know what's owed ahead of time, they can inform patients of their responsibility during the pre-op phone call, which can also give the patient the opportunity to set up a payment plan or try other options, like third-party financing. When patients present for their procedures, your business office will have a much greater chance to collect 100% of the co-pay and deductible. By securing a patient's payment on the front end, it will be easier for you to reduce your cost to collect delinquent payments, and eventually reduce your exposure to bad debt.

Create an effective patient collection policy. All hope is not lost if you're struggling to collect money on the front end. There's one big reason more facilities don't have effective patient collection policies in place: a lack of time. Most have little or no time to review outstanding patient payments or to send statements. If you fail to collect from patients on the day of surgery, your best option is to either send out timely statements on your own, or to outsource this task to a billing company. You'll find that sending out 3 rounds of statements is an effective way to remind patients what they owe. Space these statements out in a time frame that works best for your facility, though to keep AR days down, try to send a patient balance statement as soon as possible following the procedure, and then follow up in 15- to 30-day intervals. The important thing is to be consistent. These recurring statements are also helpful to patients who have misplaced their initial statement, recently moved or had their balanced-owed change due to insurance adjustments.

Did You Know? Roughly 60% of covered workers at firms with 3 to 199 employees now have a deductible of $1,000 or more.

Don't write off balances arbitrarily. Have a plan for low-balance collectibles. If a patient owes only a few dollars, consider whether repeatedly sending statements is costing you more than what is owed. For example, you may decide to write off anything under $10, because it's not worth the time and money. Just be sure there's a reason behind this policy — you don't want to be writing off balances because it's the convenient thing to do.

Set up an in-house payment plan. If a patient's insurance refuses to pay for non-covered services, set up an in-house monthly payment plan and get the patient's credit card on file before the procedure. This lets you slowly collect your debt while also ensuring patients aren't overwhelmed by a single high-sum collectible.

Document payments. Keep patient payments organized and apply them to the account as soon as you collect them. Patients often become angry when they know they've paid their bill, but the facility doesn't have the documentation saying the same. They also don't like receiving statements for balances already paid.

Turn the account over to collections. When you receive no response from patients, handing the matter to a collection agency is your last resort. However, keep in mind it's usually best to avoid doing this unless absolutely necessary, because patients sent to collections tend to view your facility in an unfavorable light and likely won't return or recommend your services to family and friends. OSM