SURGICAL BUSINESS Are you prepared to handle questions about co-pays, deductibles and insurance from patients both before and after surgery?

It's not always easy talking to patients about their out-of-pocket expenses and insurance coverage. But if you're not collecting co-pays, deductibles and co-insurance on the day of surgery, you're probably leaving thousands of dollars on the table. Now's the time to act if you've detected a steady increase in the number of delinquent and collections accounts that you're converting to bad debt write-offs. Over time, that bad debt will add up to thousands of dollars in lost revenue. Here are 6 tips for collecting patients' out-of-pocket amounts and keeping that revenue in house.

Assume patients are in the dark. I verify insurance benefits for every patient. It's such a tricky business and it's constantly changing. I also have many daily discussions with patients, both pre- and post-operatively, about their coverage and out-of-pocket expenses to try to help educate them about their health insurance plans. What I've found is widespread confusion from patients about their health plan coverage, why charges are so high and how we justify those charges. Sometimes I'll even mention why hospitals and surgery centers have to inflate charges to accepted rates just to get paid minimal contracted amounts.

Make collections someone's job. Designate a few staff members to handle patient accounts. Creating a solid team to handle patient accounting issues is key to establishing a sustainable system. We identified staff that were already knowledgeable in insurance billing procedures and that had a caring approach to patient finances. We wanted our staff to speak with a patient about the complexities of their insurance coverage and still convey caring for their financial and physical well-being. This team's responsibilities include checking insurance benefits pre-operatively, obtaining an out-of-pocket estimate based on the patient's benefits and historical insurance plan reimbursement information, and discussing those out-of-pocket estimates with patients.

COVER YOUR COSTS
Red Flag: Implants and
High-Deductible Plans

One challenging scenario is a high-deductible plan for a costly procedure — particularly one that involves implants. In this case, our policy is that the collected amount must at least cover the estimated costs of supplies and staffing. This ensures that in the event of a non-payment or low payment by the patient's insurance company, we've still covered our costs of the case. As a smaller facility, we simply can't afford to lose money on cases. Making our finance office staff aware of those case costs has improved collections efforts greatly.

— Corrie Massey, MHA

Become an insurance expert. With insurance plans changing rapidly in today's marketplace, we placed 1 person in charge of monitoring those changes. Twitter feeds, blogs and subscriptions to industry newsfeeds such as America's Health Insurance Plans (ahip.org) give real-time updates regarding insurance plans and reimbursements. That designee also corresponds with our billing department weekly to monitor unexpectedly low reimbursements. Staying updated with current marketplace trends lets you adjust your approach rapidly to avoid losing money.

Talk to patients about their insurance coverage. We find that most patients are still unaware of all of the nuances of their health insurance coverage. The Affordable Care Act has added new phrases to our vocabulary such as "narrow networks" and "managed care organizations." We call every patient before their surgery to discuss their benefits and their out-of-pocket costs. We tell patients that 100% of their co-pay is due the day of the procedure. Some of our patients want nothing more than an estimated dollar amount and don't express any interest in a deeper understanding of their benefits. Others are more engaging and, in addition to asking us for an explanation, have asked us for our interpretation of their plan compared to others or about the state of health care in general. A good approach is to give as much detail as the patient is asking for without overwhelming them.

Be kind. Patients are probably anxious about having surgery and discussions about the cost of surgery can amplify that fear. Acknowledge their concerns and try to give as much information as possible without further increasing those fears. Most of your patients will be grateful for the time you take to explain their costs to them. We also try to take extra steps to help by facilitating communication with outside services they might have, such as our laboratory, pathology or X-ray providers.

Be flexible. We have general guidelines for collecting from patients on or before their day of surgery. Some patients still have very high deductible plans or have not met their deductibles when they come to our facility. Although we would like to collect everything from them, we also don't want to lose a case because of an overly aggressive attempt at collecting their out-of-pocket costs. At the first sign of resistance, our team goes into negotiation mode. Depending on the type of case and the patient's benefits, our team is authorized to collect as little as half of the estimated amount and establish a payment plan for the remainder, perhaps splitting the remainder up into 2 separate payments. If the patient still has trouble with that option, our finance director makes the final determination of the minimum amount we can collect.

Firm but fair
Every surgical facility experiences patients that do not understand their personal financial responsibility and may even fight it. We understand that as the industry continues to change, so must we in our approach to billing and patient collections. However, we always want to maintain an attitude of respect and education, even in the face of a highly competitive marketplace.