You've sent three patient statements and still no payment. Time to send the account to collections? Maybe not. Many practices find that negotiating payment, or budget, plans is an effective way to get patients to make good on their debt.
While methods and logistics for creating such plans vary, practice managers agree that communication with patients is critical to a successful payoff.
"We are in the business of caring for patients," says Lisa Roberts, reimbursement specialist at Obstetrics & Gynecology in St. Louis, Mo. "We want to help people settle their accounts."
Senior reimbursement specialist Laurel Jones, from Bakersfield Orthopedic Medical Group in California, adds, "You can't just send statement after statement and expect those who need financial assistance to call. You've got to contact them and discuss how the account will be paid."
Sharon Cardwell, a consultant for Larson-Allen in St. Louis and a former practice manager, agrees. "Having an actual conversation with the patient can reveal a great deal of information," she says. "A phone call can quickly reveal personal situations that are keeping the patient from paying the bill — or that the patient has a secondary insurance that they assume you filed." But you've got to intervene early.
Strategies that work
Roberts' practice sends two or three patient statements after insurance pays its share, and then, if it receives no response, has a pre-collections company call the patient to find out how the account can be settled. "Often, she pays the account right then, with a credit card," Roberts reports. "Other times, a payment plan is established."
Jones uses a similar approach: "We talk to patients when they come in for their appointment — before their account gets beyond 90 to 120 days old." The encounter form used by the practice includes the patient's balance; those with a balance of $100 or more are marked with the notation to see Jones first to initiate the discussion.
With those patients, Jones says, "I sit down and ask if the patient can make a payment or if he or she needs to set up payment arrangements. About 85 percent make a payment on the spot."
This strategy has been effective, Jones says. Of the practice's roughly 140 accounts that are greater than 120 days old, 80 percent are making regular payments.
Jennifer Clifton, administrator of Myrtle Beach Internists in South Carolina, sends two statements before initiating a series of three collection letters. "During my monthly account review, I call the patients who have received collection letters," she says. "Usually I get the patient to commit to a payment series that settles the account in three months. The others go to collections, but I've only sent five or six people that route. The budget plan really works."
In hardship cases, Clifton negotiates payment plans using discounts. "In our state, many Medicaid patients need treatment beyond the number of annual, reimbursed visits [permitted by the government]," she says. "We work with these patients to make sure they receive all the visits they need, and get help paying their bill."
For those Medicaid patients who need visits beyond the allotted amount, Clifton waives 50 percent of the practice's fee when they agree to pay within 90 days. Patients appreciate this, and Clifton reports that their budget payments are on time. Check with your carrier about state laws that relate to this type of negotiation.
How much is enough?
But just how much per month can you expect patients to pay? For many practices, the answer depends on the total account balance. "We try to get patients to pay off the balance in 60 to 90 days," says Clifton. "Our patients typically owe $100 to $200 at the time we establish the payment plan, so monthly amounts range from about $30 to $60 per month."
Although patients in specialty practices typically owe more, Cardwell says the bill should still be cleared within six months. "Rarely do you want to stretch it further because the chance of collecting gets smaller and smaller," she cautions.
