It may not be feasible for employees to keep track of the nuances of all the various health plans patients carry, but they can and should advise patients on what questions to ask when they call insurers themselves.
“In other words, employees aren’t going to interpret patients’ policies, but they can explain terminology and provide guidance for reaching out to the payer,” he says. For example, employees could instruct patients to ask what their deductible is, how much of it they’ve paid for the current year, and to what services it applies.
At the very least, billers should be well-versed in understanding the ins and outs of insurance policies in general and common issues that can arise with payers, so that they can serve as a source of expertise for staff at the front desk, Hertz says. Ideally, front desk staff are trained to field these frequent questions or common scenarios.
For example, most health plans will cover one physical per calendar year. “If patients want to have it early, perhaps due to travel or another reason, our staff know to have them call their insurance company and ask whether the visit will be covered,” Boichat says. “What we don’t want to do is book it [prematurely] and have the patient get a bill.”
For staff to attain this competency, solid training is essential, experts agree. “It drives me crazy when practices hire new people and throw them into the fire without anyone sitting with them for the first few days,” Tinsley says.
Hertz agrees: “You can’t assume anything. You have to train, train, train. Remember, it’s about building good relationships with our patients. The result is that they’re going to feel much more positive toward us, and it’s going to improve our cash flow.”
Consider keeping credit cards on file
As HDHPs and other forms of consumer directed healthcare have grown in prevalence, so too have programs in which practices keep patients’ credit card information on file in a secure payment gateway that is PCI-DSS certified. This allows practices to charge and be paid for patient balances as they are incurred.
In 2009, when HDHPs were ramping up and the economy was sliding into a recession, Brandon Betancourt, MBA, implemented a credit card on file (CCOF) program at the pediatric practice where he was administrator — and has recommended it strongly ever since.
“The credit card policy states that all private paying patients must leave a credit card on file if they wish to be patients of our practice,” he wrote in a commentary for FierceHealthcare. “The practice would continue to send out claims to patients' insurance company and bill patients for their portion of the balance, per the insurance carrier's explanation of benefits. However, if we are unable to collect in full for our services after several attempts to collect, we reserve the right to process the patient's credit card.”