10 Collection Tactics for High-Deductible Patients

December 7, 2016

High-deductible health plans are on the rise. Here are 10 methods to ensure your practice collects from patients with these plans.

Patient collections are much more than collecting $10 copays: those days are long gone.  Patients are paying a greater percentage of what you get paid and will be paying an ever higher percentage in the years to come.  Smart and consistent patient collections tactics must be a part of every practice's financial strategy. 

Consider a few eye-opening stats from a 2015 survey from the Kaiser Family Foundation on employer health benefits  that emphasize why patient collections must be a priority now and for the foreseeable future:

• 24 percent of employees were in an employee-sponsored high-deductible health plan in 2015, a 600 percent increase over just ten years prior.

• The average out-of-pocket cost for patients has increased by 230 percent over this same period.

• More than 90 percent of persons enrolled in an Exchange Plan through the Affordable Care Act are in high-deductible health plans.

Though the rate of healthcare spending may have slowed, the share absorbed by patients has done the opposite.  Here are a few basics for improving your patient collections. 

Have a financial policy: Every practice should have a financial policy and every patient should sign it.  This document is in essence a contract.  In signing it, the patient agrees to your follow your rules regarding payment.  Fees for no-shows, copays, deductibles, the forms of payment you accept: all should be included.

Know in advance what your patients will owe: Most clearinghouses permit real-time and batch eligibility processing.  It is important to know in advance whether you should collect more than just a copay.

Let patients know in advance how much they will need to pay: This step is critical.  We are retraining patients who have been educated by all of us to only bring a copay to every visit.  For patients with existing balances or whose services will drop straight to their deductible, we must let them know before the service how much they must pay. 

Give patients the option: For patients who have a history of 'forgetting' co-pays or are frequent no-shows, offer the option of either pre-paying a nominal non-refundable deposit or rescheduling their appointment until they are ready to pre-pay.  Patients adjust to this policy, and our late-cancel and no-show rates have declined. 

Collect a flat amount in advance: Many practices collect a flat amount in advance of procedures when it is unclear how much the patient will owe.  After the claim has been adjudicated, either bill the patient the balance or issue a patient refund.

Accept multiple forms of payment: Permit patients to pay by cash, check, money order, credit card, and PayPal.  Most practices do, but there are a few outliers. 

Consider credit card on file: With appropriate safeguards, practices can keep patients credit cards on file and charge them for patient balances as long as the patient has given you written permission to do so.  You do not want the liability of keeping their credit card information onsite, so use a certified and secure third party to retain the information.

Offer payment plans: It's hard for most patients to come up with $1,000 on the spot.  Offer patients a chance to pay large balances over several months.  We do not charge interest, but you have every right to do so.  

Make patients aware of pharma subsidies: Saving your patients money on their prescriptions is a nice thing to do.  And as an added benefit, they may have enough money to pay your practice. 

Have a heart: There are some patients in poor or dire health who simply don't have the money.  There will be times when we care for patients with no expectation of getting paid.  It's okay. 

Patient collections is not rocket science.  The tough part, I find, is realigning patients' expectations.  We hope these recommendations help your patient collection efforts.


Lucien W. Roberts, III, MHA, FACMPE, is administrator of Gastrointestinal Specialists, Inc., a 25-provider practice in Central Virginia. For the past twenty years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He may be reached at muletick@gmail.com.