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Collecting effectively without undermining patient relationships


patient holding credit card with doctor in background

Could collecting from patients be the modern medical practice’s least favorite administrative task? Based on my experience, I’d say it’s certainly a candidate. 

It’s a hard task to like, mainly because it’s a hard task to get right. Bungling it may mean that your practice never gets paid for some services it provides, but being too aggressive may inadvertently convey that your practice is more concerned about money than patient care. 

Throw in high-deductible plans that have made patients responsible for more of the cost of their care, and it’s easy to see why patient receivables have become such a challenge to profitability for hospitals systems, small independent practices, and every type of healthcare organization in between.

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There’s no instant, painless cure-all for patient collection problems, but there is good news. It may seem counterintuitive, but collecting well doesn’t have to be at odds with patient service. In fact, taking the right steps to collect better can actually help you forge better patient relationships.

Knowledge is power

Surprise medical bills cause ill will that can undermine physicians’ relationships with their patients. In many cases, though, the “surprise” is caused mainly by patients’ misunderstanding of health plan rules.

Educating patients about their insurance may not seem like your job. Insurance companies and employers should help patients understand the complicated terms of their insurance. But whether because patients ignore insurance information until they need treatment, insurance is very complicated, or insurance companies don’t try hard enough (or all of the above), the task of explaining insurance will frequently fall on your practice’s plate. 

It’s tempting to wait and see if a patient misunderstands before jumping in to explain payment terms, but it’s better to be proactive-if you wait until a patient is confused by a bill, expensive damage may already be done. The patient who receives an unexpected bill may assume it’s wrong, refuse to pay, and even become angry. Your ability to collect what you’re owed will diminish-along with the patient’s trust in your practice. If you help your patients better understand their insurance, they’ll have an easier time navigating all of their healthcare transactions, and they’ll have you to thank for it.

Head off confusion with education-starting when the patient sets the appointment. Make sure your practice management system is able to provide your schedulers with accurate patient payment responsibility data, and your schedulers are trained to confidently access and explain this information.

Arm front-desk staff with training

The time of service is a critical time both for reinforcing payment terms and collecting. Starting the education process at the time of scheduling will make front desk collections much easier, because patients better understand their payment responsibility. But it will still be less effective than it should be if front desk employees feel unprepared for the task. 

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Develop a clear, consistent process for collecting from patients at the front desk. Make sure your employees have a straightforward, standard way of asking for payment (“i.e. How would you like to pay your copay today, Ms. Andrews?”). And make sure the way they ask for payment neither sounds apologetic nor implies that payment is optional.

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Offer role-playing practice and refresher training for your employees from time to time. And recognize that, occasionally, a trustworthy and valuable employee may be too introverted to ever feel fully confident in this role-consider preferences and personalities when (re)designing staff roles in your practice.

Make sure the rest of your billing process is optimized

The likelihood that patients will feel surprised by bills they didn’t expect is also tied to timing. If it’s been several months since they received services and they’ve not been billed by your practice or even received an EOB from their health plan, patients are more likely to conclude they don’t owe anything. That sets the stage for more frustration when a bill arrives later.

Making sure your insurance billing processes are as efficient as possible can reduce this risk. If you’re submitting claims as cleanly and quickly as possible, you’ll minimize the time it takes your patients to receive EOBs from their insurance (and, of course, you’ll also get your insurance payments faster). 

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Virtually every aspect of the billing process is connected. Improvements in one part of the process may spill over and improve other parts, too. 

Technology can help drive these improvements. Most practice management systems have rolled out automations and other tools to reduce errors and make the routine aspects of billing easier. If you haven’t had recent training on all your systems can do, consider setting up a session with your vendor.


Online bill payment has evolved in recent years from a nicety to an essential. If you’re the only creditor expecting your patients to find a stamp, write a check, or call during a busy workday, you’re significantly adding to the pain of paying your bill. Make it easy for patients to pay you! Even if your practice management system lacks a built-in solution for self-serve patient bill payment, third party systems are available that integrate with many systems. Be sure to ask your practice management system vendor about these options, too.

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