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Obtaining all information needed to check eligibility and perform pre-visit preparation can be time consuming, but is by far worth it.
Scheduling is the first contact with the patient and by far one of the most important. It is a time you can obtain all the information needed to check eligibility, notify the physician in advance for the reason of the visit, set the expectation that payment is owed at the time of service, and start building a rapport with the patient.
Obtaining all information needed to check eligibility and perform pre-visit preparation can be time consuming, but is by far worth its weight in collected dollars when reviewing financials at the end of the month.
During scheduling, the following minimum information should be obtained:
• Patient demographics (name, cell number, address, work number, social security number, date of birth)
• Insurance information (ID number, group number, payer ID, guarantor information)
• Reason for visit
• An answer to the question: Are there records or test results needed before being seen?
After the information is obtained, the scheduler should request payment of any balance on the patient’s account. This can sometimes be an uncomfortable process for staff, but by providing staff with scripts and role playing, they can perfect the process in no time.
It can even make patient collections feel natural. For example, instead of saying, “Ms. Smith you have a balance on your account. Would you like to pay that today?” Train your staff to say, “Ms. Smith I see you have a past due amount of $50.How would you like to take care of that today? We accept Visa, MasterCard, or do you have a FSA card?” It is amazing how many more payments practices can collect, just by being prepared and having the proper scripts in place.
Once the practice has obtained all the needed information, checking eligibility and benefits in advance is a piece of cake. The process should no longer be considered an option for practices today. It is estimated that only 41 percent of providers collect at the time of service, while 36 percent collect at the time of service some of the time. This is surprising considering it costs approximately $7 a statement (if not sent electronically) and eligibility costs between $0 to $0.74. So at worst-case scenario the practice saves $6.26 per patient if the money is collected at the time of service. If the patient is sent more than one invoice the number continues to increase.
Let’s compare the two different approaches:
Collection at the time of service (patient responsibility minus cost of eligibility check):
• $50- $0.74 = $49.26
Patient is billed for amount owed (patient responsibility minus cost of statements):
• $50 – 7= $43 (1st statement)
• $43 - $7= $36 (2nd statement)
• $36 - $7= $29 (3rd statement)
(If utilizing an electronic statement process the cost for three statements can vary between $2.25 to $5 depending on the process and vendor).
Comparing the two scenarios, it seems there would be no question as to which process is more efficient, but 49 percent of providers are still using the second scenario. In previous years, it was a cumbersome process to investigate patient responsibility in advance. Many times insurance feedback would not be current or correct. This in turn made the process frustrating and in many cases a waste of time and money. This made it understandable why many practices avoided the process. However, today the process could not be easier. There are various options for practices depending on their practice-management software and clearinghouse vendor.
These options include:
• Automating the process by utilizing your practice management software if offered. This will allow the practice to set up the system to check eligibility and benefits in advance before the patient is seen without staff utilizing time to retrieve the data. The information is commonly imported directly into the patient’s chart and can be viewed immediately.
• If automation is not an option for checking eligibility and benefits then centralize. Centralization can be done by utilizing a clearinghouse or other vendors that specializes in these types of services. (Tip: Make sure the vendor works closely and is compatible with your practice management software).
• Lastly, if the above options do not work, practices should go directly to their payers’ websites or call their payers. This option is more time consuming and costly considering hourly employees are performing the process manually, instead of automating after hours.
Once the process has been determined, the criteria must be decided. The information should be obtained at minimum of three days in advance of the appointment. This will allow the practice to compare the patient coverage to their fee schedule. By comparing the two, the patient responsibility can be estimated in advance, allowing the practice to contact the patient in advance. The more the process is utilized the more savings the practice will endure over time. This allows the practice to not only know patient financial responsibility, but also issues with insurance or coverage such as invalid insurance ID or that the service will not be covered.
Regardless of the method, the key is being prepared. Once the practice is prepared the practice can reach out to the patient to discuss their financial responsibility and payment expectations before treatment is performed. Before reaching out to the patient regarding their responsibility, the practice should have insight as to what will be owed. In order to calculate responsibility, fee schedules and contracts will have to be examined and compared by the practice to the patient’s coverage. Many practice management software programs have the ability to calculate this information, if it is set up and maintained properly. If the practice management software does not have the functionality, the information can even be calculated by utilizing an Excel spreadsheet if needed.
Once the amount owed is calculated, the patient counselor should contact the patient regarding the balance. The patient counselor should have strong customer service skills with a high level of billing knowledge, and the ability to be compassionate and considerate when speaking to the patients. Many times if handled properly, the patient will pay in advance or set up payment arrangements before being seen in the practice. More importantly, the patient is entering the practice with an understanding of their financial responsibility and can take ownership of the bill.
Healthcare is one of the few expenses that can unexpectedly occur but be as high as the cost of an automobile or mortgage. Isn’t it only fair we prepare our patients and set the expectation that money is to be paid at the time of service?