• Industry News
  • Access and Reimbursement
  • Law & Malpractice
  • Coding & Documentation
  • Practice Management
  • Finance
  • Technology
  • Patient Engagement & Communications
  • Billing & Collections
  • Staffing & Salary

Don't Let 30 Percent of Your Practice Income Get Away (Part I)


In the past few years, insurance companies have increased the patient’s portion due so much that patients are now responsible for up to 30 percent of your income.

Remember the golden years of insurance reimbursement? That was when you charged the insurance companies what you believed to be a fair price and they reimbursed you the full amount of your charge, or darned near to the full amount. Well, as we all know, those days are gone. Now insurance companies, as a rule, give you a contract that says they will allow you up to a certain percentage of Medicare allowable rates (usually anywhere between 95 percent and 120 percent). That doesn’t mean that they will pay you that amount, it’s just what they “allow."

The next step that insurance companies took was to only pay, on average, 80 percent of their allowable and the balance was due by a secondary insurance or the patient. Then they added copays and just as you were getting used to them, they increased the deductibles, raised the copays, and then had different tiers that reimbursed differently. The next step was for the secondary insurance companies to say the primary had made a payment as large as they would have, so they won’t be paying any more. Insurance companies were bound and determined to decrease their payouts and increase your discomfort.

In fact, in the past few years, insurance companies have increased the patient’s portion due so much that patients are now responsible for up to 30 percent of your income. Long gone are the days when patients owed nothing, and their insurance would pay for it all. The last groups of people who had the insurance company pay everything were many of the union workers. In the past year, that has changed and those employees, and especially the retirees, are not used to having to pay anything. This change in coverage has caused them, believe it or not, more confusion and discomfort than physician offices faced. Many retirees have said to me, “I have never had to pay a thing and I don’t understand what is happening now.” They are embarrassed by the whole process.

This leaves the front desk of any practice as the ones who are responsible for collecting as much as possible from the patients while they are there. Once a patient leaves, your chances of collecting decrease by 30 percent. Then, if the patients haven’t paid within the first two bills you sent to them; your chances of collecting decrease dramatically another 70 percent.

When co-pays started, many practices accepted cash and checks only. Over the past 10 years, practices have been slowly adopting credit/debit card usage. Many practices really fought it until the HSA (Health Savings Accounts) model of health insurance came into being and employees were only given a debit card to use. As practices accepted credit cards for copays and any previous balance still owed when the patient was at the office, they found that they did increase their income more than enough to offset the cost of accepting credit cards. The only problem with this scenario is that practices needed to have the card to “swipe” which meant the patient or guarantor had to be at the office.

Some practices have started to use services that make it so that they can accept payments over the phone. The fee is a bit higher; however, the payments to the practice are too!

In the next part of this blog, I'll give you the two-word key to increase your percentage of collection.

For more on Sue Irwin and our other Practice Notes bloggers, click here.

Related Videos
Physicians Practice | © MJH LifeSciences
The importance of vaccination
The fear of inflation and recession
Protecting your practice
Protecting your home, business while on vacation
Protecting your assets during the 100 deadly days
Payment issues on the horizon
The future of Medicare payments
MGMA comments on automation of prior authorizations
The burden of prior authorizations
Related Content
© 2024 MJH Life Sciences

All rights reserved.