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Patient engagement is the first step in getting paid


Patient engagement begins by recognizing that greater responsibility for payment has also led to greater expectation and choice on the part of patients.

Asking valued patients for money is one of the least favorite activities of the staff in independent health care practices. Especially these days when more patients have opted for high-deductible plans requiring higher out-of-pocket expenses, and at the same time, are feeling the financial impact and personal stress of the COVID-19 crisis. But the same challenges that have stricken patients are also straining practices, particularly unpaid patient debt that can literally put a practice out of business. Moreover, patients often neglect their healthcare if they have a large outstanding debt with their provider.

Both these problems can be minimized with patient engagement, of which patient collections is only one part. Patient engagement begins by recognizing that greater responsibility for payment has also led to greater expectation and choice on the part of patients – known as the “consumerization” of healthcare. Patients most likely will make extra effort to pay their bills if they are engaged with the practice, believe their clinicians and staff care about their health, and feel the communication they receive from their practice is consistent and clear.

In effect, a plan that results in patients paying their bills on time and in full is the same plan that will grow the practice and achieve optimum outcomes from clinical care. Independent health care practices can use a combination of people, training, planning and technology to implement an effective plan for patient collections, based on the premise that virtually every step of that plan is centered around patient engagement.

A practice’s relationship with patients today begins well before they step in the door with the impression made by the practice website, the online reviews the practice has received, and the social media used to keep patients both informed and involved with the practice. Very important are online scheduling, efficient eligibility verification, and phone, email and/or text reminders – all methods of technology that today’s informed patients expect.

The consumerization of health care means patients expect more information about their patient visits and more access to their medical records, both of which can be provided through efficient use of an EHR and/or a mobile EHR. This allows for “heads up” medicine, so providers can focus their attention on patients rather than the screen. To accomplish engagement while taking advantage of technology, providers can benefit from using gestures, finger swipes or taps, rather than keystrokes or complex navigation, as well as using bail-outs and shortcuts, creating customized templates and setting up sequences of documentation that match their thought processes.

Following the visit, patient portals are tools that patients are coming to expect. Portals let patients:

  • Access and download their medical records
  • See their lab test results
  • Request refills
  • Send secure communications to their physician
  • See and update demographic information

All of this happens before a bill is generated or payment is requested. For example, the patient is already well engaged with the practice, feels like their time hasn’t been wasted, and their provider understands and cares about their health, doing everything to interact with the patient to secure their optimum care. This impression needs to be supported by the billing and payment process.

Simplifying the billing and payment process is one of several ways that a practice can improve the patient experience. Many patients find medical billing confusing and frustrating, especially if they are being treated by multiple providers and receiving many bills. When patients are not given a heads up of the approximate amount they will owe after receiving care, they get frustrated when the bill eventually comes – especially when they receive multiple bills for one procedure. They get confused and often end up ignoring their health care bills altogether.

It’s important to have a comprehensive financial policy that outlines the responsibilities of both the patient and the practice, and to train the staff to effectively communicate that policy to patients and answer any questions they may have. In this way, a practice provides pricing transparency, improving their service level and enhancing the relationship with the patient.

A recent survey found that when patients were given an estimate at the time of service, nearly two-thirds of patients (65%) said they’d be more willing to make at least a partial payment. Also, whether the error is due to coding, pricing or something else, patients get upset when their health care bill is higher than they thought it should be. And when they don’t know what the process is for following up or making an appeal to their bill, most patients don’t pay anything hoping that the payer and health care provider will figure it out and send them a revised bill with the adjusted amount.

Here are a series of best practices that can dramatically improve patient collections:

  • Improve service by verifying patient eligibility at different stages – both at the time of setting the appointment and then again just prior to the visit – so that any issues can be caught and addressed before the patient even arrives
  • Review the patient’s coverage and discuss what the patient may owe
  • Provide your patient payment policy and set up any special arrangements in advance and in writing
  • Collect co-pays at the time of service – practices collect only 50-70% of patient payment after patients leave the office, so it’s important to collect during the visit
  • Offer flexible payment options: cash, check and credit card
  • Make sure you can take payments in the office, over the phone and online
  • Offer the option for paper or electronic statements
  • Include a link for online payments on your paper statements
  • If a patient calls with a question about their bill, take the time to answer and make sure they understand before you hang up

Training office staff in customer service is critical for improved engagement, especially when it comes to collections. In fact, 96% of patient complaints are related to customer service, while only 4% are related to quality of care. The service of a practice’s office staff will always make or break efforts to improve patient engagement. When it comes to talking to patients about their balance due, the most important thing is for staff to maintain an attitude of service and empathy – to be able to put themselves in the patients’ shoes to be understanding and friendly throughout the interaction. However, practice staff should be careful to avoid showing pity and sadness while discussing patient payments as this can often hinder staff from speaking clearly and communicating the payment requirements and process. The goal is to partner with patients to help them figure out the pathway to payment and offer as many convenient options for payment as possible.

Technology today can also greatly simplify the collections process. Providers have access to capabilities more than ever before that reduce costs, free up time for staff, and enhance accuracy. Here are some examples:

  • Systems that ensure easy eligibility checks, re-checks, automated checks and group checks
  • Ways to scrub health claims before they go to payers and clean claims so that they can be paid immediately upon submission
  • Patient engagement processes that include two-way communication through text or email, group broadcast or more – for example, being able to send a text that includes a link to the patient statement or a reminder of what is due that month
  • Improved patient statements that are less confusing
  • More options to pay such as a credit card swipe machine, ability to have credit card on file for recurring or one-time payments, and patient portals that accept payments

Each of a practice’s patients represent a lifetime of value to the practice. Based on research, the average patient sees their doctor three times a year, with the doctor being reimbursed around $500. Over a patient’s lifetime, that equals approximately $25,000. This is probably a conservative estimate because patients with chronic conditions such as diabetes, heart disease, or obesity have much higher health care costs. At the most basic level, patient engagement can help practices retain existing patients and increase referrals from those patients. Each new patient results in an increase of about $500 a year. Appointment reminders can reduce no-shows by half. On-demand online appointment scheduling can fill open appointment slots. Offering online payment options can speed patient payments, which now make up 30% of practice A/R. Providing printed education materials, visit summaries and a patient portal reduces phone calls and other unnecessary patient follow-up, freeing staff for other tasks.

If a practice prevents one no-show and can fill one open appointment a day, that could result in an additional $200-$300 a day in revenue for the average provider. If the practice has 1,500 active patients, and they can increase that by 10% through patient referrals, they increase revenue by $75,000 a year. Conversely, poor customer service and lack of patient engagement can cost the practice patients. A loss of 5% can decrease annual revenue by $37,500!

It’s certainly true that this is no longer our grandfather’s health care system. But just as close relationships with patients have always been important to achieve optimum care, today’s practices can take advantage of new systems and procedures to develop that consistent patient engagement and positive experience that can help both the practice and patient thrive.

Terri Joy, MBA, CPC, CGSC, COC, CPC-I, is a billing subject matter expert at Kareo, with over 20 years’ experience in physician billing and revenue cycle management. Aimee Heckman, CPB, CPPM, is a health care business consultant with more than 30 years of experience in medical practice management, revenue cycle management, PM/EHR implementation, and business development. More information can be found at www.Kareo.com.

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