You’ve heard it all from patients who have outstanding accounts. How can you tell a genuine plea for help from a sob story, and when does it matter?
BILLING CLERK:“Hello. May I speak with Mary Smith please?”
MARY SMITH:“Who’s calling?”
BILLING CLERK:“Jan from Dr. So-and-so’s office.”
MARY SMITH:“I’m sorry, there’s no one by that name at this number. [Long silence......*Click*]”
Ah, the joys of patient collections. The only redeeming part of the exchange was that Jan didn’t have to listen to yet another lame excuse as to why the patient hadn’t paid her outstanding balance.
The creative range of nonpayment excuses from patients seems infinite and sadly shameless. “We have had ‘Katrina victims’ who can’t even find New Orleans on a map and seen patients out shopping at expensive jewelry stores the same day they ‘can’t’ pay their copays,” reports an anonymous office manager on the pediatric-centric e-mail list PedTalk.
“I’ll pay you tomorrow with a credit card” is also popular, says Melissa Torres, clinical administrative assistant at Bay Crossing Family Medicine in Annapolis, Md. Or, it’s a more subtle rebellion: “They post-date checks without asking. When you point it out, they say, ‘Well, I have a deposit coming.’”
Or they blame-shift, like this excuse, also culled from PedTalk: “My husband wrote the check for me to bring but I had it on the visor and it blew out the window (it was early spring and cold) and I’m not allowed to write checks.” This iron-clad explanation would leave many a front-desk clerk blinking and mute (and the hinted-at back story provokes much sympathy for her husband).
“I thought insurance would cover it,” is another extremely common defense from responsibility-duckers, says physician billing consultant Lynn Thomas, who’s with Annapolis, Md.-based SHR Associates. True, insurance policies can be as easy to decipher as the U.S. tax code, but such claims are not always so sweetly ingenuous. For some, a glowing coal of resentment burns, as in: “The doctor doesn’t deserve to make that much; he spent 15 minutes with me and made $500,” recounts Thomas.
Torres concurs. As a small, patient-centered practice who eschews submitting reimbursement claims to insurance companies, Bay Crossing attracts many cash clients. After explaining the practice’s self-pay policies to potentially new patients, she hears “Are you kidding me?” often enough. “It amazes me what people value, in terms of the doctor’s time and services,” she says.
Yes, you want honesty from your patients. Economic catastrophe happens - seemingly more and more often in today’s economic climate. How can you resolve an outstanding debt with your patient if you don’t know what’s really going on?
You’ll never eliminate the unpleasant task of chasing down outstanding patient debts, but you can exact some control. Here are some effective tactics to minimize the kvetching and maximize the collecting:
Most importantly, don’t be part of the problem. “[Patients] know that physicians in the past are willing to keep billing and billing,” says Torres. If this is still you, put a stop to it.
Of course, says Thomas, as the physician, you certainly have the right to give the truly needy an occasional pass if you so choose. Be careful not to cross any legal lines here, such as waiving a copay here and there, which would violate the terms of your insurance agreement. Make sure, in fact, that you have a clear policy for financial-hardship discounts, and that you follow it, lest you be accused of playing favorites, or of having changed your “usual and customary fee,” which would prompt payers to demand discounts for them. (For a more comprehensive treatment on the potential pitfall of negotiating patient payments, read “
Patients, Pay Up!
What does it matter?
Patient accounts in chronic arrears erode your bottom line. Many practices choose to write off the debt - true, an end to the stress, but it obviously costs you. But so do collection attempts throughout the year. Mailing statements - about 60 cents apiece. A reminder phone call - about $5 in staff time. Research on a delinquent account - about $30. Bad debt due to uncollected deductibles runs practices about 18 percent annually, with the self-pay default rate at 30 percent or more. Even if you use a crack collection agency, you’ll only see a portion of the resolved debt, after the agency takes its cut.
So get smart about patient pleas by pre-empting much of it with good preparation and clear communication. And don’t give up.
Shirley Grace is an associate editor on staff with Physicians Practice. She can be reached at firstname.lastname@example.org.
This article originally appeared in the February 2009 issue of Physicians Practice.