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Should You Collect Payment Before or After You See the Patient?


In order to capture the most revenue, you need to provide the best service and experience for your patient as possible.

Billing and revenue cycle management in the medical world is constantly evolving. One thing remains constant, however: In order to capture the most revenue, you need to provide the best possible service and experience for your patient. Part of that is billing patients and collecting at the appropriate times. 

Back in November, I compared collecting a payment before the appointment to dining in a fast food restaurant, and collecting payment after the appointment to fine dining. Today I will expand on that a bit further.

First, in order to make sure you are building the practice you desire, you must decide on and get to know your ideal patient. I have some very specific ways you can determine this in your practice, but for today’s purposes, let’s loosely define a few general ideal patients.

Is your ideal patient the 68-year-old Medicare patient on a fixed income?

Or, is your ideal patient the 30-year-old with excellent insurance coverage, healthy income, and follows every instruction and recommendation to perfection?

Do you prefer to help underserved Medicaid patients? (That is okay too.)

Do you like to work with rushed soccer moms with a gaggle of kids who need to get in and out of your office quickly and efficiently (aka, the “give me my script so I can get out of your hair

Is your ideal patient other healthcare providers? Or people with high levels of disposable income?

Each practice’s ideal patient will have a billing method that helps them feel more catered to, more supported, and let them know they are receiving the very best for their money and time.

Whatever your “ideal patient” might be, you must focus your practice and marketing efforts to make sure you are speaking directly to that patient.  Often practices are marketing to their ideal patients but not providing the level of customer service their ideal patient thrives in. This happens for many reasons, but a big component of satisfying your ideal patient is goes back to the timing of asking for payments. 

Consider these four options for when to collect your payment. Remember that this will vary depending on your ideal patient, and that you may use a combination of one or all of these methods.

1. Collect a down payment or copayment over the phone, prior to the day of service. An example of the ideal patient that matches this model is the “give me my script and I will get out of your hair” patient. When you call to confirm this patient’s appointment (and you should be calling), offer to take the copayment (or if there are coming in for a procedure, the full payment) prior to their appointment. Ensure that you are following the insurance carrier guidelines where applicable for the date of service, etc. This method may involve processing the payment the day of the appointment, but taking the payment information at the time of the call.

2. Charge an annual flat rate for patients as part of a concierge-type model. An example of the ideal patient this might work for is the patient with a lot of disposable income, or the patient who wants very personalized care from the healthcare provider. For this option, you might start with a flat rate, then accept insurance payment for the services rendered and copayment via traditional billing method, or simply offer the question, “would you like to pay your copay today or receive a statement in the mail?” at the END of the appointment.

3. Collect payment up front, at patient check in. This is my least favorite model, reminiscent of fast-food dining. This method will be the correct method for some patients and even for some practices’ ideal patients. For example, if you ideal patient is the healthy rushed soccer mom whose kids lose their patience by the end of the visit, she will be thankful she got payment out of the way up front, and scan whisk out the door after her appointment. It is important to keep in mind that you must set up your clinic flow to avoid clogging up the front reception desk with patients paying copays. It is also important to track how often the scope of a visit changes once the patient is in the exam room to know if you consistently have to bill a patient a balance at the end of the appointment or via mailed statement.

4. Collecting payment at the end of the visit, after the patient has seen the physician. This is the preferred method for most patients, although it may or may not be the best method for your ideal patient (and that should be your focus). An example of one of the many ideal patients this method is good for is the 68-year-old Medicare patient. This method is far more private then standing in a waiting room full of people discussing why your card was declined, or why your co-payment is $20 higher than you expected.

Tip: No matter the method you utilize, when a payment falls outside of your normal scope of collecting, it is fair and important to charge a nominal fee to assist you in collections $5-10 is generally fair. For example, if you expect a patient to pay at the office, and they have been notified to expect to pay on the day of service, it is fair to charge for the labor, stamp, paper, ink, etc. that it takes to receive payment. Make sure patients are aware of this policy, and consider making it an individual page in your new patient packets. Be sure to send those out electronically for patients to review prior to their appointments.

Also be sure that whichever method or combination of methods you decide on that it works congruently with what is best for your ideal patient. When you are congruent with your ideal patient, your billing and payments will be accepted smoothly and consistently.

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