What Is Your Medical Practice's True Financial Responsibility?

February 7, 2015
P.J. Cloud-Moulds

If your medical practice wants to get paid for services, make sure that you understand your true responsibility to the patient, and for working with the insurance company.

It is easy to point the finger at patients or payers when problems with getting paid spiral. It might feel good, but usually that strategy fails, as your practice plays a part as well. I previously reviewed patient responsibilities in my blog "What Is Your Patient's True Financial Responsibility." If you combine this advice with my suggestions for practice responsibility, here, the chaos will settle and everyone should understand their financial expectations including patients, your staff, and you.

PRACTICE RESPONSIBILITY

• Explain insurance benefits at the first visit. It is so important that the patient is aware of what his cost-share will be. One way to anger a patient is hide this information and then SURPRISE him when he gets the bill. Collect the patient's copay, coinsurance, and/or deductible upfront. There are a handful of plans that specifically say, "Do not collect upfront" or "The patient has an HSA that needs to be billed first." Other than those situations, and, of course, Medicare patients, you should be doing your due diligence and collecting those payments from the get-go. By setting that tone at the first visit, the patient will know that is your protocol, and will be more likely to pay.

• Provide excellent customer service. As I wrote in, "Eight Ways to Retain Old Patients and Attract New Ones," it is the practice's responsibility to have competent and trained staff that are capable of providing excellent customer service with a smile.

• Bill and code responsibly and appropriately. Your staff who do bill out for appointments must be knowledgeable about not just the codes and diagnoses they are using, but what insurance plans will or will not pay. A simple cheat-sheet can be provided by the front-office, back-office, or billing staff that helps staff make good decisions when billing.

SHARED RESPONSIBILITY

• Both parties will conduct a benefits check. While the patient will probably argue with this statement, they are ultimately responsible for knowing what their plan is and what it will cover. However, for the sake of getting paid, I'm putting this under the "shared" list. It's very important for both parties to make sure the insurance representative told the patient and the provider the same benefits. I've found as high as 40 percent of payers provide incorrect benefits to physician practices. Had the patient called the payer, as well, to confirm her benefits, that conversation could happen at the time the benefits are being explained - saving a lot of frustration and headache later.

• Both parties will read and sign paperwork. Again, you're thinking, "How is that my responsibility?" To protect you and your practice. Patients must sign and date consent to treat, your payment policy, privacy policy, etc. This also shows the patient that you care about them, and how thorough your practice is. This instills confidence in your patients that you are capable and confident in your abilities.

• Both parties will ask and answer questions. This really goes without saying that setting a great communication protocol upfront is really key in the patient experience. By creating a nonthreatening atmosphere and open dialogue, the patient instantly knows they are in the right place. Also, creating an open rapport with the patient can be very helpful down the road if the insurance denies a claim for any reason, and you need the patient's help in its resolution.

These are just a few areas you can look at, but the most important aspect to remember is that you are not financially responsible for your patients or their insurance. Once you make this small shift in your thinking, you will be much more relaxed, your staff more responsive, and you are much more likely to be paid for your services.