Update your physician office financial policies to face new collections challenges

Language you can use to update your physician office financial policies for 2015 to face new collections challenges associated with high deductible plans

The ACA and policies issued through the new health insurance exchanges come with steeper patient financial responsibilities, including high-deductibles and higher co-insurance (often up to 50%). This places more emphasis on the front end of collections processes and less on the back end. As a result, we’ve been hearing from clients who want to update their physician office financial policies to ensure that they don’t have to wait excessive time frames for cash flow, and that they won’t have to expense the cost to collect without being able to recover these costs from the patients who cause the delays, rather than raise prices across the board to ensure enough net margin after collection efforts.

We routinely assist physicians all over the world with revenue cycle challenges, including, but not limited to:

  • Documentation improvement
  • Appeals for denied and short-paid claims
  • Improving pre-service collections from patients
  • Using IT to automate certain revenue cycle functions
  • Ways to predetermine payment amounts, and payment information
  • Building systems to target and identify inappropriate claims denials
  • Training payer specialists on the revenue cycle team
  • Contract analysis and recommended changes
  • Contract negotiations and re-negotiations with insurers, employers, and government payers
  • Teaching office managers how to pursue balances owed in small-claims court
  • Outsourced collections efforts on outstanding large insurance balances and complex claims

As part of the services we offer to physician practices, we help them to pursue outstanding large balances with insurers and complex claims for workers’ compensation, motor vehicle and third-party liability claims for accidents and injuries.

Fees and Costs to Collect

In order to pursue these balances at no cost to the practice, it is necessary for those costs to be chargeable to the patient or the patient’s estate in the event of a probate claim. To do this, you must have language without your physician office financial policy that advises the patient in advance that they are responsible for all costs to collect and reasonable attorney’s fees, (if any). Once that is acknowledged and agreed to, the fees for our service (usually a percentage) and any cost of expenses (postage, service by a process server, court filing fees, attorney letter fees, etc.) are added to the base cost of the outstanding bill.

If we turn your account over to collection, you will be charged X% interest on the outstanding balance from the date your bill was due, and you will be responsible for all costs and expenses of collection including, but not limited to our reasonable attorneys’ fees.

If you don’t have this language in place and acknowledged by signature, then the percentage charged for our efforts is deducted from the balance owed to you instead of adding that amount to the balance owed.

Billing Service Fees

If you plan to charge a billing service fee to cover the overhead costs to collect an amount that should have been paid effortlessly at the time of service, you must also advise this fact and have a signature in hand that acknowledges this by the patient.

Any co-payments (flat fee) are due on the date of service. A $25 service fee will be charged in addition to your co-payment if the co-payment is not paid at time of service or by the end of the next business day. This fee offsets the overhead costs associated with billing.

Credit Card on File

With the new high-deductible health (HDHP) plans, we recommend that all physicians implement the requirement of a credit card on file to clear up balances. Include these three points in your updated physician office financial policies so that the patient cannot claim that they were unaware of your policy and procedures. Most patients are actually grateful that you will do this instead of sending them a bill.

If you participate with a high-deductible health plan, we require a copy of the health savings account debit/credit card or a personal credit or debit card must remain on file. There are addenda to this financial policy, which are signed separately to authorize this credit or debit card transaction.

Co-insurance (percentage of allowed charges) that is determined to be your responsibility and/or any deductible charges will be charged to the credit or debit card on file on the date we receive the remittance advice from your plan.

Patient balances are billed to your credit card or debit card on file immediately on receipt of your insurance plan’s explanation of benefits. If we cannot successfully complete the credit card or debit card transaction for this amount, your remittance is due within 10 business days of your receipt of your bill.

Let us know how we can assist you. Send your questions or requests for information to our mail bag using the form below. We’ll get back to you with a response at our first opportunity.

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