RCM Success Begins at the Front Desk

If you’ve eaten at a restaurant with daily specials, you may have experienced the shock that comes when you receive the bill and discover that your “seafood special” is so special that it costs twice the amount of standard menu items. That’s when you kick yourself for not asking the price upfront.

Now imagine being a patient checking in for a doctor appointment. If you’re one of the growing number of patients with a high deductible health plan, you want to know what the charge will be and how much your insurance will pay.

Is your staff equipped to answer that question? Even more important, are they prepared to begin the collection process at check-in?

Transparency in Healthcare Costs

Back in the “good old days” of health insurance with comprehensive coverage, low deductibles and negligible co-pays, there was little need to explain costs to patients prior to their visits. In fact, most consumers viewed healthcare as basically free thanks to those generous insurance plans.

Fast forward to 2018, and how the times have changed. According to a CDC study, the number of American adults (age 18-64) with high-deductible healthcare plans (HDHP) has increased from 26.3% in 2011 to 39.3% in 2016. The study defines HDHP as a health plan with an annual deductible of at least $1,300 for self-only coverage or $2,600 for family coverage.

The study also found that the percentage of families having problems paying medical bills in the past 12 months was significantly higher for those with an HDHP (15.5%) than for those with a traditional plan (10.3%). There was also a big split between HDHP policyholders who did not get or delayed medical care (9.2%) due to cost versus those with a traditional plan (5.2%).

Three Steps to Improve Upfront Collections

Those statistics may help practice employees understand why patients want upfront information about charges and the portion for which they will have responsibility. It also emphasizes the need to proactively work with patients on getting prompt payment. Here are three steps to help improve collections and improve your bottom line.

  • Before the appointment – prior to the patient even showing up for an appointment, get a prior authorization from the insurance company. Whether conducted in house by staff or outsourced to a company like Azalea Health, you and the patient will have a better understanding of what the total amount due from the patient will be. You can provide this information during a reminder call – a great way to reduce no-show appointments.
  • At the appointment – collect payment from the patient before they see the physician or other medical professional. This allows you to confirm that the patient knows what to expect and to collect the amount without follow-up calls or other collection methods. If your staff feels uncomfortable starting a discussion on payments, put together a script and practice initiating a discussion of payment and providing appropriate responses to questions.
  • After the appointment – are you still sending out snail mail notices? Are they clear and easy to understand? A proven way to get payment – and improve patient satisfaction – is to communicate with the patient in the manner they prefer. For many patients, that communication channel would be electronic, including patient portals, rather than print missives.

While the patient is responsible for a growing portion of the cost of healthcare, insurance still plays a major role in achieving a healthy RCM.

In our next blog, we’ll provide tips on optimizing payments from private insurers to strengthen your revenue flow.