Submitted on Tue, 2014-05-20
By Sakina Hussain

Out-of-pocket fees are a sizable chunk of a health center’s revenue. What are you doing to collect it all?

public health collecting revenue

One of the biggest challenges facing any health clinic is their ability to collect fees from patients. This is especially true for local health departments and community health centers that serve poorer regions. It’s hard, but it’s not impossible. The sustainable revenue it helps generate can be a differentiating factor in whether or not a clinic stays afloat. Here are the six most important things to do to ensure you’re not leaving any revenue on the table.

1. Educate Your Staff

Having a staff with a more sophisticated understanding of the ins and outs of insurance policies will reduce denied claims and allow you to better educate your patients. This is especially true for new patients from the ACA. Some may not have interacted with a medical professional so getting them off on the right foot will create a better patient-centric experience.

  • Develop Specialists: While every client-facing employee should have a general idea of how insurance works and how to approach patients about monetary issues, it’s best to develop specialists internally. Nurses or doctors shouldn’t be submitting claims or verifying insurance, they have to worry about helping sick people. Select an employee or two that can become your resident experts on insurance topics. This will help smooth out your claims process, and will ensure that members of your staff can easily explain all facets of insurance to potentially confused patients.
     
  • Communicating Financial Obligations with Sensitivity: Money is a sensitive topic for most people to talk about, especially if a lack of it gets in the way of desperately needed health services. Train your staff to always be respectful when it comes to talking money with patients. Create a script for employees to learn from. Teach employees in charge of billing how to phrase certain questions to reduce how confrontational or demanding they sound. For instance, it’s better to ask “Cash or charge?” instead of just saying “you owe $x”. Stage mock patient interactions for your staff to get them role playing to prepare for every situation.

2. Clear Communication with the Patient

Collecting out-of-pocket fees relies heavily on being completely open and transparent with your patients. Make sure to always behave with professionalism towards patients no matter how frazzled they may get and to explore all avenues to ensure they get the service they need.

  • Visits by Appointment Only: Requiring all patients to schedule their visits ahead of time will allow you to better capture their information and verify their insurance status. Such a setup may be difficult for public health agencies to transition to, but it’s a vital step in cleaning up and optimizing the claims and billing processes. Having a website with appointment scheduling functionality on it could be a great way to start the transition.
     
  • Policy Overview: Make sure all prospective patients are 100% clear on your clinic's policies. They need to know that payment is due before they will receive treatment and be aware of all the options open to them for payment plans. An explanation of how insurance works may be a necessity here as well.
     
  • Pre-register Patients: 48 hours before a patient’s appointment, you should have a staff member call them to serve as a reminder to the patient and to go over billing, if that hasn’t been done yet. Pre-register the patient by collecting their name, birthday, and insurance ID number at the very least. Also, remind them to bring in their insurance cards, relevant photo IDs, and a form of payment. This will give you plenty of time to verify their info with insurance companies to determine their plan, how much is covered, and how much you should collect from the patient upfront.
     
  • Hang Office Signs: A simple tip, but an important one. Make sure there are clear signs hanging around the entrance, registration, and waiting areas that clearly state that payment is due before services are provided.

3. Clear Communication with the Insurance Company

Now that you have a trained staff and processes that can quickly secure a patient’s information, it’s time to work with insurance companies to ensure you get reimbursed.

  • Verify Coverage: Most rejected claims are the result of poor verification efforts prior to service. After pre-registering the patient, reach out to their insurance company to verify that the patient is covered for the services to be rendered. Make sure the patient will be covered on the date of services being provided, and all the intricacies of their insurance plan. In order to make a smart estimate of the amount the patient should pay upfront, you’ll need to know about the copay, coinsurance percentage, deductible amount, out-of-pocket maximum values for their insurance plan.
     
  • Batches: Collecting all your patient data 2 days in advance makes insurance verification more efficient as well. Instead of verifying insurance on a patient-by-patient basis, you’re able to submit an entire batch of verifications to insurance companies at once.

4. Estimate Fees & Collect Payments Upfront

Once a patient walks out your doors, the chances of them paying in full are slashed dramatically. Do everything you can to collect revenue from your services before they are provided.

  • Estimate Fees: At the very least, you should be collecting a copay or any past balances from patients before providing services. It’s strongly recommended that prior to the patient coming in for their visit, you should have an estimate of the full total they’ll owe your clinic after insurance is accounted for. This will give you value to collect from them when they come to check-in for their appointment. If your electronic billing program doesn’t have this type of functionality build it, you can use this very basic responsibility calculator from the University of Colorado, or follow an example calculation of patient responsibility from about.com:

    $100.00 Cost of Procedure

    x 80% Contract Rate

    = 80.00 Allowed Amount

    - 50.00 Patient Deductible

    - 10.00 Patient Copay

    = 20.00

    x 20% Patient Coinsurance Percentage

    = 4.00 Patient Coinsurance Amount

    + 50.00 Patient Deductible

    + 10.00 Patient Copay

    = 64.00 Patient Estimated Responsibility

     
  • Payment Plans: A few situations are going to pop up where a patient in dire need of services won’t be able to afford to pay, especially at the public health department level, so don’t compromise patient care. Work with the patient to make sure they get the treatment they need while compensating your clinic as well as they can over time. Place them on a monthly installment plan and let them pay off their bill over time. Make sure there are written contracts in place for any payment plans.
     
  • Refunds: Since you’re estimating the upfront fees, be sure to have the proper processes in place should refunding your patients fees be necessary. A patient should never have to ask for a refund, it should be sent to them before they’ve even noticed they’ve overpaid when the insurance statement comes.

5. Automate, Automate, Automate!

Make it easier for both the patient and your staff by automating as much of this process as possible. Many billing processes can be handled by billing software to ease the toll on your staff. To make life easier for your patients and increase the likelihood of them paying their balance in full, allow payment by credit card (you can ask permission to keep this on file for recurring visits) or set up auto-deduct payments directly from their bank account with their permission.
 

6. Track, Track, Track!

Just because the claim has been processed and you’ve received payment from the patient doesn’t mean the process is done. It’s in your clinic’s best interests that it keeps detailed analytics on all the claims it has submitted so that you can improve your processes over time. Here are a few examples of the metrics you’ll want to track:

  • Aging of claims and patient receivables
     
  • Gross charges and collection ratio
     
  • Percentage of copays collected at the time of service
     
  • Claims denial percentage by insurance company


Benchmarking all of these items will allow you to constantly improve the efficiency and effectiveness of your billing process to bring in as much revenue as possible to preserve your clinic’s important role in the community.
 

Upp Technology offers an easy-to-implement healthcare claims management and patient management solution to help keep public health departments doing great work for our communities. With our program, local health departments can learn how to develop self-sustaining revenue within the next 30 days. Read about more of our healthcare revenue cycle management tips and learn more about how we make revenue generation for public health easy!


public health expertAbout the Author

After working in the healthcare industry for many years, Sakina has developed the skills essential for research, implementation, and improvement of the public health sector. Whether it's working with clients as a photographer or with local health departments, she believes that communication is the key to change. You can contact Sakina at shussain@upp.com.

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