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9 Best Practices for Point of Service Collection and Payment Options

Tuesday, November 1, 2016   (0 Comments)
Posted by: Cheryl Toth, KarenZupko & Associates, Inc.
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Success requires more than just updating the financial policy


"Don’t worry, you don’t need to pay anything today. We’ll bill you after insurance pays.”

For decades, this mantra has summarized the collections culture in most orthopaedic practices. But, as deductibles continue to skyrocket, patient receivables tend to grow. And the older they get, the harder they are to collect. This is why implementing an effective point of service collections model is an essential part of a modern practice's collection strategy.

Here are 9 best practices that can help your practice achieve success.

1. Shift your mindset. Moving patient collections “up front” is a philosophical change for most physicians and staff. For decades, the typical first attempt at asking patients for anything more than a visit copay has been four to six weeks beyond the date of service, after the insurance payment is posted. Longer, if the case was in appeals. Point of service collections flips this process completely around. Staff collects unmet deductibles, coinsurance and non-covered services amounts before patients leave the office, and prior to having surgery. The ultimate goal is zero patient statements. Our firm has trained staff and implemented up front collections processes for decades. One thing we know for sure is that all surgeons must stand united in the new philosophy. If one or two of them maintain the status quo or go rogue with their own rules, your point of service collections efforts will fail or will be marginal at best.

2. Make financial policies clear and specific. Revise common policy statements such as: "You are responsible for paying your financial portion at the time of service." Clarify what you expect from patients by coverage type, and distinguish between what patients are expected to pay for specific services. For example: If you are covered by a plan we've contracted with, you'll be asked to pay at the time of service for your visit copay, plus any unmet deductible and coinsurance amount, up to the contracted rate for office visits, X-rays, and injections.

3. Set expectations at the time the appointment is made. Provide training so staff knows how to do this in a service-oriented way. For example: Ms. Jones, I have you scheduled with Dr. Winner. Based on your symptoms, it is likely he will need to X-ray you. Your co-pay does not cover X-rays. X-rays, depending on the number of views, can range from $xxx - $xxx..."

4. Provide price transparency and collect a pre-surgical deposit. Empowering patients with data is the first step toward helping them determine how they can pay for their care. Provide a Surgery Cost Quotation for each surgery candidate. This form explains their plan's allowable amount, summarizes their unmet deductible, coinsurance, copay, and non-covered services, and calculates their out-of-pocket responsibility. Staff can obtain the patient's coverage information by calling the plan or using its online portal, or using online cost estimators.

5. Give front desk staff the data and tools they need to succeed. A big reason staff do not collect from patients is that they don't know how much to ask for. Change this by collecting and organizing allowable amounts for common services and key plans. Create a spreadsheet of the most common services, X-rays, and injections delivered in the office. Gather plan payment schedules, look up the contracted rates for the common services, and enter them into the spreadsheet. Calculate 20%, 30%, etc. of the plan rate so it's easy for busy check-out staff to quickly find the service, the patient's plan, and the amount to ask for on a laminated version of the spreadsheet. Store the digital version in your system network so everyone has access.

6. Offer multiple payment options. Whether it's due to a high deductible, a recent layoff, maxed credit cards, or financial hardship, many patients simply can't pay in full all at once. Offering multiple payment options like these improves the chance you'll collect:

Payment plans. It's surprising how many practices tell staff to wait until the patient asks about a payment plan before they are "allowed" to discuss it. Be proactive and aim to create a mutually agreeable plan with a three to six month pay off. Ideally, patients pay a portion “down,” then divide the remaining payments equally. Develop guidelines for handling patients whose financial situation requires more time to pay the balance.

Patient financing. Engaging a third party to handle financing can eliminate uncomfortable conversations between patients and staff, and is often appreciated by patients with unexpected injuries or surgeries with high deductibles and out-of-pocket balances. Patient financing companies provide patients various payment programs and options; such as promotional financing with differed interest if paid in full options.  Practices can choose to offer 6, 12 or 18 month special financing options. Typically, the patient's balance, less a small processing fee, is paid in full and the financing company assumes all collections tasks directly with the patient, removing this administrative burden from your staff.

Recurring, automated credit card payments. Automating payments on a credit card is convenient and more secure than asking staff to maintain patient credit card numbers on a spreadsheet. Some practice management systems include recurring billing in their collections module or portal. Cloud-based credit card processing companies and e-payment vendors are options as well.

7. Online bill pay. Essential for the millennial generation, busy professionals, and harried parents, online bill pay is a home run for making payment easy. If you don't already offer it, contact your practice management system or portal vendor, or use an online credit card processing or e-payment company.

8. Ask for payment when scheduling follow up appointments. Train appointment schedulers to look up the patient's balance as part of scheduling an appointment or making confirmation calls. It's a great opportunity to proactively ask the patient to settle their bill over the phone with a credit card, or walk them through how to do it using online bill pay.

9. Train staff. Just because someone can collect a $10 copay does not mean he or she is comfortable or capable asking patients for large dollar amounts. Create talking points for completing and reviewing the Surgery Cost Quotation. Ask staff to role-play with other staff posing as patients to be sure they can handle questions and objectives. Doing so will identify training needs and knowledge gaps, and build the confidence required for their success.


Learn more about strategies for patient financing by registering for the AAOE Hot Topic Webinar: Help Reduce A/R With Patient Financing, sponsored by CareCredit.  Click here to register now!


About the Author

Cheryl Toth, MBA is a consultant and trainer with KarenZupko & Associates, Inc. ( She brings more than 23 years of practice consulting and training, as well as healthcare technology product and executive management to her projects.

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