Physiatry Practice Management Resources

There’s plenty you can do to make the task of collecting copays and deductibles less onerous for you, your staff, your carriers, and your patients.

 Here are some tips on gathering collection information, managing patient expectations, training staff, and following up that can help make your managed care practice more profitable.

Tracking eligibility and copayments

It’s a fact of life that patients switch jobs and employers switch carriers. Keeping up with who is covered by what plan — let alone what their copayments are — can seem like an overwhelming task. Yet it’s critical to collecting the copayments you’re owed, says Debi Croes, a principle with the Croes Oliva Group, based in Burlington, Mass. She suggests the following to streamline the task:

• Find out what plan a patient has before they come to see you. If the patient is new or one you haven’t seen for a while, get the information over the phone and verify it before you see them. You can collect this information at the time appointments are scheduled.

• Where carriers offer them, use swipe card readers and online coverage verification services. These are typically the easiest and most up-to-date sources of information on patient eligibility and copayment information. If you’re doing any volume at all, it’s worth investing in card swipe machines and computers to use them.

• Batch your calls to verify plan membership, copayments and coverage. Your staff probably knows in advance most of the patients you’ll be seeing on a given day. Have them call carriers before the appointment date during off-peak hours (early in the day or late in the afternoon or evening) to verify coverage for several patients at a time. This will cut down on long waits for verification at the time of service.

• Check your patient records against health plan membership rosters as they are delivered. It may seem like a lot of work, but if it helps you avoid even a couple of rejected claims, it will pay for itself.

• Print out copayment information on labels and attach them to the superbill or encounter form. That way your receptionist will have the information readily available when the patient arrives.

• Check insurance cards for any copayment information.

Tracking what’s covered by health plans

While most health plans cover a core of more-or-less standard benefits, there are wide variations in “extras,” such as routine checkups, well baby and well women exams, and refractions for eyeglasses. In some cases parts of a procedure may be covered while other parts are not. For example, insurance may cover removal of a leaking breast implant, but not a replacement done at the same time.

Complicating the situation are frequent changes in coverage, making it hard to know what should be billed to patients and what should be charged to the health plan, notes practice management consultant Debi Croes of the Croes Oliva Group in Burlington, Mass. She suggests the following to help keep up:

• Download electronic plan descriptions when available. If they aren’t formatted for your computer, it may be worth getting them translated so coverage information is instantly available. The cost of doing this may be split among a number of practices that contract with the same plan.

• For plans that offer plan descriptions in writing only, keep the binders up to date. Also, develop “cheat sheets” outlining the major coverage issues in which your practice is interested (such as ultrasound for OB/Gyn) for the plans you deal with most often. These sheets will help your receptionists know when to ask for payment and when to bill carriers.

• If there is any question about whether the insurer covers a given service, ask the patient to sign a form that states the service may not be covered and that the patient will pay if it is not. These forms should list the service explicitly; a blanket form covering all services will often result in misunderstandings and angry patients.

Tracking deductibles

It may seem like a lot of work to keep track of individual patient deductibles, but it can pay, says Debi Croes of the Croes Oliva Group in Burlington, Mass. If you can collect deductible amounts directly from patients at the time of service, it can cut weeks or even months off your billing cycle. Here are some pointers on when and how it can be done without becoming an unmanageable administrative burden:

• If deductible information is available online, use it.

• Pursuing deductibles early in the year is likely to have a bigger impact on your cash flow than later in the year. It’s pretty safe to assume that patients whose benefit period begins at the first of the year (which includes all Medicare patients and a good portion of commercial patients) have not fulfilled their deductible in January and February.

• Ask patients whether they have fulfilled their deductible. They often know to within a few dollars how much they have left.

• Be careful not to violate carrier contract provisions that might require you to bill the carrier first, and make sure you are not billing more than what a given plan allows for a particular service.

Preparing patients

We are all creatures of habit. If you make an effort to mold your patients’ payment habits in positive directions, you will likely improve your cash flow, notes practice management consultant Debi Croes of the Croes Oliva Group, based in Burlington, Mass. It will also help create reasonable expectations about payment, leading to higher satisfaction. Here are some ways to do it:

• Be consistent in when and how your practice asks for money. If your patients know what to expect and when, they will be ready.

• Tell patients when they make appointments that you will be collecting for uncovered services, copayments, and deductibles at the time of service. They should not be hearing it for the first time when they walk into your office. If possible, let them know in advance the copayment amount and charges for uncovered services.

• Reinforce the message through signs and notices on account statements and bills.

• Check your patient records against health plan membership rosters as they are delivered. It may seem like a lot of work, but if it helps you avoid even a couple of rejected claims, it will pay for itself.

• Print out copayment information on labels and attach them to the superbill or encounter form. That way your receptionist will have the information readily available when the patient arrives.

• Check insurance cards for any copayment information.

Training staff

Money is a sensitive topic for many people. Asking for money can be particularly difficult for your staff, says Debi Croes, a principle with the Croes Oliva Group in Burlington, Mass. This hesitation can be overcome with training and by creating a positive attitude about improving collection performance in your practice. Here are some pointers:

• Give your staff a script to use in collecting, and give them a chance to practice it through role-playing. The script can be as simple as “You have a $5 copay” followed by silence. Often, patients are waiting for a signal to pay and this way you don’t have to ask them. Simply state the fact that there is a copay and most people will pay.

• For those who don’t volunteer to pay, follow-up with something like “We accept cash, checks or credit cards. How would you like to pay?” Note that the question is not “Would you like to pay?” but “How would you like to pay?” The underlying assumption is that the patient is obliged to pay.

• Decide when you will collect. If you know what the charges will be, it’s usually best to do it at check-in time rather than check-out. That way you don’t risk losing track of the patient in scheduling follow-ups or in getting prescriptions or referrals at the end of the appointment.

• Make collecting a positive experience for your staff. Contests with rewards for improved performance can really motivate staff to focus on collections at the time of service.

Dealing with the reluctant patient

While the majority of patients will pay deductibles and copayments without a problem, there are a few who resist it, notes Debi Croes of the Croes Oliva group in Burlington, Mass.

If sending bills and gentle reminders don’t work, there is one thing you might try before resorting to a collections agency or dismissing a patient from your practice: Get the carrier involved.

A letter to the patient stating that you have a contractual obligation to collect the copayment and deductible, with a copy to the carrier, may help. It’s not just you asking for the money, it’s also the insurer and, by extension, the employer.

Before doing this, be sure you run the language by your carrier.