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There have been many efforts to collect more money from patients or reduce bad debt from patients. One of the things that we’ve seen that can be very successful in doing this is, particularly for extensive procedures. I’m sure you’re with me on this one…
How can you determine what patients owe accurately?
When there are office visits, this is relatively simple. You can run and see there’s a $25-50 copay, whatever the dollar amount might be. There may be some coinsurance or other dollar amounts associated with that clinic or office visit. In general, these are relatively small dollar amounts. Even if the patient is responsible for the entire stay, it might add up to a couple of hundred dollars.
Here’s the interesting part…
When you get into situations where there are procedures, even if they’re minor procedures, injections, things that involve C-Arms or larger procedures, shoulder procedures, general surgery procedures, whatever it might be, frequently, it’s the case that the patient might owe $300, $400, or $500, or even perhaps $2,000, depending upon their deductible. We’ve seen situations where patients owe $3,000, $4,000, or $5,000, or even $10,000.
To minimize the situations where you bill a patient after a procedure and then find out that you’re not going to get paid for that, many practices have started to estimate what the patient will owe for a particular procedure. This sounds relatively complex, but the reality is, even if you don’t do it perfectly, it’s still worthwhile doing. And I think patients will be understanding.
So what’s our point?
There are some nuances and some ways that you can do this. In one case, we started building a tool like this for clients. If you know your contracted rates… It’s an entire separate conversation around, “Do you know your contracted rates?” but you should know your contracted rates for all of your procedures, for all the codes, for all of your payers. Or, of course, if you are not contracted, then you know the fee schedule and, therefore, the out-of-network rate.
If you know that, then you can check the benefits for that patient and determine unmet deductible coinsurance and so on, and pick if the patient has benefits for this particular test or procedure because that’s another situation you often run into. It’s therefore not payable by the payer, and the patient would be responsible for it.
Address potential payment issues from the start
You can figure out all of that information, collect all the data you need, and then calculate what you anticipate the patient will owe, $212, $463, $5,896, and then collect that money before doing the procedure. If the patient isn’t capable of paying it, you’d rather know that now and deal with it upfront before you do the procedure and then try to put the horse back in the barn after the doors were left open.
It all boils down to this…
Many practices are reluctant to do something like this because they believe that patients won’t understand, or they won’t go for it, or they won’t do the procedure. Well, that’s fine. If they don’t want to do the procedure and pay for it, then you shouldn’t be doing it anyway because, otherwise, you’re going to do the procedure for free unless you’re looking to do pro bono work.
You can make that determination once you figure out how much they pay, or even you can work out something with the patient. Okay, they can’t afford the $5,100, and you have a double bottom line mission where you’re trying to provide a social benefit in addition to a profit motive. That’s fine. You can charge them less.
Configure discounts to boost the patient experience
You can discount it for whatever it might be as long as it’s not a government payer. Government payers are not going to require that kind of massive deductible coinsurance situation. But you can adjust that. You can put together a payment plan. There are all kinds of different ways you can deal with this.
If you run into resistance, where the patient says, “No, no, no, it’s not going to be that much” or “Hey, I just had a ton of stuff done, and a ton of procedures, a ton of healthcare I’ve just gone through, and I paid all kinds of stuff,” you won’t hit that giant deductible. Someone else’s already consumed it. It doesn’t matter. The patient will owe less than that, so at least you are protected from a practice standpoint.
Here’s what we found…
If the patient isn’t willing to go forward because of all that health care he’s just gone through, you can work with them. Again, you can make a deposit and say, “Hey, if that comes through between now and the time of your procedure, then we’ll refund it to you,” and put it in writing or stuff like that. If they’re not willing to do that, then perhaps it’s an elective procedure.
You can put it off a little bit, or you can try to get some confirmation that that had happened, get some documentation from the insurance company that those claims have been submitted. Therefore, even if they haven’t processed them yet, they’re likely to consume all of that deductible, and you can take that risk assessment.
The solution is simple
That’s our advice for how to make sure that you don’t get stuck with enormous bills if you have procedures, if you have office visits, and so on. Of course, this doesn’t work in all situations. If you’re in a trauma kind of environment, where you’ve got patients coming into the hospital, you have no control, and you cannot check those things ahead of time.
However, for many practices, even surgical practices, unless this is an emergent situation, you can put in place this mechanism, and it will save you an enormous amount of money. It will improve both how much money you make and the amount of work you do for free. So you will do fewer procedures and make more money. It’s a double win, and there aren’t a lot of dual wins in healthcare.