Estimating and Collecting Patient Responsibility

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Estimating and Collecting Patient
Responsibility
Estimating and collecting patient responsibility
is a challenging task. Not only you must collect
money directly from your patients but also you
need to ensure patient satisfaction that
guarantees repeat visits and positive online
reviews. Patients who have an exact idea how much
they owe are more likely to pay, which increases
collections and ultimately improves practice cash
flow. 92 of consumers want to know their
payment responsibility prior to a provider visit,
and 47 would switch providers to understand the
costs of services at the time of scheduling
appointments. With the growth of high-deductible
payment plans and out-of-pocket responsibility
for patients at an all-time high, collecting on
those patients at time-of-service is crucial to
your practices financial health. Estimating
patient responsibility prior to claims
adjudication is really tricky and so far, there
is no estimation software or tool that serves the
needs of smaller, independent practices. However,
small practices can absolutely estimate patient
responsibility successfully to minimize risks and
effectively improve the critical task of
improving patient collections.
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Estimating and Collecting Patient
Responsibility

• Defining Patient Responsibility
• Patient responsibility is the total amount
  patient owes to their healthcare provider. Its
  the portion of a medical bill that the patient is
  required to pay rather than their insurance
  provider. Patients with no health insurance are
  responsible for 100 of their medical bills. A
  patient with a High-deductible health plan (HDHP)
  is required to pay on their medical bills until
  their deductible is met and it is a higher amount
  on average.
• More number of patients are choosing a
  High-deductible health plan (HDHP) thinking they
  will not likely seek medical attention that
  specific year. Most of the time they have to see
  their provider more than they initially think,
  leaving them with more medical expenses than
  anticipated.
• Estimating Patient Responsibility
• The reason why practices avoid estimating and
  collecting patient responsibility is because they
  are not sure whether theyre really allowed to
  collect the estimated patient responsibility at
  the time of service. Patient Responsibility
  largely depends on payer contracts and state
  laws.

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Estimating and Collecting Patient
Responsibility

• As mentioned before, as more patients are covered
  by High Deductible Health Plans (HDHP), many
  payers have become more flexible in allowing the
  collection of coinsurance and deductibles at the
  time of service based on the estimated patient
  responsibility. However, this often requires that
  you include the amount paid by the patient on
  your claim when it is submitted. They also
  require that you process any refunds for
  overpayments as soon as the overpayment is
  identified.
• The next question is whether you should collect
  the full estimated amount. This depends on how
  well you are monitoring your patient accounts for
  overpayments and issue refunds. You need to
  investigate your practice management software and
  need find out how well it supports your patient
  collections process.Unless the patient has a
  large deductible that is not even close to being
  met, you could end up having to refund the
  patient. This can happen when a claim from
  another provider is processed before your claim
  and there is no longer a deductible owed.
• There are also patients who have Flexible
  Spending Accounts (FSA) and Health Savings
  Accounts (HSA) that may be linked to their
  insurance payer and are automatically charged to
  pay for services. To collect the full estimated
  amount at the time of service, find out your
  patients that have an FSA or HSA tied to their
  insurance.

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Estimating and Collecting Patient
Responsibility

• Collecting Patient Responsibly Portion
• The best way to collect the patient responsibly
  portion is to ask for permission to put a credit
  card on file with authorization to charge up to a
  certain amount automatically directly after
  adjudication.
• You can make it your financial policy to collect
  a percentage of the full estimated amount at the
  time of service.
• Some numbers show that on average, practices only
  collect 50 (sometimes less) of patient
  responsibility after patients leave your office.
  This means that if you collect more than 50 of
  patient responsibility at the time of service,
  then youre improving your collections rate.
  Non-collected patient responsibility portion
  increasing all over the country, make sure your
  practice has the right workforce to optimize
  their patient payments and claims process.
• About Medical Billers and Coders
• We are catering to more than 40
  specialties, Medical Billers and Coders (MBC) is
  proficient in handling services that range
  from revenue cycle management to ICD-10 testing
  solutions. The main goal of our organization is
  to assist physicians looking for billers and
  coders.