by Jonathan May, BSN, RN*
In no other industry are the consumers of goods or services so unaware and uninvolved in the reimbursement for the goods or services received. The United States healthcare industry has created and allowed to perpetuate a “hands-off” compensation approach that has created a consumer mentality proving quite difficult to change.
In this article, the author describes the origin of this outdated approach and suggests a restructured office and clear communication with patients as starting points to change this deep-rooted mind-set. He describes how an up-front approach to patients’ financial responsibilities and proactive staff can help reduce miscommunication between provider, patient, and insurance carrier and improve your practice’s cash flow. The author also suggests that the patient’s financial burden will continue to increase and offers tips to maintain positive patient relationships, improve your accounts receivable management, and protect you financially.
When a patient receives services from your office, the last thing on his or her mind is how the bill will be paid. Patients provide an insurance card to your staff, and many times there is no further discussion regarding payment. Providing clear, up-front information and answering questions can greatly improve your practice’s ability to collect patient balances and expedite claims processing.
THE ISSUE
Medical offices are in the business of providing healthcare, and the patients who visit these offices are the customers. Unlike most other business customers, however, healthcare consumers often have little or no knowledge of the services they receive or the means by which they will be paid. Patients rarely inquire about fees for office services, and fee amounts are seldom a determining factor as to which physician they choose to see. Most often, healthcare consumers assume that when the insurance premium is deducted from their paycheck, the rest is up to the provider and insurance carrier.
This is a serious flaw that the healthcare industry and providers have allowed to perpetuate. Likely because of the past complexities, inconsistencies, and immaturity of the managed care environment, providers’ own knowledge of the business aspects were limited. As healthcare offices become more business savvy, however, passing this knowledge and an expectation of accountability on to the healthcare consumers is the next responsibility of providers.
...fee amounts are seldom a determining factor as to which physicians patients choose to see.
How many times has a billing staff member heard, “Do your job right,” from an incensed patient disputing a balance correctly applied to the patient’s deductible. What about, “It’s not my responsibility to talk to the insurance company,” or simply, “Why are you billing me for this?” Whether these statements are angry or inquisitive, they all stem from only one thing—lack of consumer education. Health plans and employers are improving their ability to communicate and explain the provisions of healthcare coverage to their insured lives. The attempted communication, however, does little for a disinterested, nonparticipatory audience. Some employees will choose to learn about their healthcare coverage during information sessions conducted by their employer or health plan. The other segment will need assistance and further education from their healthcare providers.
THE OFFICE STRUCTURE
Think about your office staff. Are your least expensive employees sitting in the front at the reception desk? Are your higher-paid ancillary staff in the back? If so, your office might be built upside down. Considering the difficult tasks the front desk is challenged with in today’s healthcare environment, it may benefit your office to rearrange this structure.
Prior to managed care, ancillary staff had two primary functions: facilitate the physician/patient contact; and collect a fee for the medical service provided. The scheduler’s responsibility was to take a patient’s name and put it on the appointment list for the correct provider. The current environment has a drastically different imperative. Reception and front desk staff are tasked with: determining a provider’s contractual entitlement commensurate with a patient’s insurance policy; coordinating services; the exchange and maintenance of referrals and authorizations; upholding privacy requirements and patients’ rights regulations; a basic competence in software interface and hardware support; verifying patient eligibility; accurate data entry for patient registration and scheduling; facilitating physician/patient contact; collecting a fee for the medical service provided; and educating patients on your practice’s policies and procedures.
If more expensive staff sits in the back and waits for the problems to arise because other staff is not doing the necessary work prior to the patient’s visit, then one thing is certain—your staff in the back will have plenty of work to do.
How are you situated to deal with these issues? If more expensive staff sits in the back and waits for the problems to arise because other staff is not doing the necessary work prior to the patient’s visit, then one thing is certain—your staff in the back will have plenty of work to do. A proactive, competent, professional reception staff can make an immeasurable difference in the success of your practice. Proper training and working tools are major elements of a rewarding and successful practice. Another large facet is a staff willing and able to perform the tasks required of their positions. Without a doubt, your return on investment will be quickly realized.
THE DELIVERY
Delivery does not just mean the delivery of healthcare services, but also the delivery of up-front, clear information regarding your practice’s policies and expectations and the patients’ responsibilities. This can be the single most important piece of your collection philosophy. Your entire practice is the billing department. Every piece of information that is collected at each stage of the patient’s healthcare experience is vital to the overall success of the medical office. Another vital piece is the information disseminated by the medical office.
Patients, as consumers, should be given a clear picture of what they can expect when they visit your medical office. Billing procedures, collection policies, and health plan contracts need to be communicated to patients in clear and concise terms. Many patients are overwhelmed by or genuinely disinterested in the details of their health plans. Although it would be impossible for your staff to describe the details of a patient’s individual health plan, your staff can, and should, talk in detail about your office policies and what you expect from your patients.
The most frequent source of frustration for patients is the receipt of an unexpected bill.
The most frequent source of frustration for patients is the receipt of an unexpected bill. Well-informed and knowledgeable patients are those who pay their bills. Medical offices who provide their patients with information and the opportunity to ask questions up front receive patient payments more quickly, with less follow-up effort and fewer telephone calls taken by staff needing to explain patient balances. This small time investment at the beginning will yield significant results in the end.
The key is to know what patients know. Staff buy-in is an integral part to the success of your practice. Consistency and reliability of the information disseminated to patients provides your office with the ability to address patient questions with confidence and impartiality. Having all employees on the same page presents an unwavering message to your patients and removes some of the uncomfortable decision making from your staff. Exceptions will always exist, but definitive collection policies and procedures and ongoing patient education are key elements to a successful practice. Patients will learn from the actions of your office. Excessive exceptions or an erratic adherence to policies will be quickly picked up by patients, and soon the exceptions become the expectations.
THE FUTURE
Patients’ financial responsibilities are steadily increasing. Healthcare premiums are on the rise, fewer employers are able to afford healthcare benefits, and those who do pass a greater portion of the premiums onto their employees. In addition, deductibles continue to climb, further increasing patients’ out-of-pocket responsibilities. This is a trend that patients will resist. Some will be resentful and question the accuracy and ethics of your billing practices. If your office has properly communicated with the patient, however, there will be little for the patient to question.
...increasing ...out-of-pocket responsibilities ...is a trend that patients will resist.
It is an unfortunate reality that providers have little control over how insurance carriers handle claims and what these carriers communicate to patients. Instead of controlling this information, therefore, providers are better off managing the information. An office that can successfully manage information (i.e., submit “clean” claims quickly; provide timely, consistent, accurate explanations; and hold patients accountable for that which you know they have been informed) will be steps ahead in achieving a successful practice and satisfied customers.
ACTION ITEMS
A few simple steps can produce a positive healthcare experience for your patients, your staff, and your practice’s bottom line.
- Understand that you are providing a valuable service and expect that you will be paid. Communicate this expectation to your staff.
- Educate your staff on the rules and regulations of medical billing. Provide clear office policies and procedures and consistently adhere to both.
- Educate your patients. Be up front about your billing policies, your fees, and your expectations in writing.
- Eliminate any surprises patients may experience in your billing for services. You may want to give patients an easy-to-understand summary of billing policies—you may even want to have them sign it.
- Emphasize patient advocacy. Assist patients in dealing with their insurance and difficult billing situations. A helpful staff won’t bear the brunt of patients’ frustration more appropriately directed at their insurance carriers.
- Make it easy for patients to pay their balances—provide clear statement messages, accept credit and debit cards, allow payments over the phone, etc.
- Be consistent in your policies and procedures. Don’t allow policy exceptions to become patients’ expectations.
- Evaluate your office structure, job descriptions, and accountabilities. Collect and disseminate accurate information from the very first encounter with patients.
- Simplify the “process” for staff and patients. Provide your staff with the tools needed to perform their jobs accurately and efficiently.
- Communicate, communicate, communicate!
Additional articles from The Journal of Medical Practice Management:
Reprinted with permission from The Journal of Medical Practice Management, Copyright Greenbranch Publishing, (800) 933-3711, www.mpmnetwork.com.
*Director of training and staff development, HuTech Resources LLC, 650 E Devon Ave., Suite 165, Itasca, IL 60143; phone: 630-285-1040; fax: 630-285-1210; e-mail: jrmay@hutech.net. Copyright © 2006 by Greenbranch Publishing LLC.