This is an excerpt from the ebook “The Patient Costs Playbook: When High Deductibles Turn Patients Into Payers”. Click here to read the complete ebook.
In the U.S., the average annual deductible for a single person with an employer-provided health plan increased more than 250% between 2006 and 2018. This has shifted the burden on patients to become payers and on doctors to become debt collectors.
Now that an estimated 35% of their revenue comes directly from patients, doctors in private practice say getting reimbursed is their top concern for staying in business. Like other business owners, they collect a salary only after covering monthly expenses. But even group practitioners and hospitals aren’t immune from worry about reimbursement.
For any type of practice, having too many patients who can’t (or just don’t) pay their bills isn’t profitable—or sustainable. And the higher a patient’s deductible, the less likely they are to pay any portion of their bill. That’s why high deductibles are creating financial hardships for patients and healthcare providers alike.
Among patients who don’t pay their medical bills, a recent survey identified the top reasons as unknowing visits to out-of-network providers (32%), claims denials (26%), and high deductibles (26%). Collecting insurance information and assessing a patient’s ability to pay before treatment can help eliminate denials, and give them a heads-up about out-of-network costs.
Your first step as a provider: Educate staff about the importance of collecting insurance information—and payments—up front. Connect the dots between patients paying their bills and your ability to make payroll. Then, coordinate across teams to implement a financial clearance process like the one outlined below for every patient touchpoint.
Role: Collect Information
When patients call to schedule appointments, require schedulers to collect personal, insurance, and relevant procedural information such as:
Role: Verify & Document Information
Verifying insurance coverage collected at the time of scheduling will help eliminate denials, which decreases out-of-pocket expenses for patients—and increases your likelihood of getting paid. Pre-registration staff should contact insurance companies to verify:
Role: Verify Identity & Collect Payment
At check in, registration staff serve dual roles: as gatekeepers who ensure your practice gets paid, and as guides who help patients understand what they owe, how to pay, and where to seek financial assistance if they need it.
For same-day and emergency appointments, registration staff should follow the pre-registration checklist above. Otherwise, they can simply verify:
They should also collect:
Role: Adhere, Communicate, & Refer
At every patient appointment, your clinical staff should adhere to the procedure(s) for which benefits have been verified. When changes are necessary, clinicians should quickly communicate to billing staff which services were performed.
When patients have questions about the cost of services, clinical staff should be prepared to refer patients to front-office and financial staff. Additionally, if your practice has an online portal where patients can access medical records and make payments, equip doctors with a fact sheet they can share with patients about how to access and use the system.
While healthcare providers can’t help patients improve their insurance coverage or decrease their deductibles, you can help eliminate denials by verifying insurance coverage before treatment. This informs patients what they owe in advance, so they’re not surprised by your bill, and are more likely to pay.
To learn how to save time by automating eligibility and benefits verification, download our ebook, “The Patient Costs Playbook: When High Deductibles Turn Patients Into Payers.”
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