How To Encourage And Facilitate The Financial Responsibility Of Your Patients

I don’t know how closely you watch your accounts receivable but if you do, you will notice they are higher than they have ever been. If you haven’t been watching, you are in for a very rude awakening. While most physicians are concerned about a reduction in fees from government and private payers, you might not have noticed that may be the least of your financial concerns.

Private payers are making it increasingly difficult to collect the money that is rightfully and contractually owed to you. Those companies provide more and more roadblocks to get out of paying for services rendered. They commonly require increased documentation and create capricious denials that require increased manpower to fight to collect the money.

We are seeing an increased tendency of these companies to deny payments on services rendered, deeming them not medically necessary, or flat out ignoring the evidence-based medicine guidelines or accepted association guidelines like the American Academy of Orthopedic Surgeons has on the appropriateness of care. It seems that these companies’ medical and podiatric consultants who advise them are totally ignorant of appropriate care and have not read a peer-reviewed article in years.

These companies are apparent mercenaries and will do and say anything for the right price, all the while leaving the physicians who are actually helping patients twist in the wind.

With the changes in healthcare financial responsibilities shifting more to the patients with higher deductibles, co-pays and percentages of the accepted payment, you need to have a strategy to deal with this. It used to be that patients had very little financial responsibility for medical care. However, now it is quite different. Today, the average patient responsibility for those with non-government insurance is 20 percent of the medical bill. 

Despite this shift in responsibility, patients don’t seem to take on that burden like they do with other financial requirements like mortgages, car payments, cable/satellite bills, cell phone plans, cell phones, computers, TVs and more.  Medical bills take a back seat to all the aforementioned for many patients.

If patients are not paying their share of the bill, what do you do?

If Medicare proposed a 20 percent reduction in physician reimbursement, there would be mass rebellion. If it were 10 percent, same thing. Why do we allow patients not to pay their bills to us?

Take a look at your accounts receivable. How much of your AR is patient responsibility? I will venture to guess it is 10 to 20 percent. Are you willing to take a 10 to 20 percent reduction? Of course not.

Six months ago, we implemented a system whereby we asked each patient to check in for the appointment at a computer kiosk. When checking in, the computer asks the patient to swipe a credit card in a secure way to guarantee payment for the visit. There are instructions that tell patients that once the insurance adjudicates the claim, they will be notified by email, told of their responsibility and get the opportunity to submit payment with the credit card that they swiped at the time of the visit. Patients can opt out of using the credit at the time of the appointment but our staff is trained on how to educate the patients as to why it is advantageous to them to swipe the card.

As the months have gone on, we have more and more patients swiping their card and making payments. In fact, more than 60 percent of our patients are choosing to swipe their card with each visit. For those people, we are collecting 94 percent of the money owed by patients once we notify them of their responsibility. For the nearly 40 percent of patients who refuse to swipe their card, we are only collecting 46 percent of their responsibility. Essentially, by not swiping their card, many patients are telling us, “I have no intention of paying your bill.”

As physicians, we are not supposed to talk about money. For years, it has been “voodoo” to bring up money with patients or discuss it with other doctors.  Well, I have a different take. Our organization employs nearly 200 people.  Those employees are financially responsible for an average of 3.3 people each (spouse, children, parents, etc.). That means our organization provides an income and support for over 800 people every two weeks. We have a responsibility to these people. If we do not get paid, the people who rely on us might not get paid, and that is a spiral I do not want to think about.

People who are used to not paying for things have a hard time accepting when they have to pay. Patients are the most perfect example of this in healthcare in the United States.

We have come up with a plan to educate our patients in order to help them understand their responsibilities and simplify ways to allow payments to happen. It will be critical in the coming years that practices have strategies and processes to deal with this ever-changing paradigm shift of who is paying for medical care.

If you want more information about the kiosks mentioned above, contact me at lwj@weil4feet.com .