An important part of the revenue cycle is upfront collections. Upfront collections reduce the number of patient accounts that end up in bad debt or collections status. It is easier to collect from patients prior to services being rendered than 60 days later after insurance has finally paid.
Accuracy and consistency along with a system for determining and collecting patient responsibility is key for your upfront collections policy. When developing a policy for upfront collections for your office, be sure to include the following steps in mind.
Step 1
Contact the patients insurance company after the appointment has been scheduled in order to verify that the patient is still covered and to make check on any precertification guidelines. Find out what the patient’s copay, deductible and coinsurance information.
Step 2
Check your managed care contract to determine what your reimbursement is for the patient’s visit, test or procedure.
Step 3
Calculate the patient’s estimated responsibility. See the example below.
$100.00 Cost of Procedure
x 80% Contract Rate
= 80.00 Allowed Amount
- 50.00 Patient Deductible
- 10.00 Patient Copay
= 20.00
x 20% Patient Coinsurance Percentage
= 4.00 Patient Coinsurance Amount
+ 50.00 Patient Deductible
+ 10.00 Patient Copay
= 64.00 Patient Estimated Responsibility
Step 4
When calling patients to confirm their upcoming appointment, make sure you remind them to bring their driver’s license or other form of ID, their up-to-date insurance card, and advise them that they will be expected to pay their estimated responsibility prior to having their procedure.
Step 5
Before the patient goes back for their appointment, make sure the front desk staff requests payment and remind the patient that the amount they are paying is based only on an estimate. Never write paid in full on the receipts until after you have received payment from the insurance company and the patient’s responsibility is indicated on the explanation of benefits (EOB).
Step 6
Offer payment plan options for those high priced test and surgical procedures.
Step 7
Never attempt to collect payment from Emergency Room patients until after they have been seen by a physician due to EMTALA regulations.
Step 8
Make sure signs are posted in patient waiting areas clearly stating:
“Payment is Due Prior to Services Rendered”
