Guest Author | by Elizabeth W. Woodcock, MBA, FACMPE, CPC

Improving patient collections may not be at the top of the to-do list in many radiology practices, but it should be. There’s no non-clinical activity more important to your practice’s future than taking action to get paid for the services you provide.

With the continuing shift of financial responsibility to patients in the form of higher deductibles, coinsurance, copayments and out-of-pocket limits, the collection challenge is no longer relegated to the nearly one-in-five patients who are without insurance. Today, the majority of Americans with medical insurance also have a financial responsibility to you after their insurer adjudicates the claim. If you haven’t updated and intensified your collections efforts lately, it’s time to get serious about getting the money you’ve earned.

Unsuccessful patient billing causes more than an uptick in your aging accounts receivables; it prevents your radiology practice from garnering its full potential insurance reimbursement. Insurance?! you might ask, but consider the commercial insurer that agreed to a fee schedule of 140 percent of current Medicare rates for your services. The fee schedule is not what the insurer pays you; it’s simply what you’re allowed to collect. In contrast to the past, a good portion of that 140 percent must actually come from the patient, not the insurer. Failing to collect the patient’s full responsibility significantly erodes the net value of that contracted reimbursement rate. It’s the same as signing a contract for a much lower reimbursement rate. In order to ensure that you are capturing your full revenue potential, resolve to make patient collections a business critical priority in your radiology practice.

Once considered the sole province of the business office, collecting from patients actually begins at registration. Accurate and complete registration information is required to submit insurance claims to the appropriate insurance company and send patient statements to the correct addresses. Breakdowns in the process of gathering and recording this information undermine timeliness and accuracy – two essentials for successful billing and collections.

Correcting addresses in databases and managing denials gobble huge chunks of staff time. And, worse, it is unnecessary and avoidable (unlike so many other administrative tasks in health care). You just have to get it right the first time, starting with your practice’s earliest contacts with patients. Your registration process should always include the steps of determining insurance coverage, verifying benefits eligibility and understanding the patient’s current financial responsibility.

For practices that must rely on a hospital’s admissions team, hold an open and frank dialogue with hospital administrators about your needs to get accurate, complete and timely patient registration data. This communication process cannot be left to chance; personnel and policies may change at the hospital. As these transitions occur, your radiology practice’s needs may be overlooked. Meet no less than quarterly with hospital staff to express your necessities and hear theirs. Be prepared to quantify the impact that registration issues have on denials and how hospital administration should address these process deficiencies. Monthly denial reporting and trending are critical to supporting your communication and measuring the effectiveness of agreed upon interventions.

The stakes get higher at outpatient imaging centers that must position themselves to always collect payments from patients at the time of service. It’s no longer good enough to rely on the little VISA sticker adhered to the front office window or to meekly ask patients: “Would you like to pay today?” Instead, develop a new strategy that includes training your staff to:

• Confidently ask: “How would you like to take care of your payment today?”
• Look patients in the eye while asking for payment.
• Determine and request the estimated balance due.
• Write out a receipt while asking the question to demonstrate the expectation of payment.
• Know how to establish payment plans when time of service collection is not successful; for example, ask patients who cannot pay: “How much more time do you need?” instead of suggesting an acceptable installment amount.
• Print a statement as a receipt so patients can see in print any outstanding balances.
• Complete “if not, why not?” reports to document the reasons for failing to collect an expected payment from a patient

After training staff in effective techniques to request payments, develop a reporting system that monitors receipts by employee. Post results in the staff break room weekly or monthly, and consider offering a small financial reward for employees who exceed established expectations. Gift cards to gas stations or major retailers – even in small amounts – are always welcome rewards.  It’s a fact of life in many radiology practices that there is simply no opportunity to ask patients for payment face-to-face. Because you may have to rely on sending out patient statements followed by collection calls when those fail to produce payment, try these tips to improve the success of your patient billing process:

• Mail statements as soon as they are due instead of following an alphabetical approach to statement mailing. In other words, mail Mr. Z’s statement right along with Miss A’s.
• Evaluate your statements to assure they are clear – for example, drop “contractual adjustment” and call it a “discount” – and informative – list your telephone number, business office hours, and options to pay online.
• Lose the boxes on statements that track the aging of money due. A patient receiving a statement showing a “current balance” might not feel any urgency to pay that month. And, watching the balance due amount move – unchanged – to the next box over (labeled “30 days”) probably won’t spur action, especially when there are more boxes to go!
• Experiment with various combinations of communications and time intervals for patient billing—statements, telephone calls and pre-collections correspondence—to identify what works best for you

Finally, be sure to look for insurance. Place charges for patients who have been identified as Medicaid eligible in suspense. Check daily to spot the patients who have been granted Medicaid eligibility. Avoid billing these patients as self-pay unless you must. Before sending self-pay accounts to a collection agency, check each one for Medicaid eligibility.

Even if your collections strategy doesn’t produce 100 percent success – and it probably won’t –you can always reduce your cost to collect. Shop around for the best rates on credit card processing. Recognize that you may need one vendor for traditional in-office credit card swipes, and another for those processed securely online. If you don’t yet have the capability to handle online payments, make it a priority. Look for a vendor whose services also allow you to record and securely store patients’ credit card information in advance for time-of-service payments, as well as for payment plans. At minimum, migrate statements from paper only to an online option; the savings can be considerable, and collections can be accelerated.

The importance of improving your patient billing performance cannot be overstated. For all the things promised in national health care reform legislation, reducing patient responsibility was not one of them. We may see employers and other payers shift more financial responsibility to patients in ever more creative ways.

Gearing up to design and implement the collections improvement steps outlined here will take time. The process starts with a careful evaluation of all current processes and concludes with intensive staff training and performance monitoring to assure it is implemented. It will be well worth the investment if even a few of these efforts are successful in collecting dollars you would not have otherwise received.