insights webinar - patient payments

Patient Responsibility –

Solutions for Increasing Self Pay Collection Rates

Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices.

Increasing Move to Self Pay

Financial responsibility for healthcare has shifted to consumers, especially with the advent of the ACA.

Patients now pay more healthcare costs than employers.

This is leading to more cost sensitivity from patients.

Jimmy The Patient

Healthcare Costs and Operations

No Choice, No Concept, Blind Trust

Healthcare Costs and Operations

Office Visit Bills

Radiology Referral

X-Ray

Medications

Lab Referral

Admission

Emergency Room

Procedures

Procedures

Medications

Specialty Visit

Specialty Referral

Medication Administration

Discharge

Physician Rounds

Questions? Tons.

Why did my PCP refer me to that specific specialist?

Why did my PCP prescribe me that specific medication?

Why did my specialist refer me to that specific radiologist?

Did I really have to go to the same lab twice?

How many physicians in the hospital actually saw me and billed me?

I wonder how much this is all going to cost me….

I don’t understand how any of this works!

Is This Information Being Published?

• Some patients might already be seeing how much you charge or at least have access to that information.

• Some patients might already have access to your quality scores or other performance based metrics.

• Medicare is shining lights all over different partnerships in healthcare and how much physicians have been paid.

• There are companies specifically dedicated to showing all of this information.

Companies To Know

Patients Are Now Consumers

Many consumers now shop around for the best healthcare deals.

With HSAs, FSAs, and HRAs, people can now manage for themselves how to pay for their healthcare

Patient Enrollments The proliferation of HDHPs means patients pay for a larger

portion of their care.

An estimated 15% of patient enrollments comes from HDHPs.

Patient Enrollments

Other Payments

HDHPs

Who are these self paying people?

Have not met their deductibles

Have high copays or coinsurance

Lack health insurance coverage (in whole or part)

Require services not covered by their plans

Have exhausted their benefits

Why should we be concerned?

Patient Out of Pocket Expenses

$250 billion - 2009

$450 billion – 2015 (expected)

= 68% increase

WHY SHOULD YOU BE CONCERNED?

Self paying patients made up more than 11% of annual revenue in 2010.

Self payers default at the rate of about 30%.

81% of self pay revenues (by dollar) go unrecovered.

Medical liabilities for self pay patients are growing at 19% per year.

The Challenges

Strong pursuit of patient payment negative message

Payment collections cost time and money Insurers More difficult Automated process

Self-Payers More expensive Slower payments received

How Can You Get Your Payments?

Providers are loath to broach the subject of patient financial responsibilities and payment plans, but it has become a necessity.

These days, the one size fits all payment approach does not work.

Keep a Card On File

PROS CONS

Safely Store Credit Info

Store patients’ credit card information securely in a certified system.

DO NOT keep a paper copy of any card numbers.

Communicate Safeguards to the Patient

Make sure you have the patient’s permission to use the card for payment.

Use it as part of an easy-to-understand financial policy form, complete with explaining how the card will be used.

Have the patient sign the policy.

Estimate Costs and Collect Payment Before Treatment

Plans are increasingly complex, so correctly estimating costs is difficult.

Knowing when a patient has met a deductible and/or copay is a challenge.

Patients may balk and choose another provider whose costs are less expensive for the same services.

The best solution is to collect patient payment up front.

Once a patient goes out the door, your chances of recouping full payment decrease dramatically.

Staff accordingly – this takes time!

Collect Payment Up Front

Cash, checks, credit and debit cards, HSA and FSA cards, etc.

Be very clear about what you will accept and what you will not.

Offer Multiple Payment Options

Inform the patient before you charge their card.

This will make patients feel more comfortable keeping their card on file and result in fewer disputes later.

Communicate Safeguards to the Patient

Use kiosks to collect

payments before patients

can even finalize check in.

Utilize Technology

Make it clear all bills are clearly marked as patient responsibility. Patients receive so

many “This is not a bill” EOBs that they can become confused.

Send Clear Bills

Follow up with a personal call. This one-to-one contact produces better results than

paper collection notices.

Personalize Follow Up

- Patients are on the hook for more of their health costs and are making decisions as educated consumers using new tools. You need to ensure the patients see the value you provide.

- Tools such as “card on file” can, when implemented correctly, help significantly

when the patient is ultimately responsible.

In Summary

Q&ABen.quirk@quirkhealthcare.com