The proliferation of high-deductible health plans has not only caused hardship for patients, but has added a difficult layer of administrative and financial burden for physician practices and ambulatory surgery centers, according to an article from the Pittsburgh Post-Gazette.
The challenges of collecting balances from patients are multi-fold, with practice managers and consultants citing the following issues:
- Despite the movement toward consumer-directed care, patients still rarely understand insurance terminology such as deductible, copay and coinsurance, and how they translate to out-of-pocket expense. Often patients don't even realize they have a deductible until they need expensive care.
- Collecting reimbursement from patients is far slower than collecting from insurers, and is slowing practice revenue streams as a result. "If we bill an insurer, we would be reimbursed in seven to 10 days. If a patient gets a bill for $600, you're lucky if you can get paid $25 a month," Ashley Santoro, practice manager for Cardiovascular Disease Specialists of Pittsburgh, told the newspaper.
- Practices can experience a "Catch-22" in discussing patients' bills before providing service. "We don't want to make it about money," said Santoro, nor do providers want patients to forego care. Santoro added that her practice has already had patients with conditions such as congestive heart failure or uncontrolled diabetes either cancel appointments or ask that their quarterly check-ups be reduced to twice yearly.
- Bad debt is a major risk. One billing company said one of its client practices has seen its outstanding accounts receivable double in the last four years, as a direct result of patients who can't pay their deductible at the time they receive care.
- Patient collections require a special skill set. Under federal law, for example, there are only certain times of the day a creditor is allowed to call about an outstanding bill. "Collecting from the patients requires knowledge and an attention to detail," Donna Kell, of the Kell Group billing services, told the newspaper.
As a result, practices need to update their collections strategies to rise to these new challenges.
To learn more:
- read the article