By Angela Mattioda, Vice President of Revenue Cycle Management
More and more often, patients are experiencing higher financial responsibility
for surgeries. This has driven up patient balances as a major revenue
source for ASCs. The increase in patient financial responsibility has
simultaneously increased the responsibilities of front office staff when
scheduling and collecting patient deposits as well as those of the billing
staff tasked with collecting additional monies owed postoperatively.
Providing your patients with an estimate well before their surgery is one
of the best ways to ensure a better patient experience.
While it might not seem obvious, another of the best ways to provide an
improved patient experience is by submitting clean claims so that they
are processed timely and with the correct patient responsibility accounted
for. Patients who receive statements several months after their surgery
— and well after they thought the experience was behind them —
may not only find a bill upsetting, but may also push back on covering
this remaining responsibility.
ASCs should have a well-defined patient upfront collections and balance
policy to avoid becoming a lending company on top of all other functions
that fall under the facilities’ responsibilities.
Below are some tips to help ensure your center has a smooth process for
its staff and patients, broken down by upfront and backend processes.
1. Review benefit verification approximately 2 weeks prior to the scheduled
surgery. This should provide patients with ample time to plan for their
2. Make sure your scheduling staff confirms if the patient has any previous
balances or collection agency referrals that may need to be resolved before
scheduling the upcoming case.
3. Use patient software that enables electronic deposit requirement notifications
with links for patients to pay their deposit online. The software should
allow the ability to track which patients have opened the notifications
(i.e., texts or emails), which patients paid, and which did not. The front
office can follow up with the patient via phone if the deposit hasn’t
been collected one week prior to service. Using these specialized software
options will also produce professional looking estimates to the patient,
which leaves a more positive experience.
4. If you are using specialized patient estimation software, it is a good
practice to have it set up to verify benefits 1-2 days prior to service
to ensure you have the most updated information. This can help reduce
the number of refunds processed each month.
5. For health reimbursement arrangement (HRA) patients, it’s still
best practice to collect their estimated owed amount. These patients can
contact their HRA provider to determine how they can be reimbursed. Even
if you confirm there are funds available in their account, the funds may
not be available until after the claim fully adjudicates.
6. If the patient is strained financially, establish a payment policy that
has been legally vetted and approved by the board of directors. Options
include the following:
- Patient funding — The industry is not lacking vendors providing funding options.
- Charity or financial hardship applications — These should be well-defined
and offered fairly without discrimination.
- Payment plans — It is best practice to set the patient up on an auto-payment
plan through your online payment portal. It is recommended that you require
50% of the deposit upfront with the remaining balance to be paid over
the next 2 months. The policy can range between 3-6 months but extended
when approved by the administrator. It is always recommended to start
with requiring the deposit to be paid in full prior to their surgery.
It’s also best practice to collect the full amount of the unmet
deductible and as much of the estimated coinsurance as possible.
7. Prompt-pay discounts can be used as an incentive to the patient to pay
in full up front. Typically, a prompt-pay discount can be anywhere between
5-15%. Prompt-pay discounts can also be used when collecting the patient
responsibility after insurance processes the claim. It may sometimes be
beneficial to offer a higher discount as a last-ditch effort if the patient
hasn’t been responsive, considering the ASC will need to pay a collection
agency a higher percentage.
When setting up policies for prompt-pay discounts, be sure to check your
contracts and state regulations. Below are a few websites to reference
for additional information.
8. Do not tell patients that you will accept the insurance payment as payment
in full. This can lead your ASC down a questionable road as this is considered
a violation of most contracts and out-of-network payer regulations. It
is also not advisable to tell an out-of-network patient that they will
be treated as an in-network patient. Many payers still send out questionnaires
to patients asking them what they were told by their provider, what they
paid, and other questions that often speak to financial matters.
1. Statements should look professional, be in color, and preferably contain
your facility logo. Statements should also include a hyperlink for patients
to pay via online payment portal.
2. Statements should be run weekly in 21- or 28-day cycles. The dunning
messages should be appropriate to the aging of the statement.
3. Electronic statement options have become all the rage, and for good
reason: They work exceptionally well. Statements can be sent electronically
through the clearinghouse via U.S. mail, email, or text message.
4. Have a process to handle returned statements and/or address exceptions.
If necessary, follow up with the physician office to see if it has any
alternate phone numbers or addresses if you find you cannot reach the patient.
5. Make sure that staff who are responsible for answering incoming calls
or make outgoing calls to patients are well versed with the policies and
options as well as the explanation of benefits (EOB) to help ensure the
patient has a positive experience with someone who can help them. Most
people working in this industry see EOBs frequently but for non-healthcare
professionals, these can be very confusing.
6. If insurance is holding up processing a claim because it is waiting
for the patient to answer correspondence (e.g., accident information,
coordination of benefits), don’t hesitate to drop the balance to
the patient after a few good-faith attempts to reach out and ask them
to complete the insurance request.
7. Process patient refunds in a timely manner. In most states, this is
highly regulated, and it’s typically 30 days from claim adjudication.
8. Stay on top of unresponsive patients and consider referring patients
to a collection agency if you still haven’t received payment after
contacting them multiple times about their balance and giving them ample
time to pay. Depending on the availability of staff, try to make a last-ditch
attempt with the patient prior to referring to collections by offering
a deeper prompt-pay discount, keeping in mind the collection agency fees
if the account is transferred to it. Follow the collection agency’s
minimum referral threshold to determine which accounts will need to be
adjusted as patient bad debt instead of referring to collections.
9. Have a policy for patient small balance adjustments that enable your
staff to write off balances that fall below a threshold, whether it’s
a credit balance or debit balance. Be sure to exclude payer small balances
from this policy. Don’t become complacent with adjusting off small
balances that are contractually owed to the center by a payer. A one-off
is acceptable, but when there is a pattern of small underpayments, it
should be addressed with the contracting representative because they can
add up quickly.
10. Track and report metrics to your board pertaining to historical collections
cases and the amount the facility is a losing to bad debt monthly. If
the bad debt seems high, it should be looked at closely to determine the
reason(s). The data can also be used to help make improvements to the
front-end collection process.