The Billing Byte: When a patient asks “What do I owe?”
Lisa Maciejewski-West
CMC, CMOM, MCS-P
The patient is walking up to check out and you're cringing inside. They are going to ask you, "What do I owe?" When you look at their account, you have no idea what to tell them. They have been working on a deductible and, after that, they are supposed to pay 30% of the allowable charges. So, you know they owe SOMETHING, but there are still three outstanding claims, one of them from over three months ago. Doubt creeps in. You think "Maybe they mettheir deductible somewhere else.... I don't want to overcharge them." The bottom line is that your software really can't tell you what the patient owes "to the penny," so very often nothing gets collected. Over the years I've trained hundreds of CAs. And the issue of not knowing what to collect over the counter is probably the most common cause of job stress for the front desk CA. On one hand, you don't want to get the patient angry by collecting MORE than you should. On the other hand, you don't want to get your doctor angry by not collecting anything. So where is the middle ground, and how can you create an environment where everybody is satisfied?
The bottom line is that nowadays, more and more of the financial burden of a patient's visit is the patient's responsibility, not their insurance plan. National estimates showthat patient collections in a Chiropractic office represent on average 65-70%
of the total revenue. So the front desk CA has a big responsibility over the fiscal health of the practice. Here are a few tips that can help make collecting over the counter less stressful:
1. Don't stress over the minutiae. Maybe you can't tell what they owe to the penny. But always collect SOMETHING. This is known in business as a "Fair Exchange of Services." The patient is receiving great care, they should expect to pay something. A good rule of thumb is, if they are working on a deductible and you have a single fee schedule, collect about 60-70% of the billed fee. Or set a flat minimum amount. Explain to the patient that you will be collecting (as an example) $40 at each visit. This will help them work toward their deductible and coinsurance. Then at the end of their care, they may still owe some money (or may even have a small credit), but the amount will be manageable either way.
2. Show no fear. Even if you're not sure, act like you are. Smile, and let them knowthe amount they must pay that day. Then zip up and let the patient respond. They will either pay the bill, or tell you they can't afford it. But don't jump the gun and make deals and payment arrangements before they need to be made.
3. Get the details of payment ironed out up front. Have a written financial policy that is reviewed with the patient at the first or second visit. Let them know what is expected of them as far as paying at time of service. The fewer surprises, the better.
4. VERIFY BENEFITS. This way when you're explaining the patient's financial responsibility, you have a framework to go on. Always explain that benefits can't be guaranteed, but that you will use them as a guide for what to collect from them at each visit.
5. Consider Auto Pay. This is becoming more and more common. The patient gives you a credit or debit card that you keep on file (must be kept in a PCI compliant software program). You instruct them that you will charge their credit card for any remaining balance after their insurance has processed. Nowadays, most carriers pay within days to a few weeks from the time the visit is billed. This is also a great option when you are contracted with an insurance plan that prohibits you from collecting up front. You can even use Auto Pay to set up weekly or monthly
payment plans for patients with large balances. Some software programs have the ability to let you schedule the automatic payments, so you don't even have to think about it.
The bottom line is that collecting at the front desk should not be so painful or stressful for either you or the patient. They receive an invaluable health service from your doctor. Chiropractic care has one of the highest patient satisfaction rates in all of medicine. It has great worth, so collect for it. You can be the hero of the practice, as you find your cash flow begin to increase and stress decrease. You can do this!
Lisa Maciejewski-West, CMC, CMOM, 4 I MCS-P With 35 years of experience in the chiropractic field, Lisa is the president/owner } '’A/ ofGold Star Medical, offering professional billI ^wA ing, compliance, and consulting sendees. Lisa holds certifications in coding, management, and compliance. She speaks regularly at local and state associations, as well as for medical and chiropractic organizations nationwide. Lisa can be reached at [email protected] or by phone 866-942-5655.
