In an optometric practice, approximately 60% of revenue comes from the patient. This revenue is generated through optical and contact lens sales, copayments, coinsurance, deductibles, non-covered and other services, making the patient your highest-producing payor. Understanding the patient revenue impact on your practice and implementing sustainable insurance verification processes in your workflow will positively increase patient collections. Remember the revenue cycle starts the moment the patient schedules their appointment.

Improving Communications

It is important to clearly set your financial expectations early in the patient experience. With the growing trend of increasing patient financial responsibility, communications about deductibles, copayments, non-covered services, and prior outstanding balances are key to collections. Your financial agreement and collections policies should be transparent. Having a knowledgeable staff that is comfortable discussing these expenses will help patients navigate their medical and vision plan coverage.

At the conclusion of the visit, the patient’s financial responsibility should be communicated, with balances collected before the patient leaves the office. If the practice is unable to determine the exact amount owed, collecting even a portion of the estimated balance is better than not collecting at all. Letting the patient know there may still be a portion owed will prepare them to look for a balance notification and minimize any surprise.

Continuing effective communication after the patient visit remains crucial. Emailed electronic statements along with electronic payment options such as text to pay or online bill pay are increasingly becoming the norm. Having different payment options allow flexibility for your patients and tends to shorten the number of days it takes to receive payment.

Improving The Outcome

Improve collections by obtaining the patient’s complete and accurate information during scheduling and verifying insurance eligibility and benefit coverage prior to the visit.

Be sure to capture both medical insurance and vision plan information. Knowing the benefits of each plan prior to and during the visit can allow for informed financial discussions regarding services provided or needed for a future visit. Any financial responsibilities can then be discussed up front while the patient is present in the office. For out-of-network services, a Good Faith estimate should be provided as outlined under the No Surprises Act.

Improving The Workflow

It is important that your practice’s front office and billing staff have the tools they need to confirm insurance eligibility and benefit coverage as well as determining correct copays, coinsurance, and deductibles. Eligibility and coverage can be verified electronically through a clearinghouse, insurance plan websites, and/or by phone. The practice should have clear policies on how to manage hardship cases and self-pay discounts.

Best practices include:

  • Confirming insurance and eligibility no more than three days prior to a visit because coverage can terminate at the end or during the month.
  • Notify patients ahead of the visit if there is an outstanding balance or a balance will be owed at the visit.
    Educate patients on their financial responsibility and help them navigate their insurance benefits before, during, and after the visit.
  • Provide patients with cost estimates prior to service whenever possible, especially for services and procedures that are planned in advance.
  • Provide alternative payment options.

If improving your patient collections is a goal for your practice, identify two or three areas that will have the greatest impact. It’s not necessary to change everything all at once. Monitor your progress and adjust the steps as needed to reach your goal. Making gradual calculated changes will make a significant difference.

If you need help evaluating your collections procedures and identifying opportunities for improvement, PECAA’s Member Business Advisor (MBA) team is here to help. As a PECAA Max member, you can receive expert advice from PECAA’s Business Operations Advisor Kathy Long at no additional cost! Already a member? Book a meeting with Kathy here to get started. Not a PECAA Member? Contact us to learn how PECAA can help your practice thrive.

Download Our Ultimate Checklist for Running a Successful Optometry Practice

This checklist will help audit key areas of your practice and guide you toward sustainable, long-term success and growth.

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