In an eye care practice, the patient is often the highest producing payor. Understanding the impact patient revenue has on your practice and implementing sustainable insurance verification processes in your workflow will positively increase the efficiency of your patient collections. When approaching patient receivables, the following four steps can effectively increase your revenue and decrease the amount of time spent chasing down payment.

Step 1: Set Financial Expectations And Present Payment Options

A lot of effort goes into the patient’s clinical and retail experiences, however, the patient’s financial experience can be equally as important. Not setting clear financial expectations can negatively impact the practice’s relationship with the patient.  With recent coverage trends resulting in increased patient out-of-pocket responsibility, clear communication of deductibles, copayments, non-covered services, and prior outstanding balances are key to reducing hard to collect receivables. Your payment policies should be transparent and accessible, while meeting practice needs and expectations. Be sure to review your internal financial communications regularly and update as polices change. Having a knowledgeable staff that is comfortable discussing these expenses will help patients navigate their medical and vision plan coverage.

Financial responsibilities should be made clear to the patient, so they can expect monies owed to be collected during their visit. If you are unable to determine the exact amount owed, collecting even a portion of the estimated patient responsibility is better than not collecting at all. Letting the patient know there may still be a portion owed can prepare them in advance for a balance notification, removing any surprises. When patients anticipate a balance, they are more likely to pay sooner.

There is a growing trend of adopting non-contact payment options along with emailed statement notifications, such as text to pay, online bill pay or options to pay over time, moving away from or reducing the use of the traditional paper statements and checks by mail. Having different payment options allows flexibility for your patients and tends to shorten the time it takes to receive payment.

Step 2: Capture Complete Patient Information During Scheduling

Obtain complete and accurate patient information during scheduling so you’re able to verify insurance eligibility and benefit coverage prior to the visit. There are HIPAA (Health Insurance Portability and Accountability) compliant online options and website integrations that can help streamline the intake process and reduce staff administrative time.

Capture both medical insurance and vision plan information while scheduling — it may be necessary to verify both medical and vision benefit coverage to determine if the plans are in-network. Knowing the benefits for each plan, prior to and during the visit, can allow for informed financial discussions regarding services provided on the date of service or at any time in the future. Any financial responsibilities can then be discussed up-front while the patient is still in the office. For out-of-network services, a good faith estimate should be provided, as outlined under the No Surprise Act.

Step 3: Obtain Insurance Eligibility and Coverage

It is important that your practice’s front office and billing staff have the tools they need to confirm insurance eligibility and benefit coverage to determine 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 handle hardship cases and self-pay discounts.

Best practices include:

  • Confirming insurance and eligibility no more than three days prior to a visit. Insurance plan coverage can term anytime during or at the end of the month.
  • Notify patients ahead of the visit if they have an outstanding balance or if an anticipated balance will be owed at the visit — this allows the patient to plan or make payment arrangements before or at the visit.
  • Help patients navigate their insurance benefits and understand monetary responsibility.
  • Provide patients with cost estimates prior to service whenever possible, especially for services and procedures that are planned out in advance.
  • Provide alternative payment options.

All information captured and verified should be housed in the patient record. This allows anyone in the practice access to the information so financial and benefit coverage details may be discussed with the patient at any time.

Step 4: Evaluate and Monitor

Patient collections is not a set it and forget it process. In today’s climate you must continue to monitor your practice’s collections effectiveness to ensure the adoption of best practices. Monitoring on a monthly basis will keep you moving in the right direction and identify oversights before cash flow is impacted.

When monitoring your aged patient accounts receivable (A/R) brackets, 0-30 days should have the largest outstanding balance. The remaining brackets of 31-60 days, 61-90 days and 91-120 days (about 4 months) should gradually decrease. Patients with balances over 91 days (about 3 months) should be called and past-due notices sent. If utilizing an outside collections agency, accounts with balances exceeding 120 days (about 4 months) should be transferred to the collection agency. State collection laws dictate how soon an account can be transferred to a collection agency, so familiarize yourself with your state’s requirements. Adjusting collection balances off your A/R in accordance with your EHRs (Electronic Health Records) functionality tracks separately from your active accounts and will keep your reporting accurate and your A/R easier to manage.

When reviewing the aged patient A/R, analyze to determine what makes up outstanding patient balances and isolate any repeat patterns, such as copayments and non-covered refraction fees not collected during the visit. Smaller balances of $50.00 or less likely cost the practice more to collect after the visit than the actual balance itself. You can reduce recovery costs by setting goals to collect these smaller balances during the patient’s visit.

If improving your patient collections is a goal for your practice, identify two or three areas that will have the greatest impact if improved upon. It is 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 substantial difference!

If you need help improving patient collections in your practice, including what information should be obtained when scheduling a patient or what should be asked while verifying insurance coverage, PECAA’s Billing and Coding Advisor, Teri Thurston, is here to help. As a PECAA Max member, you can receive expert advice from PECAA’s Member Business Advisors at no additional cost! Already a member? Book a meeting with Teri here to get started. Not a PECAA Member? Contact us to learn how PECAA can help your practice thrive.

Teri Thurston, Billing & Coding Advisor
Connect with Teri on LinkedIn

Teri is a revenue cycle professional with over 25 years of experience in the eye care industry. She has managed complex billing teams for ophthalmology and optometry practices. She has worked with various physicians to increase profitability, implement RCM efficiencies, and ensure billing compliance. She is passionate about supporting eye care professionals through billing and coding education.

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