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Educate patients on their health plan deductibles for faster payment

A prominent study at the USC Schaeffer Center for Health Policy and Economics found that over 40% of respondents didn't understand the concept of a deductible. How well do your patients understand their plan benefits and what are the ramifications to your bottom line when they do not?

Critical metrics in value based reimbursement include patient engagement, quality of care, and prevention. An easy way to engage patients is through education, which can promote patient loyalty and new business. Here's how this might work: Patients who do not understand deductibles or their plan benefits, and who are not counseled at the office prior to their service, will likely be furious with the eventual results of their bills after they receive the insurance payment decision. They will receive bills of several hundred dollars or more for just routine visits. If they don't understand the concept of a deductible, they're also not likely to understand why the initial costs were so high and why they are responsible for the entire amount. For first quarter 2014, the average national individual deductible was approximately $ 4,300.00 and family deductible $ 8,000.00.

By contrast, a patient who has received even a little information from your office team will be more prepared to handle those high-dollar medical bills. They will also be able to create better financial decisions because they know what their monetary contribution will be. This translates to building a better relationship.


Do provide financial counseling and education

Regardless of the structure or design you use, patients will be better served by understanding the ins and outs of the insurance and medical billing process before they receive their bills. Even a little bit of information can help many patients avoid a blood pressure spike when they receive sticker shock bills, even after insurance has been applied.

Do verify insurance active coverage before each date of service

Another must have standard is your front line team verifying the effective date on the insurance card along with coverage at every visit, rather than simply viewing what’s in your electronic system. This ensures that insurance policies are active, accurate, and that companies will pay out, or at least, not deny for lack of active coverage or excluded plan benefits. Any differences should be updated in your system.

Do collect at time of service

This extends beyond co-pays. Other point of service collection activities include deductibles, co-insurance, and outstanding balances. Why increase your recovery time and expense any more than necessary? Prepare your patients with your collection processes through education.

Do educate staff on insurance jargon and the process

Ensure frontline staff in reception and scheduling not only understands how insurance works, but can articulate it to your patients. Each payor is different and below this, each plan is unique. A little footwork may be required to fully understand the benefits for that patient's visit.

Do support staff

Be attentive and provide the applicable resources and solutions so your team can effectively support the revenue cycle and assist patients with their financial questions.


Do not avoid becoming inflexible

While you want to set a standard, you also want to avoid appearing inflexible. If you choose to skip important financial discussions and then aggressively collect against patient balances, your practice’s reputation may reap the consequences.

Do not skimp on personnel

Some physicians feel like they don't want to invest in more labor, but it may hurt you in the long run. Even being down one person can be the difference between a vibrant medical office where patients feel well served, and a place where it's hard to balance direct care needs, finances and more. Breakdown your current office staffing model to identify inefficiencies and lost revenue opportunities then build back up.

Do not skip current healthcare financial trends and models

Stay engaged in the current healthcare market atmosphere and stay competitive.

Do not leave decisions to others

Involve all major stakeholders in your medical office in active brainstorming to discover solutions to challenges. It's not always a good idea to simply assign everything to one point person or to think that these issues will work themselves out.

Do not blame Uncle Sam

While government regulations and implementation of the Affordable Care Act are creating new concerns for your medical practice, new innovations and opportunities are also blooming. How can you leverage this to your advantage?

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Keep your patients prepared and well informed of their financial obligation, preferably before their appointment. This results in transparency, open communication, and faster cash turnaround.

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Sue (Sunni) PattersonPresident/CEO

Sue (Sunni) Patterson started in the healthcare industry as a senior medical claims processor with a major insurance payer. Sunni is President of RMK Holdings Inc., a healthcare revenue cycle management services firm. Key specialization areas in...

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