Ask for Patient Pay, Give Options
The rise of consumerism in health care is occurring
at the same time as federal and state efforts to
promote the “Triple Aim” of improved care experiences and health at a low cost. Medicare patients
can find hospitals and physicians that accept their
insurance, and, in many cases, evaluate providers’
quality scores through a rating system. States are
getting into the ratings game, too (see “Washington
With patient satisfaction data being used to
determine quality scores for hospitals and providers, practices are understandably reluctant to
ask for upfront payments. The numerous physician
rating websites and apps reinforce that reluctance
for fear of poor reviews.
Two things are required to increase point-of-care
payments: payment options and a workflow that
reinforces asking for payment. When asked why they
aren’t paying their healthcare bills, the most common
response from insured patients was lack of provider
financing options, followed by delayed patient
statements and confusion over the amount owed. 4
Practices should offer a variety of payment
options, from in-person payments by cash, check,
Automated Clearing House (ACH), or credit/debit
card payments to patient portals. Whatever the
method, consider that payment card industry (PCI)
penalties are more severe than even Health Insurance Portability and Accountability Act (HIPAA)
penalties, so make sure your payment vendors are
abiding by industry standards and certifications.
Washington State Program
The State of Washington has HealthCareCompare, which allows people to
research common procedures or parts of the body, determine costs at local
facilities, and check out quality scores for both facilities and physicians.
1. America’s Health Insurance Plans. 2018. Health Savings Accounts and High
Deductible Health Plans Grow as Valuable Financial Planning Tools. Accessed
April 4, 2019 at ahip.org/wp-content/uploads/2018/04/HSA_Report_4.12.18.pdf.
2. HealthCare.gov. 2019. High Deductible Health Plan (HDHP). Accessed April 4,
2019 at healthcare.gov/glossary/high-deductible-health-plan.
3. M. Evans and K. Fleming. 2017. What We Can All Do About Rising Healthcare Costs.
Forbes, June 28, 2017. Accessed April 4, 2019 at forbes.com/sites/allbusiness/
4. T. Pellathy and S. Singhal. 2010. Revisiting Healthcare Payments: An Industry
Still in Need of Overhaul. Accessed April 4, 2019 at healthcare.mckinsey.com/
5. ALN. 2016. Patient Pay Fact Sheet. Accessed April 4, 2019 at alnmm.com/
Time Well Spent
Poor cost estimations and claim inaccuracies set
the stage for chasing payments from insurers
and patients post-service, which practices
increasingly cannot afford to do. Think about the
amount of time staff spend on the phone with
insurance companies fighting denials or under-
payments or with patients who still won’t or can’t
pay. How much better would that time be spent
maximizing the patient experience?
Interestingly, 80% of patients who gave a pro-
vider high marks for care also gave similar marks
for their billing and payment experience. Con-
versely, 85% of those who gave poor marks to a
provider also derided the payment experience. 5
An accurate bill starts with an accurate
claim. The goal is real-time claims adjudi-
cation that takes into account a patient’s
insurance, remaining deductible, co-pay, and
co-insurance. Practices need advanced claim
editing tools that include both clinical and
financial edits that are constantly updated
with new information and customizable to the
requirements of the practice.
The goal isn’t a high claims acceptance
rate—it’s fewer denials resulting in fewer days
in accounts receivable, because accurate claims
get paid quickly. That might be a subtle distinc-
tion, but fast payments equal a healthy practice.
Estimation tools should follow the same
standard. If a practice is constantly refunding
overpayments to patients, the patients are less
likely to use this method in the future.
Practices face three fundamental issues when
procuring upfront payment: workflow, payment
options, and claims/estimator tools. Asking for
money up front can be difficult, but communication about financial responsibility throughout
the patient journey can ease those challenges.
Setting the expectation of payment at the time
of appointment scheduling and reinforcing
during the appointment reminder ensures the
patient arrives prepared.
Providing a variety of payment options helps
patients pay in a way that’s comfortable to them.
Patients will consider prepayment as long as
they are confident in the cost of the procedure.
That confidence starts with knowledgeable staff,
accurate claims, and precise estimation tools.
Timothy Mills is chief growth officer, Alpha II, LLC.