Best front desk sign I've ever seen so far

I was in a primary care physician’s office recently (not a client) where this sign was on the receptionist window:

 

“We regret, but in order to see you, your insurance company requires us to collect your co-payment at the time of service.”  

 

My reaction? Brilliant! Outstanding! This office follows this sign up with a strong front desk policy that requires patients to reschedule if they do not have their co-payments. I found out their co-payment collection ratio for managed care patients was near 100%. For those patients coming to this office who are in acute crisis and must be seen, they are triaged for acuity and the self addressed stamped envelope for the copayment is sent home with the patient. Yes it is tough times for many people but I continue to stress that in any “service industry”, and yes, healthcare is a service industry, goods and services are not delivered without payment received. It’s that black and white.

Look ahead to your office’s future

Besides considering how the office affects your current practice, think about how the facility fits into your future. Offices often hinder doctors' ability to change the way they practice. Don't, for instance, let your office impede these four growth strategies:

• Adding physicians or merging practices. Carefully project your future office needs early in the planning process. Real estate issues sometimes completely derail a merger or make new-doctor recruiting grind to a halt. "Squeezing in" a new physician is at best a very short-term alternative to acquiring needed space.
• Building patient-management teams. Moving to a team-management patient care approach, many physicians discover that office limitations prevent them from being on the staff, like mid-level providers and patient educators, they need to make the approach work.
• Adding in-office procedures. Technological advances continue to move medical and diagnostic procedures into the office. Many payers prefer practices able to provide more services, so don't let yourself lose out simply because you lack the additional work space.
• Bringing in new revenue. Colleagues around the country are breaking new ground with expanded lines of service, like optical shops, physical therapy, new diagnostic tests, executive physicals, and even medically related retail. Ideas like these require expanding or redesigning your office.

Charging a re-billing fee

I ran across a physician practice that has begun charging a "rebilling fee" beginning at 90 days. They clearly state on their patient statements that the rebilling fee will be charged on balances over 90 days. According to the administrator, this has been really effective in getting patients to pay earlier rather than watching their balance role across until it reaches the 120 day box.  It has also helped with balancing out what they might receive in the future when we finally do send a patient to collections (they include the rebilling fees along with the balance). Is anyone else doing this?

Again, remember my mantra – one statement only to the patient, then out goes the 10-day letter, and if the patient does not respond to the 10-day letter, then off to the collection agency.

Communicate effectively with referring physicians

When it comes to ensuring your referral sources last, spend time giving your referrers what they most want-timely and effective communication. When a new referrer enters your market, make contact. If possible, personally call or visit the physician and introduce yourself, as well as your personal or practice subspecialties. Your administrator or designated employee should also make contact with his or her peer at the referrer's office to discuss communication and referral particulars. Drop off information about your practice, your physicians, office hours, and driving directions to your practice.

Further, have your manager handle the specifics of how to make the referring office's job easier. That doctor may prefer reports delivered in a particular manner or may express specific concerns about scheduling patients in short turnaround. While you use this first meeting as a time to discuss the clinical side of patient referral, your manager can assess specific needs concerning patient scheduling, flow, and paperwork.

Handling fixed assets under an office sharing arrangement

Suppose a physician will begin sharing his office space with another physician. They will maintain separate medical practices and will be sharing expenses only. They have agreed on a shared expense arrangement covering monthly office expenses and payroll.  The physician who has the office lease also has very sophisticated office and medical equipment in his office and feels the new physician should pay some rent for the use of his tangible assets. How should this be handled under an expense sharing relationship.

 

In similar arrangements, I have included an "Equipment Usage Charge" in the calculations which is basically writing off the cost of the equipment over its useful life (5 to 7 years) on a straight line basis. You can also call it "rent" if that is more understandable for the physicians. You might want to also add a profit amount to the equipment usage charge the same as you would in an arm’s length lease negotiation.

Promote cultural competency

Cultural differences between patients, staff, and physicians pose barriers to true patient involvement. Such differences can occur in thoughts, communications, customs, beliefs, and values. Cultural competence, therefore, is integrating the knowledge of cultural differences into your standards, policies, and practices to increase the quality of services and thereby improve patient outcomes. It promotes inclusiveness, respect, and value with regard to cultural differences.

Examining and improving cultural competence can have a positive impact on prevention, identification, and treatment of your patients. Failing to do so can affect what information you are able to gather for a patient history and about patient symptoms, which you use to diagnose illness and provide quality treatment. Handle these issues from an organizational standpoint, including incorporating them into your policies and procedures.

Deceased patients with unpaid balances

How are you managing the accounts of deceased patients when they have a balance?  If you were told there is no estate, are you confirming this with the courts?  Do you get involved in probate?

In case of unfortunate death of a patient who has a balance, it is best to first bill the patient’s estate. Most of time someone from the family will call and offer to settle the bill and ask for some discount (You should probably be offering some kind of a discount anyway in most of these circumstances). Since the cost of collecting by collection agency is at leaset 25%, offer a discount from 10% to 25% if they pay right away with a credit card or mail a check within a week.

If there is no response or no offer to settle by the family because they say the person did not have any estate, turn the account to collection agency.

Employee policy handling lax work effort that may lead to internal theft

A medical practice recently had two instances of what appears to be cash theft by an employee.  The staff in the reception area that handles the cash boxes had been quite lax for some time now when it comes to the security of their cash.  The practice wants to have zero tolerance but was unable to determine who is taking the missing cash. The practice recently adopted the following changes:

1.    The safe combination has been changed.

2.    New cash boxes and keys have been purchased. 

3.    New locks have been put on reception area draws where the cash boxes are kept during the day.

So what is a good policy regarding theft/missing cash?  Obviously if a theft can be proven, immediate termination must occur. But what about sloppiness or carelessness that could lead to a theft? How do you handle that?

I like how one physician office handles it – a policy called automatic Corrective Action - Decision Making Leave – used when employees don't lock draws; leave cash unsecured, can't identify where cash has gone due to sloppy work, etc. Under this policy, employee is sent home for a day without pay. It sounds much better than “Suspended Without Pay.”

Registration evaluation

Does the staff make it a priority to accurately gather and enter the necessary registration information for each patient? ___Yes ___No

 

Do they know what information is necessary to prevent claim delays or rejections? ___Yes ___No

 

Do they clearly understand the importance of recording information accurately? ___Yes ___No

 

Is there a clear understanding of what information is essential? ___Yes ___No

 

Is staff aware of what information is needed to do appropriate follow-up? ____Yes ___No

 

Does the staff discuss and obtain preauthorizations and referral information from patients? ___Yes ___No

 

Is there a clear understanding of when and how to obtain preauthorizations and referrals? ___Yes ___No

 

Does the staff understand and effectively communicate the financial expectations to patients? ___Yes ___No

 

Are copays collected at registration? ___Yes ___No

 

Does the staff discuss the payment options that are available to patients (credit cards, debit cards, cash, checks)? ___Yes ___No

 

Does the staff try to identify credit risks? ___Yes ___No

 

Does the staff recognize their potential to reduce patient statements? ___Yes ___No

 

Reducing payment denials

So what advice do I have for ways to reduce payment denials? Start simply – but right away – by implementing a system such as the following:

 

1.    Flag all denied charges, making a copy of the related EOBs and placing them in a folder.

2.    Hold staff meetings of the billing and collection personnel twice a month if possible or, at a minimum, once a month. In the meetings review and discuss the denials; why they occurred, and what corrective action needs to be taken to prevent them in the future.

3.    Implement the corrective action by communicating with the individuals who are involved with the process. In most cases this will be the people in attendance at these meetings – but not always. It could also include anyone from front desk personnel to even the physicians. For example, a denial pattern might be identified as stemming from the fact that a particular physician is filling out the patient charge ticket incorrectly.