Collections: Is your practice getting its money's worth?

According to a recent article in the Los Angeles Times, four million Americans are enrolled in consumer-directed health care plans. That number is expected to swell to more than 20 million by 2008. This means every urology practice will be expected to make collections a bigger priority. If you don't, it's a sure bet you'll absorb far more overhead for staff to chase after overdue patient receivables for which you may end up getting only 40 cents to the dollar.

I recently made some mystery patient phone calls for a urology practice. Posing as a new patient, I called the practice and one of its competitors for comparison. It was interesting to evaluate the multiple calls I made and realize how little emphasis was placed on patient finances. I was asked what type of insurance I had when scheduling an appointment, but none of the schedulers told me what financial expectations they had of me, the patient. You can't expect your patients to take the cost of medical care seriously if you don't.

Every staff member needs to understand his or her role in collections, starting with collecting financial information before the patient comes into the office and letting patients know how you expect to be paid. It's important for your staff to determine whether patients have large deductibles or a high percentage of costs for their care.

The patient accounting form on your practice management system is only reliable if your staff members understand the importance of, and are dedicated to, obtaining accurate, timely patient information. After all, this is your first financial document for each patient.

Train your staff to scrutinize the patient registration form carefully and make sure it is complete as to patient demographics, responsibility party information, and insurance details, that all information is legible, and that the form has been signed by the patient.

Remind your staff about important questions to be asked of established patients at every visit. Keeping patient registration and insurance information current depends on how these questions are asked, as shown in the table below.

Changes should be made in the computer system when the questions are asked, and your staff should receive an updated copy of every patient's insurance card. Working in real time ensures that when the billing office, nurses, and doctors can pull up the patient's account or electronic medical record, they have the most accurate information.

In addition, have patients complete a new patient information form annually. Color coding these forms by year ensures compliance and holds your staff accountable for maintaining accurate, current patient records.

Make sure that all services provided are documented on the charge ticket and are coded properly. Physicians are sometimes lax in reporting charges, and they need to make greater effort in reporting them in real time on the day the service is performed. Setting standards to ensure accurate coding and prompt submission of charges will go a long way toward improving your practice's finances. Monitor for compliance, addressing areas in which standards are not consistently met or assistance is needed.

Train for timely collection

Collecting from the patient when he or she is in the office is called "over-the-counter" (OTC) payment. OTC payments add incredible power to your collection efforts. Effective OTC payments require that your staff assume responsibility for collecting patient payments whenever the patient has an appointment in real time. Failure to do so is a missed opportunity, resulting in delayed payment and further expense.

Some experts estimate the cost of sending billing statements at $12 to $15 per patient. With $15 co-pays, you'll just break even, assuming the patient pays with the first statement. Urologists, already struggling with high operating costs and lower reimbursements, are not in a position to absorb this added expense when the balance could be collected at the time of service.