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nsuring providers are paid is a priority for every practice manager. Getting paid has always been challenging, and today is no different – maybe even more complex. There are lost or denied claims, requests for additional documentation, questions on timely filing and more with health plans. But the newer concern involves the increasing patient responsibility in payment for services provided. The financial burden has shifted, and it is putting patients and providers at risk. You and your staff are likely seeing more patients with high deductible insurance plans requiring co-pays and co-insurance. This means it is critical to have office staff and systems that are aligned. Front and back office staff need to work together and processes for check-in, check-out, charge capture, documentation, follow-up and billing (for insurance and patient) need to be clear so they are easily understood and followed. As providers of healthcare, you want your patients to have what they need. That includes smooth and supportive interactions with you and your staff. Day-to-day challenges, misunderstanding why something is necessary, fear of conflict when asking for payment, and a myriad of other reasons that may or may not be related to the job, cause stress and result in poor communication and interactions with the patient. A case example: Susan is a 55-year-old female patient undergoing chemotherapy for breast cancer. She has a $5,000 annual deductible with her health plan, and she has a $45 co-pay each time she sees her oncologist. She makes sure to pay her co-pay at each visit. Susan and her spouse are exceptional in understanding their healthcare coverage and keep rigorous records of their expenses. On a recent visit to the oncologist, Susan was approached by one of the billing office staff about her payment plan. Susan was informed that one of her treatments was not covered until she meets her plan deductible. Sounds confusing, right? Susan was shocked by the revelation that a treatment she had been receiving for the past month was not covered. She was appalled as the billing person showed her an invoice for $2,500 that was considered patient responsibility. The situation devolved further as Susan burst into tears wondering how she would pay this and whether she could even continue treatment. While this conversation occurred in a small room off the patient waiting area, the entire waiting room could hear most of what was being discussed. No one was spared from emotional upset as fear, anger and sadness spread from patients to staff. This type of patient situation is not unique to specialty care. Patients and providers are continuously surprised by medication coverage, co-pays and cost sharing. Patients think their doctor should know, but things are not always clear – even when the most current plan information is available. Understanding what’s covered, what’s not covered, what needs authorized, etc. is more complex than ever. As healthcare professionals, we think patients should know their coverage and financial responsibility. While more patients are beginning to understand their part in the payment process, many still do not. When something
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ARIZONA PHYSICIAN | May 2017
FOUR THINGS YOU CAN DO TO STRENGTHEN YOUR PRACTICE
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Listen to the patient.
What is the patient really asking? If you’re not provoked by an angry or upset patient, your staff will notice. Remember that they are watching you and will follow your lead.
Ensure your staff have the skills and desire to work with patients.
When patients call, don’t make it hard for them to get answers to their medical or billing questions. Billing questions can be challenging, as conversations about money often evoke an emotional response. Staff may need training on how to • collect the co-pays and deductibles with ease, • stay calm and diffuse conflict, and • stay engaged with the patient to understand the real concern.
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Pay attention to communication and processes throughout your practice.
Notice what works or doesn’t work and encourage your staff to consider this as well. Don’t settle for how things have always been done, especially if you notice problems. Talk with your practice manager about how the front and back office team work together to ensure people and processes are aligned.
4
Promote accountability and a culture of caring.
Cultivate a culture of caring with your patients and with each other. You may already have this approach. How clear is this expectation with your team, your partners, the organization? Working together means understanding the impact we have on each other in ensuring patient satisfaction, collecting payment, and having a practice that is successful and financially sound.