How to get patients to pay their bills

A column about keeping your practice in good health

By — Posted July 9, 2012.

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When it comes to asking patients for payment, medical practice consultants say this should be done much like the old joke about voting in Chicago — early and often.

But an effective collection strategy isn’t just about asking over and over again. It’s about how the asking is done. Timing plus delivery can get the response you want.

“People asking for money have to be welcoming and natural,” said Bill Hughes, administrator with Women’s Health Specialists, a seven-physician practice with three offices on the southeast coast of Florida. “They cannot be harsh.”

Patients are responsible for an ever-larger share of their medical bills, and practices have a greater need to ask for payment at the time of service. The average co-pay required by patients with employer-sponsored health insurance to see a physician was $21.53 in 2009, according to a data brief released in April 2011 by the Agency for Healthcare Research and Quality. In 2004, the average co-pay was $17.49.

The first step is to think about the best times to ask. The fact that a co-pay is due at the time of service can be mentioned when a patient calls to make an appointment or during the reminder notification. If the practice has the technology to retrieve the information quickly or link it to the reminder system, staff should give an exact amount.

“You want to lay it out up-front,” said Lisa Asbell, RN, president of TrainRX, a medical practice consulting firm based in St. Petersburg, Fla. “And you need to say things two or three times before people grasp it.”

Composing the question

Staffers then can ask for the amount of money known to be due when the patient is in the office, but proper phrasing is important. It should start with the patient’s name. If there is doubt about whether a patient wants to be addressed by first or last name and the appropriate title, staffers should ask.

“If you engage patients and make them feel important, it’s a lot easier to get money out of them,” Asbell said.

Patients should not, however, be asked whether they are going to or want to pay. Rather, the question should focus on how they want to pay and give the options available.

“We get very good compliance when we ask for cash, check or charge,” said Hughes, who is also a managing partner in the medical practice consulting firm Business Allies Group. “When you say, ‘Your co-pay is $30. Are you able to pay it today?’ it’s easy to say no,”

But while patients should not be asked a yes-or-no question on this subject, staffers should be prepared with scripted answers if patients try to decline.

Consultants recommend telling patients how valuable they are to the practice but that insurers require collecting certain amounts. If a patient hesitates because of economic or other issues, staff should acknowledge this. If full payment is not possible, an installment plan should be established.

“You can say that you understand their plight and be quite creative in making a payment plan,” said David MacDonald, chief executive officer of Aegle Advisors in Boston, which works with medical practices on this and other issues. “That builds loyalty among patients.”

Other options include giving patients stamped, addressed envelopes to mail payments or a phone number of someone who will take down credit or debit card information when patients return home. Some practices may decide that in certain situations, a patient could be turned away.

The next issue to consider is who should do the asking. Experts who work with practices say money issues should be delegated to staffers who are not shy about asking for money but who can ask with tact.

“I would not be good at this,” Hughes said. “It’s takes a special, well-trained person with the right personality to do this well. Not just anyone can do it.”

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