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Tricky Territory: Collecting Patient Payments

Providers need to start collecting co-pays up-front. How can they ease the change?

• By David Kopf
• May 01, 2018

One aspect of RCM that has been a “work in progress” for providers is collecting co-pays and ongoing payments. The issue concerns how the culture of how HME provider businesses work with patients has changed. Back when DMEPOS reimbursement was much more profitable, and providers could stand to be a little more flexible with patients. However, in an era of tough Medicare cuts, that culture needs to change. Providers need to start collecting co-pays up front. How can they make that culture change?

“You know, it’s one of those things where you just have to rip off the Band-Aid,” says Joey Graham, vice president of Prochant, a consulting firm that specializes exclusively in helping HME provider business with RCM. “It’s about how you present it to the patient. Your existing patient base who’s used to you never charging them, they’re going to be your trouble. Your new patients, they’re used to it, they expect it, and it’s not questioned at all. … the reality is patients expect that nowadays. … You have to set the tone up front: this is not free.”

Here staff can start working with patients to manage their expectations and let them know that co-pays are going to be collected up-front. And this is an effort the entire organization should support. Similarly, the provider should put procedures in place to help patients who cannot pay the full amount, but perhaps can pay a portion of the co-pay, and then arrange a payment program for those patients.

“Strong patient private pay collections practices are critical,” Graham explains. “Everybody’s been talking about it for years now, but of course collecting that money up front, there’s no substitute for it. What I tell providers over and over again is your only point of leverage with your patient is your product or your service. That’s it. The moment you give it to them, you just lost all your leverage. Do you walk into Walmart and think that you’re going to walk out without paying? You can’t say, ‘send me a bill.’

Graham notes that RCM-minded providers have re-tooled their eligibility processes so that they are determining the patient’s responsibility, and communicating it to the patient very clearly. Instead of asking “Would you like to pay now,” they ask “Is that going to be Visa, MasterCard, or American Express?”

And once staff gets the credit card, they need to ask to keep the number on file so that they can apply it to rentals or other charges.

“We need to get a card on file because traditionally in our industry patients only pay about 50 percent of the time,” Graham explains. “Believe it or not, if you have a balance — the patient responsibility — and you are only going to send them a bill, you have about a 50/50 chance of getting paid.”

This article originally appeared in the May 2018 issue of HME Business.