Ultimate Guide to Collecting Money from Patients

THE ULTIMATE GUIDE TO  
COLLECTING FROM PATIENTS
AT TIME OF VISIT

Getting Started
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THE ULTIMATE GUIDE TO COLLECTING FROM PATIENTS AT TIME OF VISIT
www.aﬂxhealth.com

5 Steps to collecting more from  
patients at the time of visit
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This guide provides you with the resources you need to
implement better time of visit collections in your practice.
You will learn the steps needed to master insurance  
eligibility, establish stronger ﬁnancial guidelines,  
understand how to calculate patient costs, and even handle
challenging conversations with patients.

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THE PROBLEM:
Patients are unable to keep up with the increasingly  
large portion of the cost of their medical care. This leaves patients frustrated, practices
with higher accounts receivables, and more money that goes uncollected.
49%
Providers & staff don’t know patient
responsibility at time of visit.
The collection rate goes down by 60%
when the patient leaves the ofﬁce.
60%
62% of patients are confused and
frustrated by out-of-pocket medical costs.
62%

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THE PROBLEM:
larger portion of the cost of their medical care. This leaves patients frustrated, practices
The average American  
has $1,766 in overdue
medical debt.
About 42.9 million U.S. residents have outstanding medical debt, according to a Consumer Financial
Protection Bureau (CFPB) report.

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THE PROBLEM:
larger portion of the cost of their medical care. This leaves patients frustrated, practices
You will recover just $15.77 for every
$100 owed once a patient’s bad debt is due
past a certain point.
About 42.9 million U.S. residents have outstanding medical debt, according to a Consumer Financial
Protection Bureau (CFPB) report.

Healthcare Insurance Plans  
Out-of-Pocket Costs
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TOTALANNUALPATIENTCOSTS
$0
$1,143
$2,286
$3,429
$4,571
$5,714
$6,857
$8,000
Bronze Plan Silver Plan Gold Plan Platinum Plan
$1,680
$1,770
$3,009
$6,000
$3,350
$2,796
$2,316
$1,731
Annual Premium Total Out of Pocket
Most common plan with lowest
premiums has highest total out of pocket
cost from deductibles and co-insurance.

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Bills consumers are least likely to pay if  
lacking funds to pay all bills
0%
5%
10%
15%
20%
25%
30%
35%
40%
CreditCard
Phone
Healthcare
Other
Utilities
Loan
Mortgage
Healthcare Bills 3rd most likely to  
default on payment.
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What patients are saying…
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“Our deductible is so high, we practically pay for all of our medical
expenses out of pocket,” said Wendy Kaplan, 50, of Evanston, Ill.
“So our policy is really there for emergencies only, and basic
wellness appointments.”
“We could not afford the deductible,” said Kevin Fanning, 59, who
lives in North Texas, near Wichita Falls. “Basically I was paying for
insurance I could not afford to use.”

How patients are responding  
to higher costs:
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1. Avoid seeking care when they need it for fear  
of the “aftermath” and being billed.
2. Default on their doctor bills and end up in
collections.

$317,000
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On average, there are about $317,000 per year per
provider in patient responsible costs.
(Co-Pay, Deductible, and Co-Insurance)
Why you need to solve your collection problems  
while the patient is in the ofﬁce.

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On average, only 15% ($47,550) of that amount
is actually collected from the patient once it is
past due.
$317,000 Per Year
$47,550

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InternalCosttoCollectonBalance
$0.00
$0.25
$0.50
$0.75
$1.00
Today 30 Days 60 Days 90 days 120 days 6 months 1 Year
$0.45
$0.60
$0.73
$0.80
$0.90
$0.97$1.00
$0
$0
$1
$1
$1
How patient receivables lose value over time  
and cost more to collect.
Costs more to collect
on balance than value
of the receivable.
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THE SOLUTION:
The collection rate goes down by 60%
when the patient leaves the office.
60%
THE PROBLEM:
Collect more patient payments  
at the time of visit instead
of after they leave the office
62% of patients are confused and
frustrated by out-of-pocket medical costs.
62% Educate your patients  
on their financial responsibility.
49%
Providers & staff don’t know patient
responsibility at time of visit.
Accurately estimate patient
financial responsibility
with a realistic  
verification process.

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By implementing an effective system of collecting all
payments (co-pays, deductibles, and co-insurance) from
patients at the time of service – before they walk out of the
door – your practice can:
• Get more money into the practice faster
• Reduce billing and back-end collection write-offs,
• Improve patient satisfaction
THE BENEFITS:

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Implement your 5 step system to  
collect at the time of visit.
Step 1: Create clearly written financial policies.
Step 4: Collect money at the right time.
Step 2: Accurately estimate financial responsibility.
Step 3: Communicate clearly with your patients.
Step 5: Make it easy to pay.

Step 1: Create Clearly
Written Financial Policies.
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Establishing your financial policies.
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Communicating clearly with your patients about
financial responsibilities and working openly with
them to resolve outstanding balance issues
establishes good expectations, better patient
accountability, and higher patient satisfaction.
Patients will take a greater level of ownership in
their care and treatment when they understand the
costs involved.
They will respect your physicians and staff as
expert partners in helping them manage the rising
costs of their healthcare.
Insurance / Financial Policy Patient Agreement
INSURANCE CLAIMS/BILLING
As a courtesy to our patients, we will file insurance claims for those insurances with which we
participate. The agreement of the insurance carrier to pay for medical care is a contract be-
tween you and your insurance company. Any amount not covered by your insurance company is
your financial responsibility. This includes co-payment, coinsurance and deductibles.
PAYMENT
Payment will be requested at the time of service for all services which are non-covered or de-
termined to be patient’s responsibility, including co-payments, co-insurance and deductibles.
(This is the policy of your insurance company)
We will kindly reschedule your appointment if you do not have your co-payment or any
past due balances.
Methods of payment accepted include cash, debit, Mastercard and Visa.
PATIENT FINANCIAL RESPONSIBILITY
The patient or their guarantor is responsible for all co-pay, coinsurance, balances and de-
ductibles on the day of service.
You are ultimately responsible for payment of services provided if your insurance carrier does
not pay for any reason. If we do not receive payment within 30 days, the patient will be billed.
**IT IS YOUR RESPONSIBILITY TO BE AWARE OF YOUR INSURANCE BENEFITS.**
If we are a preferred provider on your insurance plan, we will submit the claims to your insur-
ance company and make every attempt to collect with the information that you provide. Howev-
er, the agreement of the insurance company to pay for medical care is between you and your
carrier.
**Please present your insurance card at each visit.**
If you are unclear of your insurance benefits, you will need to contact your insurance carrier for
clarification of coverage. If you are waiting for coverage to become effective or have no insur-
ance, payment in full will be expected the day you are seen.
Delinquent accounts over 60 days will be sent to collections for processing.
At which point all collection fees, contingent or not, shall be added to the patients responsibility.
In the event legal action is required, the patient shall be responsible for all reasonable attorney’s
fees and costs.
**All Delinquent may be shall be a month assessed late fee until paid.**
It is your responsibility to notify our office if there is a change in your insurance coverage, resi-
dence, or phone number. I have read and I understand the above FINANCIAL POLICY and I
agree to abide by its terms.
Printed Name:____________
past due balances.
Methods of payment accepted include cash, debit, Mastercard and Visa.
PATIENT FINANCIAL RESPONSIBILITY
The patient or their guarantor is responsible for all co-pay, coinsurance, balance
ductibles on the day of service.
You are ultimately responsible for payment of services provided if your insuranc
not pay for any reason. If we do not receive payment within 30 days, the patient
**IT IS YOUR RESPONSIBILITY TO BE AWARE OF YOUR INSURANCE
If we are a preferred provider on your insurance plan, we will submit the claims
ance company and make every attempt to collect with the information that you p
er, the agreement of the insurance company to pay for medical care is between
carrier.
**Please present your insurance card at each visit.**
If you are unclear of your insurance benefits, you will need to contact your insur
clarification of coverage. If you are waiting for coverage to become effective or h
ance, payment in full will be expected the day you are seen.
Delinquent accounts over 60 days will be sent to collections for processing.
At which point all collection fees, contingent or not, shall be added to the patient
In the event legal action is required, the patient shall be responsible for all reaso
fees and costs.
**All Delinquent may be shall be a month assessed late fee until paid.**
It is your responsibility to notify our office if there is a change in your insurance c
dence, or phone number. I have read and I understand the above FINANCIAL P
agree to abide by its terms.
Printed Name:____________
Signature:_______________ Date:______

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Establishes the foundation for your financial
relationship between the practice and patients.
Prevents patients from being surprised  
about their financial obligation.
Gives your practice some legal protection should a
patient fail to pay what you are entitled to collect.
Benefits of a well written financial policy

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1. When payment is due  
(e.g., the date of visit, unless other arrangements have been made in advance);
2. Who is responsible for payment  
(self-pay patients are responsible for the entire amount of the bill; patients in health
plans are responsible for any amounts not covered by their insurance);
3. The relationship to the insurance companies 
(make it clear that coverage is determined by patient and their insurance plan);
4. How co-pays and deductibles will be handled  
(co-pays are collected at each visit without exception, deductibles and co-
insurance as agreed upon);
5. What forms of payment your practice accepts  
(e.g., personal checks, debit cards, credit cards, online payments);
6. Your practice’s policy regarding nonpayment  
(collection enforcement and fees).
6 Key Ingredients of a Well Written Financial Policy

How to handle the signed  
financial policy at the time of visit.
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1. Upon registration the check-in person should walk the
new patient through the document (even if pre-filled) and
verbally explain the expectations.
2. Have each patient (or guarantor) read, sign and date the
document.
3. Make a copy for the patient and then add it to the patient’s
chart.
If a patient says, “I didn’t know I had to pay my co-pay, or deductible” simply
refer to the policy stored in his or her chart.

3 Simple Steps to an Airtight Financial Policy
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Firm guidelines
Consistent follow-through
Clear communication
WHAT TO DO IF A PATIENT CHALLENGES YOU:
Be calm, be polite, refer to the payment policy, and move forward with a solution. Do not
dwell or go back and forth with the patient about what they should know.
 
USE THE LAST METHOD TO DEAL WITH PATIENT BILLING CHALLENGES
L - LISTEN - A - APOLOGIZE - S - SOLVE T - THANK

Step 2: Accurately Estimate
Financial Responsibility
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The 4 Types of Financial Responsibility
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1. Copays. They are almost always indicated as fixed amounts based
upon the terms of the patient’s insurance policy.
2. Co-Insurance. If the patient’s insurance policy indicates that the
insurance payer covers 90% of the cost for an office visit, the patient is
responsible for the remaining 10%.
3. Remaining deductible. A deductible is a specified amount of money
that must be paid before the patient’s insurance company will pay
money towards a claim.
4. Self-Pay. Patients without any insurance coverage or with a plan the
practice does not accept are considered Self-Pay.
**Co-insurance, co-pays, and deductibles are all forms of cost sharing. Federal and state laws prohibit
clinicians from waiving cost sharing fees, doing so may violate payor contracts and is considered fraudulent.**

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1
2
3
4
5
7
8
9
10
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Front of Card
6
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Sample Health Insurance ID Card
1. Member ID Number
2. Member Name
3. Group Number
4. Primary Care Provider (PCP)  
Name and Phone Number
5. Plan Type
6. Co-Pay for Visits to Primary Care Provider
7. Co-Pay for Specialty Care
8. Co-Pays for Emergency and Urgent Care
9. Prescription Drug Plan Information

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3
4
8
9
10
11
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Back of Card
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10. Health Plan Website Address
11. In-Network Deductible and Coinsurance
12. Out-of-Network (OON) Deductible and
Coinsurance
13. Plan Contact Information
14. Claim ﬁling information
Send Billing Claims to: USA INSURANCE 
PO BOX 12345 | Newark NJ, 0710114

The challenge estimating  
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The high level of complexity of patient responsibility makes it
seem like a moving target that you can’t seem to pin down.
This is true when trying to get accurate to the dollar detail about
what will be covered vs. what will be owed.
The solution is to implement a system that ESTIMATES what
the patient will owe so that you can communicate and collect
the right amount from every patient.

How to Estimate Financial Responsibility
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1. Copays. There is generally no calculation associated with copay amounts. You
simply determine the type of service PCP/Specialty/ER and follow what is on the card.
2. Coinsurance. Calculations for coinsurance amounts are based upon the level of
coverage that the patient’s insurance policy provides. Coinsurance calculations are
based on the contracted fee schedule rate and not the practice’s retail charge.
3. Remaining deductible. Determine how much of the patient’s deductible remains
unmet by verifying eligibility and benefits with the insurance company before the visit.
4. Benefits. Some services are covered entirely by the patient’s plan and others are
not. This is part of the eligibility process when you contact the insurance company.
4. Self-Pay. Self-Pay or Cash Pay patients are responsible for 100% of the “cash pay”
discounted amount.

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CPT CODE Visit Description
Average Expected  
Re-imbursement
Co-Pay Co-Insurance
Remaining
Deductible (Not Met)
Patient
Responsibility
99204
Office/Outpatient
Visit, Est. $140.90 14.09
36415
In Office Blood
Draw $22.50 2.25
76805
OB US(transabd)
>/= 14 WKS,
SNGL FETUS
$209.77 20.98
Totals: $373.17 $20.00 $37.32 $315.85 $373.17
Patient HAS NOT met deductible and remaining deductible is MORE THAN amount owed.
How to Estimate Financial Responsibility When:
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How to Estimate Financial Responsibility When:
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CPT CODE Visit Description
Average Expected  
Re-imbursement
Co-Pay Co-Insurance
Remaining
Deductible (Met)
Patient
Responsibility
99204
Office/Outpatient
Visit, Est. $140.90
36415
In Office Blood
Draw $22.50
76805
OB US(transabd)
>/= 14 WKS,
SNGL FETUS
$209.77
Totals: $373.17 $20.00 $37.32 $0.00 $57.32
Patient HAS MET deductible and remaining is LESS THAN amount owed.

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Figuring out Average Expected Re-imbursement
Option 1: Use the Medicare Fee Schedule Option 2: Payer Mix Analysis Report
Source: CMS website:
https://www.cms.gov/apps/physician-fee-
schedule/overview.aspx
Source:  
Practice Management Software or  
Billing Company Report
This method gives you quick and easy access  
to the average re-imbursements of all procedures.
Since all fee schedules are based off of the
medicare schedule it is reliable as an estimate.
This method gives you a more accurate estimate  
of what you can expect to get paid. You will have to
spend the time tracking your payments (which you
should be doing) to get a good set of numbers.
How to Estimate Financial Responsibility:
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How to handle self-pay patients:
Self-Pay Patients should  
be presented with an easy to
understand Cash-Pay price
list of common services.
This gives them an idea of
what the responsibility will be.
Payments can be collected at
the beginning of the visit
(preferable) or at the end after
all needed services have
been provided.
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How to Verify Insurance  
Eligibility Correctly Every Time
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• Electronic Eligibility Verification
• Manual Eligibility Verification (picking up the phone)
• Verify Patients Insurance Coverage & Benefits
• Determine Patient Financial Responsibility
• Identify Secondary & Tertiary Payers
• Confirm Assignment of Primary Care Provider for
Authorizations
Information to verify during an eligibility inquiry:
Options to perform an eligibility inquiry:

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DID YOU KNOW?
The Affordable Care Act has mandated specific
guidelines for all payers to provide accurate and
timely information regarding patient financial
responsibility.
(Finally!)

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1. Electronic eligibility verification / electronic data
interchange (EDI)
• Practice Management Software
• Clearinghouse Website
• Payer Website
• 3rd Party Website (AVAILITY.com / navinet.com)
2. Manual eligibility verification (pick up the phone)
Options to perform an eligibility inquiry:

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http://www.availity.com/register-now-for-web-portal-access/
Availity is a free web based portal with easy to use dashboard and hundreds  
of payer integrations for real-time electronic eligibility verification.
3rd Party Options for Bulk Online Verification: AVAILITY

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http://www.navinet.net/solutions/providers/all-payer
Navinet is a free & FEE Based
web based portal with hundreds  
of payer integrations for  
real-time electronic eligibility
verification.
3rd Party Options for Bulk Online Verification: NAVINET

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3rd Party Options for Bulk Online Veriﬁcation:
NAVINET VS. AVAILITY
Both NaviNet and Availity have easy to use portals and a simple
sign-up process. The main difference is going to be the payers that
are available on each and the type of information you can get.
You should sign up with both and create a process to check both
portals to get insurance data on the maximum percentage of their
patients.
Still, that's a big improvement over the old multiplicity of individual
insurance portals, and it should get more accurate information in less
time.

Step 3: Communicate
Clearly with Your Patients
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How to talk about money with patients
Patients are looking to you to help them understand
what to expect. Listen to them and be honest. By
being transparent about their ﬁnancial
responsibility, you establish a more respectful
relationship with them.
Start with Empathy
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How to talk about money with patients
Talking to patients about money is not easy, but can be done
consistently and in a way that helps build the value of your services
and improve patient satisfaction.
• Use scripts for front-office practice staff to achieve consistent
messaging.
• Make sure that your practice’s written policy is consistent with  
any verbal representations your staff makes.
• Hold daily staff huddles to review the days financial responsibility
report and cover any special circumstances before the patient
arrives.
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Handling frustrated, embarrassed or angry patients:
First, let the patient speak and attentively listen to him or her without interruption.
Then, address the issue with empathy, but be direct when stating that you need to
work out a solution for payment (it is quite common for patients to believe their
insurance is paying all of it or should be and to fault the practice if they are not).

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What to do when the patient won’t pay:
First, let the patient speak and attentively listen to him or her without interruption.
Show empathy and say:
“I understand that you're upset about this. Our practice has a contractual obligation
with your insurance company to collect payments at the time of service.  
 
If you are unable to make payment at this time, I am happy to re-schedule your
appointment.”
Wait for the patient to respond.

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When to be flexible and when to be firm:
Sometimes there are obvious circumstances that demand some flexibility. This may
be the case for patients that have established already good relationships over time
with the practice or they are in need of urgent care.
In these circumstances the staff should understand the protocol to check with the
Practice Manager or the Physician to assess the risk to the practice and decide to
see the patient knowing there is a chance that payment will not be collected,
Show empathy and say:
“I understand that you're upset about this. Our practice has a contractual obligation
with your insurance company to collect payments at the time of service.  
 
Let me see if there is something we can do to accommodate you.”
Ask for the patient to be seated and to be patient. Then follow the protocol.
Then say, “Thank you, [Mr/Mrs/Ms Last Name], for your understanding.”

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Help your patients to  
understand their Medical Bills
Medical billing in the United States can
seem like an extremely convoluted
process. About 54% of Americans are
confused by their medical bills, and 62%
of patients are confused by out-of-
pocket medical costs.**
USE a sample EOB to teach
patients about their responsibility.
**According to a 2014 public opinion survey conducted by TransUnion Healthcare
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Help your patients to understand their Medical Bills
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Help your patients to  
understand their Medical Bills
Encourage your patients to use their
insurance plans portal
**According to a 2014 public opinion survey conducted by TransUnion Healthcare
UnderstandingHealthcarePrices:AConsumerGuide
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Step 4: Collect Money at  
the Right Time
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Understanding the revenue cycle.
There are 5 main stages to a patient visit. The ideal time to collect from patients  
is on the front end of the visit and decrease the time on the  
back end chasing claims and the dead-end of collections.
Pre-Visit
Scheduling
Patient
Check-In
Patient
Visit
Patient  
Check-Out
Post Visit
Follow - Up
1 2 3 4 5
Patient Satisfaction & Collections Heat Map
Best Time To Collect Worst Time to Collect
The entire process of a patient visit, pricing, coding, claim submission,  
and collections is called the Revenue Cycle.

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Pre-Visit and Scheduling
1. Clearly communicate key points of
financial policy and payment
options to patients when
scheduling.
2. Determine patient financial
responsibility from insurance
company.
3. Make reminder call in advance (at
least 3 days) of appt. notifying of
financial responsibilities.
4. Provide financial policy packet to
patient before they arrive via
website or email.
Pre-Visit
Scheduling
Patient
Check-In
Patient
Visit
Patient  
Check-Out
Post Visit
Follow - Up
1 2 3 4 5
[FRONT OFFICE TASK CHECKLIST]

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Patient Check-In
1. Confirm patient demographics
and scan insurance card (both
sides to get the “send claims to”
dress on the back.”
2. Walk patient through policy
document and confirm
signatures.
3. Review patient worksheet with
4. Collect co-pay and collect
against deductible.
Note, Step 4 is office specific depending on specialty and
needs of the office and collections may be done at check-in
our check out .
Pre-Visit
Scheduling
Patient
Check-In
Patient
Visit
Patient  
Check-Out
Post Visit
Follow - Up
1 2 3 4 5

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Patient Visit
1. Make patient aware of
potential costs of labs,
imaging, and prescriptions.
2. Remind patient to check-
out to review outstanding
balance and payment.
Pre-Visit
Scheduling
Patient
Check-In
Patient
Visit
Patient  
Check-Out
Post Visit
Follow - Up
1 2 3 4 5
[BACK OFFICE TASK CHECKLIST]

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Patient Check-Out
1. Request co-pays, deductibles,
co-insurance, and previous
balances.
2. Ask if patient wants credit card
info securely stored to pay
future balances.
3. Request payment for existing
balances or establish
electronic payment plan if
payment can’t be made
immediately.
Pre-Visit
Scheduling
Patient
Check-In
Patient
Visit
Patient  
Check-Out
Post Visit
Follow - Up
1 2 3 4 5

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Post Visit Follow-Up
1. Schedule time for billing
inquiries.
2. Provide 2 follow-up calls to
patients every statement cycle.
3. Collection agency management
and account selection for
collection agencies.
Pre-Visit
Scheduling
Patient
Check-In
Patient
Visit
Patient  
Check-Out
Post Visit
Follow - Up
1 2 3 4 5

Step 5: Make it  
Easy to Pay
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Create incentives to pay early for larger balances
• Full payment discounts for amounts over  
a certain amount.
• Payment plans with standardized down payments.
• Financing options.
Provide multiple payment options
• Credit cards / cards on-ﬁle &
• Online payment options
Improving patient satisfaction.

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Patient Friendly Billing & Collections Resources
Some vendors, such as CarePayment, ClearBalance, and
Simplee seek to make it easier and less confusing for patients
to pay bills.
Improving patient satisfaction.

Training Staff
& Making it Stick
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Implementation Planning
How to implement successful, sustainable practice change.
1. Select a high-level champion for the change.  
This can be someone from the administrative staff,  
medical assistants, or physicians.
2. Involve all members of the team.  
Creating a respectful team environment where everyone’s voice is heard
is important. However, that doesn’t mean that everyone on the change
team will agree with everything that is said during the team’s meetings.
3. Measure the progress.  
Measurement gives the team a goal to work towards; showing
improvement helps the team maintain enthusiasm and support for the
project.

Ultimate Guide to Collecting Money from Patients

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