How does the process start before the patient comes in the door? By our expectations.
When patients call for an appointment we should let them know we expect payment at the time of service and remind them of outstanding balances. Patients get upset when there are surprises regarding payments. Use any patient contact time to clarify financial policy. Communication and education is the key. Be clear that payment is expected at the time of service Old habits must change from saying if you can pay $5.00 on your account to your balance is ___ how would you like to pay, cash, check or credit card.
If patient is ignored they feel unwelcome. Must provide good customer service. We have an open concept area out front which gives the appearance to be much more friendly in a open environment.
If you are the one that made their appointment you could say. I spoke with you yesterday, welcome to the Cabarrus Health Alliance.
Remember the 3 P’s.
Remember when you can’t see the body language, the visual messages are removed we need to listen to hear what is really going on. “Listen between the lines”. Try to hear the hidden messages that people say. Clients can also read our body language. Flinching is a reaction they can read if we don’t approve. If they are not in front of you it is vital that you develop phone skills that compensate for the loss in the clarity of communication afforded by observing body language. A lot can be gained from what you hear. HEATHER, what are do doing? Heather WHAT are you doing? Heather what ARE you doing? Heather what are YOU doing? Heather what are you DOING? .
Do not want to sound phony when showing enthusiasm. Extroverted person to work the front desk.
The impression your give at the front desk presents to patients is a reflection of your entire practice, and can determine the tone for the rest of the visit. Look at yourself in the mirror while at your desk to see your expression and how others view you. Smile and deal will have positive effect on collecting money.
Refuse to behave unprofessionally yourself or accept unprofessional behavior. If they get abusive, transfer the call to someone else or tell them you will call back later.
You have to have that professional balance of understanding and firmness because you don’t want to be taken advantage of. Have an open mind and try to put yourself in the debtor’s shoe. Listen to the debtor. Solve problems but do not blame. Make them think you are doing them a favor and you really want to help them out. How you say it can set the tone. An example would be,”Carol, we have gotten serious about sending accounts to collections and I don’t want this to happen to you. If you can pay $20.00 on your account, and be sure to pay $20 or more every month it would keep you out of collections”. I would hate that to happen to you. If they get on the defense they are going to challenge you and hold on to that money.
With today’s insurance shifting to higher copayment amounts, collecting copayments at the time of service is an important task. Some employers try to reduce their insurance costs by acquiring plans that pay out less money for claims. Instead of paying at 80 – 90% they may only pay 50 – 60% of the claim allowable amount which puts more of a financial burden on the patient. Failure to be able to collect the coinsurance portion clients are responsible for paying can significantly cut into the agencies profit especially if this is a 100% paying patient that does not like to pay her bill.
Even though it costs more to collect the copay when a statement goes out than the actual copay we have a legal obligation to collect them
You don’t go to the grocery store and walk out with groceries without a means to pay for them.
Don’t let the patient establish the collection procedure. Sell the patient on importance of paying today. It’s the best collection chance you have. Don’t ask how much they can pay today. If you feel uncomfortable, remember that expecting payment for past service is no different from what these same patients experience at the video store when they must pay late fees for other overdue balances before renting another movie.
Response to patient. “Many patients like taking care of their balances up front so they don’t have to worry about it later. That’s why we’re giving you the opportunity to pay now. Would you like to pay by cash, check, or credit card?” OR “Paying now helps us to avoid extra billing cost. We’re trying to do all we can to control health care cost for our patients, and be sure to be here when they need us. Now, how would you like to take care of the balance today?”
You can categorize accounts by amounts owed and rank for most money owed to least and work those accounts first or by days late and rank accounts from newest to oldest. Keep track and document accounts. There is more people in debt than ever before. Why? Because it’s so easy to obtain a credit card. Some of them are up to 20 to 30%. People owe more than they can pay. We can’t compete with necessities like power, water, food or gas so we have to be high on the pecking order with other creditors.
Open ended questions will get them to discuss account. If they say they can’t pay, ask why can’t they pay this month. Did you know you have an outstanding balance?
What your saying is if you’ll pay we’ll take part of the balance instead of the whole balance. Trade of principle – If I do that for you, what will you do for me. Nibbling – if reach agreement get a little more of what you want. Nothing ventured, nothing gained.
Your chances of collecting payment at the moment they are in front of you are far greater then trying to collect later. Money is essential if you intend to stay in business. Get paid for your work.
One year would cost us $76,800.
The U.S. Dept of Commerce reports that accounts more than 90 days old depreciate at 0.5 percent per day. Put another way: accounts lose 15 percent of their value every month after the first three months. That’s all the more reason to collect sooner rather than later.
The Credit Research Bureau gives us these figures. The newer the bill is the easier it is to collect on. We have $285,183.60 in accounts receivable for our self pay patients and 71.% is over 1 year old.
$60,000 of debt in accounts receivable just because patients left no forwarding address. If a patient tells you they are going to move, get that new address. If they call in for some reason alert staff to get that new address. Question patient, sometimes it’s because they have no mail receptacle not because they have moved.
Listen openly Stay positive in negative situations.
Reality – not a lot you can do if they have lost job or husband left and left a lot of bills
A term you here a lot now. Seal the deal. Car dealers will ask what will it take to seal the deal.
Stay calm, polite and in control. Has this happened to you? Were you able to stay calm, polite and in control?
Passing the client to someone else works. I’ve had the front desk to transfer call to me because they had a client that was ugly and I’m sure they were but once they had someone else on the line their tone changed.
If they tell you they will pay next Friday, document and follow-up. You lose credibility if you don’t. Clients will figure out you don’t follow-up so they can tell you what you want to hear knowing that you will not follow up on their promise to pay. Review account to see if they are giving you and same excuse each time and confront them about it.
You look at thermometer and measure temperature. What is your outstanding receivables. Days in A/R <1% over 1 year for Medicaid. Incentive plans. Increase improve revenue cycle. Failing to collect the correct Insurance or Medicaid information can negatively impact the revenue process. Missing encounter report.
These are laws for the consumers.
Educating your patient about your expectations for payment before services are rendered will help prevent problems and costs with billing and collections after the fact. If it is to be, it is up to me. Anom
Debt Collecting Presentation
Prepared for the
Finance Focus Group
by Kathy Hartsell
TO BE SUCCESSFUL IN
The process starts before the patient even
comes in the door.
Where do we get our expectations? From
our eligibility, debt management, fee, bad
debt write off and any financial policy
information forms that our patients sign.
Be sure patient knows what our
expectations are when appointment is made
and at time of eligibility.
HOW TO GREET A PATIENT
When a patient presents at the front desk
greet patients warmly.
Always acknowledge the patient.
Good morning. My name is Melissa,
welcome to the Cabarrus Health Alliance, I
will be checking you in today.
MAKE YOUR PATIENT FEEL
They may be apprehensive about being
THE THREE V’S OF
Verbal – 7% - What you say
Vocal – 37% - How we use our voice
Visual – 56% - What people see when we
Tone of voice should be friendly.
Do not sound cold or abrupt.
Must be knowledgeable about your agency.
Must have enthusiasm.
Whether you are on the phone or in person,
smiling has a positive effect on collecting
When face-to-face, the look
in your eyes while
collecting should reveal
that you genuinely expect
that he/she should pay for
the service that was
Be courteous even when a patient gets
Being too aggressive can hurt your
BE A GOOD LISTENER
Always keep in mind that people are often
dealing with health issues and other
Express compassion for someone’s situation.
Never assume a patient is intentionally not
paying until you have taken the time to listen.
COMMON PROBLEMS THAT
CAUSE REVENUE LOSSES
Failure to collect patient’s
Not obtaining current
Lack of, or inconsistencies
in collecting copays.
Must be done correctly to achieve
appropriate sliding scale.
Must be verified before patient is seen.
Be sure to make a copy of the card front
Complete the insurance verification form.
Always verify who the insurance benefits
will go to.
Document insurance info in the PMS.
BE SURE TO COLLECT
The cost of sending out statements for copays is
expensive and seldom results in collection. Small
amounts due are often ignored by the patient.
They assume the amount is an error or does not
want to be bothered to write a check, mail or use a
stamp for such a small balance.
Practices that do not collect copays are violating
their contracts with payers who require them.
At each visit check the Medicaid card for:
Managed care information
Change in recipient’s name
Month card was issued
WHAT IF THEY FAIL TO
BRING THEIR CARD
Enforce the need for patients to bring their
cards when they come in for services.
WHAT IF YOU CAN’T VERIFY
Have patient bring in letter they received form
DSS confirming they are Medicaid eligible.
If you can not verify Medicaid eligibility, then
offer sliding scale fee. If no proof of income
patient will be placed at 100% until verified,
except for programs or if your policies that state
you will accept declaration of income.
HOW DO YOU ASK FOR MONEY
When a patient checks out, tell them
amount owed and ask if they want to pay by
cash, check or credit card, then wait for
them to reply.
Do not say another word!
The collector’s adage:
The next person who speaks, loses!
So let them speak next.
“I’VE NEVER HAD TO PAY AT THE
TIME OF SERVICE BEFORE.
WHAT DO YOU MEAN I HAVE TO
What would you say in response?
“I CAN’T PAY IN FULL” OR “I
DON’T HAVE THE MONEY”
“Our program services are based on a sliding scale
fee to reduce your fee based on your eligibility
and this is what you are expected to pay” Review
eligibility with them.
“We do accept credit card payments”.
Negotiate with them “If you pay half today, we’ll
send a bill for the balance due in 30 days.”
“SEND BILL NO MONEY
Were you not told you would be expected to pay
today? If they reply “no”. Apologize and give
them our expectations.
If you can not get money, get a commitment from
patient and follow-up.
Make notation in your patient management system
of this excuse.
Example: “I will mail a check in two days.”
Your response should be to:
Call them if you don’t receive a check.
If you don’t, you lose credibility.
Remember, you are in competition with other
DISCUSSING THE ACCOUNT
Get people to talk by asking questions.
Don’t ask closed in questions that only
require a yes or no answer.
Ask open end questions where they will have
“HAVE A LOT OF BILLS TO PAY.
JUST HAD A BABY AND HAVE A
LOT OF HOSPITAL BILLS”
I understand you have a lot of bills to pay but ours
is just as important as any of bills you may have.
You are expected to pay on this bill.
(This is where you use your negotiation skills) How
much can you pay us?
WHAT IS A NEGOTIATION
Something you are willing to give up to
CREATIVE THINKING IS
Understand the goals of the other person.
Determine your own goals.
Establish a range between your goals and the other
Identify what goals can be left unmet.
Think of alternate ways of collecting the debt.
Help clients realize that the debts must be paid and
you are willing to work with their problems.
Look at the issue from their point of view.
HOW DO YOU RESPOND?
If someone tells you they are short on cash, ask how
much are you short.
Persuade patients to pay with a credit card.
Get them to commit a date to pay amount owed.
Try not to go beyond 30 days.
Document and follow-up.
If they ask “How much do I have to pay?”
Start high instead of low. Be a negotiator.
Ask for $40 instead or $5 or $10.
If they say they can’t pay $40, ask for $30.
Take what the other person is saying and give
back to them.
“I don’t have money to pay.” “I understand you
said you don’t have money to pay but there is a
charge on our service.”
“I have too many bills to pay.” “I understand
about your bills but we do expect payment for our
WHEN THE PATIENT LEAVES
Collection is expensive!!
Avg processing cost for self payers = $8
In 3 months time, $24 on one person is spent.
Average cost of 800 bills per month
• $6,400 per month.
• 3 months time = $19,200
About 20% of what practices collect is
spent on going after receivables.
Once they have left the office, chances of
getting paid by self-payers could be cut in
After the 60-day mark the chances drop
CHANCES OF COLLECTING FROM
THE CREDIT RESEARCH BUREAU
1 – 60 days past due:90%
61 – 90 days past due:50%
91 – 180 days past due: 20% (1 in 5)
NO FORWARDING ADDRESS
$60,000 of debt is in
Patient may have and old balance but does not
want to pay because they are now 0%.
Inform patient of old balance and state that
balance should have been paid during that time
frame. It was determined that you could pay
during that time and you do owe that balance.
Determine if it is an excuse or reality.
Eliminate the excuse so you never have to
hear it again.
Think ahead to the next excuse you might
hear and eliminate it now.
Create a sense of urgency about getting
your bill paid.
EXCUSE OR REALITY?
I don’t have money to pay.
Ask why they don’t have money to pay.
Make monthly payment schedule until
things pick up.
Sound as if your doing them a favor.
Seal the deal.
Need a commitment for the agreement.
WHAT DO YOU DO WITH AN
Patients sometimes get mad with you
because they owe you money and want to
get out of paying their bill.
Remember you are a professional. Stay in
COOLING TIPS FOR THE
Actually lower your voice and speak slowly.
Stay personal and use their name.
Don’t get angry and avoid humor.
Passing client on to colleague often changes their
Document, Document, Document!
Always note when you have talked with a
patient regarding their account. Good
record keeping is a must because you may
need to review payment history and excuses
they have given you in the past.
THINGS YOU CAN DO TO MAKE
BILLS STAND OUT
Stickers on bills (Insurance obligation and
Yellow highlights on statements.
HAVE GOOD REVENUE CYCLE
Measure performance on:
FAIR DEBT COLLECTION
This act requires that debt collectors treat
you fairly and prohibits certain methods of
debt collection. Of course, the law does not
erase any legitimate debt you owe.
HOW MAY A DEBT COLLECTOR
A collector may contact you in person, by
mail, telephone, telegram, or fax. However,
a debt collector may not contact you at
inconvenient times or places, such as before
8 a.m. or after 9 p.m., unless you agree. A
debt collector also may not contact you at
work if the collector knows that your
employer disapproves of such contact.
CAN YOU STOP A DEBT
You can stop a debt collector from contacting you
by writing a letter to the collector telling them to
stop. Once the collector receives your letter, they
may not contact you again except to say there will
be no further contact or to notify you that the debt
collector intends to take some specific action.
Please note, however, that sending such a letter to
a collector does not make the debt go away if you
actually owe it. You could still be sued by the
debt collector or your original creditor.
MAY A DEBT COLLECTOR
CONTACT ANYONE ELSE
ABOUT YOUR DEBT?
If you have an attorney, the debt collector must
contact the attorney, rather than you. If you do
not have an attorney, a collector may contact
other people, but only to find out where you live,
what your phone number is, and where you work.
Collectors usually are prohibited from contacting
such third parties more than once. In most cases,
the collector may not tell anyone other than you
and your attorney that you owe money.
WHAT TYPES OF DEBT
COLLECTION PRACTICES ARE
Harassment. Debt collectors may not harass, oppress, or
abuse you or any third parties they contact.
Use threats of violence or harm.
Publish a list of consumers who refuse to pay their debts
(except a credit bureau).
Use obscene or profane language, or repeatedly, use the
telephone to annoy someone.
Collect any amount greater than your debt, unless your
state law permits such a charge.
Deposit a post-dated check prematurely.
Use deception to make you accept collect calls or pay for
Take or threaten to take your property unless this can be
Contact you by postcard.
Salary adjustments are
based on the year end
results so how well we
collect does have an
impact on ourselves
and everyone we work
Collecting Accounts Receivable, presented by
National Seminars group a division of Rockhurst
University Continuing Education Center, Inc.
U. S. Department of Commerce
Credit Research Bureau
Physicians Practice March/April 2002 issue
Fair debt collection.com
Focusing on Front Desk Collections: Balancing
Effectiveness with Compassion Webcast – Health
Resources and Services Administration