The document discusses the increasing financial responsibility of patients in healthcare due to shifts in insurance models, suggesting that healthcare providers need to adapt their payment collection strategies. It emphasizes the importance of clear communication regarding patient financial obligations, offering multiple payment options, and utilizing technologies like kiosks for payments. Furthermore, it highlights the challenges of managing self-pay collections and the need for personalized follow-up to enhance recovery rates and patient understanding.

1. Patient Responsibility –
Solutions for Increasing Self Pay Collection Rates
Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a
synthesis of publically available information and best practices.

2. Increasing Move to Self Pay
 Financial responsibility for healthcare has shifted
to consumers, especially with the advent of the
ACA.
 Patients now pay more healthcare costs than
employers.
 This is leading to more cost sensitivity from
patients.

3. Jimmy The Patient

4. Healthcare Costs
and Operations

5. No Choice, No Concept, Blind Trust

6. Healthcare Costs
and Operations
Office Visit Bills
Radiology
Referral
X-Ray
Medications
Lab Referral
Admission
Emergency
Room
Procedures
Procedures
Medications
Specialty Visit
Specialty
Referral
Medication
Administration
Discharge
Physician
Rounds

7. Questions? Tons.
Why did my PCP
refer me to that
specific
specialist?
Why did my PCP
prescribe me
that specific
medication?
Why did my
specialist refer
me to that
specific
radiologist?
Did I really have
to go to the
same lab twice?
How many
physicians in the
hospital actually
saw me and
billed me?
I wonder how
much this is all
going to cost
me….
I don’t
understand
how any of
this works!

8. Is This Information Being Published?
• Some patients might already be seeing how much
you charge or at least have access to that
information.
• Some patients might already have access to your
quality scores or other performance based
metrics.
• Medicare is shining lights all over different
partnerships in healthcare and how much
physicians have been paid.
• There are companies specifically dedicated to
showing all of this information.

9. Companies To Know

10. Patients Are Now Consumers
 Many consumers now shop around for the
best healthcare deals.
 With HSAs, FSAs, and HRAs, people can now
manage for themselves how to pay for their
healthcare

11. Patient Enrollments
 The proliferationof HDHPs means patients pay for a larger
portion of their care.
 An estimated15% of patient enrollments comes from
HDHPs. Patient Enrollments
Other Payments
HDHPs

12. Who are these self paying people?
Have not met their deductibles
Have high copays or coinsurance
Lack health insurance coverage (in whole or part)
Require services not covered by their plans
Have exhausted their benefits

13. Why should we be concerned?
Patient Out of Pocket
Expenses
$250 billion - 2009
$450 billion – 2015
(expected)
= 68% increase

14. WHY SHOULD YOU BE CONCERNED?
Self paying patients made up more than 11% of
annual revenue in 2010.
Self payers default at the rate of about 30%.
81% of self pay revenues (by dollar) go
unrecovered.
Medical liabilities for self pay patients are
growing at 19% per year.

15. The Challenges
 Strong pursuit of patient payment  negative
message
 Payment collections cost time and money
 Insurers
 More difficult
 Automated process
 Self-Payers
 More expensive
 Slower payments received

16. How Can You Get Your Payments?
 Providers are loath to broach the subject of
patient financial responsibilities and
payment plans, but it has become a
necessity.
 These days, the one size fits all payment
approach does not work.

17. Keep a Card On File
PROS CONS

18. Safely Store Credit Info
 Store patients’ credit card information
securely in a certified system.
 DO NOT keep a paper copy of any card
numbers.

19. Communicate Safeguards to the
Patient
 Make sure you have the patient’s
permission to use the card for payment.
 Use it as part of an easy-to-understand
financial policy form, complete with
explaining how the card will be used.
 Have the patient sign the policy.

20. Estimate Costs and Collect Payment
Before Treatment
 Plans are increasingly complex, so correctly
estimating costs is difficult.
 Knowing when a patient has met a deductible
and/or copay is a challenge.
 Patients may balk and choose another provider
whose costs are less expensive for the same
services.

21.  The best solution is to collect patient
payment up front.
 Once a patient goes out the door, your
chances of recouping full payment decrease
dramatically.
 Staff accordingly – this takes time!
Collect Payment Up Front

22.  Cash, checks, credit and debit cards, HSA
and FSA cards, etc.
 Be very clear about what you will accept
and what you will not.
Offer Multiple Payment Options

23.  Inform the patient before you charge
their card.
 This will make patients feel more
comfortable keeping their card on file
and result in fewer disputes later.
Communicate Safeguards to the
Patient

24. Use kiosks to
collect
payments
before patients
can even finalize
check in.
Utilize Technology

25. Make it clear all bills are clearly marked as
patient responsibility. Patients receive so
many “This is not a bill” EOBs that they can
become confused.
Send Clear Bills

26. Follow up with a personal call. This one-to-
one contact produces better results than
paper collection notices.
Personalize Follow Up

27. - Patients are on the hook for more of their
health costs and are making decisions as
educated consumers using new tools. You
need to ensure the patients see the value
you provide.
- Tools such as “card on file” can, when
implemented correctly, help significantly
when the patient is ultimately responsible.
In Summary

28. Q&A
Ben.quirk@quirkhealthcare.com