How to create a financial policy.
A good financial policy is critical to all healthcare practices. It details expectations for your office staff as well as your patients. It provides guidelines for the practice and your patients, supports the financial goals of your practice and facilitates communication for all concerned.
There are really two different types of policies you’ll want to create.
- Office policies and procedures. This gives your staff clear guidance on what to do and how to do it.
- Patient Policies: This establishes clear expectations, guidelines and communication of what patients can expect from your office and what you can expect from them. It helps prevent any misunderstanding and miscommunication.
When creating new financial policies or updating existing ones, you’ll want to start by answering several questions. These questions will give you a starting place.
- What is your practice model? Are you a direct pay practice or will you bill insurance?
- If you are billing insurance, which companies and plans are included in your network? Will you also be billing Medicare, Medicare Advantage Plans, Medicaid or Medicaid Managed Plans?
- What about your patients who are injured on the job or in a MVA or other accident?
- What will you do about co-pays, deductibles and co-insurance? Do you plan to collect them at the time of service?
- How will you handle the patient who arrives for an appointment without their co-pay, insurance card or ID?
- What methods of payment will you accept? Cash, check, credit card? Online, or over the phone? What about a credit card on file program?
- How will you verify insurance and how often? Who is responsible?
- What means will you use to verify that a deductible has been met?
- Do you plan to collect payment from patients if deductibles are not met? Is there anything in your payer contracts that would prevent this from happening?
- How will you handle patients with outstanding balances? Will they be required to pay their balance before being seen? Will you allow them to make “arrangements”?
- If you allow a payment schedule what will it look like?
- Will you bill just primary insurance? What about secondary or tertiary insurances?
- Will you provide patients with claim forms to file for reimbursement from insurance?
- Are insurance cards due at the time of service? What if the patients do not bring them?
- Will you have a cash discount for patients who pay at the time of service?
- What is your policy on returned checks, completing forms, no show fees, collection agency fees, etc? How will you communicate these charges to patients.
- What do your contracts say about non-covered charges and collecting from patients?
- How will you educate your patient on the policy so they understand it?
- How will you document your policy?
- How often will you update your financial polices and procedures?
- How will you communicate any changes to your policy with staff as well as patients.
Creating office polices and procedures from scratch can be frustrating and time consuming. Offices will often do a quick google search looking financial policies to use as examples. There are both good and not-so-good policies that you can use as models.
Should you go this route, I suggest that you use it only as a model. Any model or template will need to be customized not only to your practice, but also potential state rules and regulations, and changing healthcare rules. Various specialty organizations may also offer you guidance specific to your speciality. You may want to consider consulting a knowledge consultant or attorney in your state regarding specific policies such as financial.
Are your healthcare office financial polices up to date?