If you are like me, you grew up in healthcare never having to ask patients for money. That was all handled by the business office, somewhere far away from the clinical workspace. We had no idea what the cost of care was or how it impacted patients. If we worked in small offices, we were probably more in touch with some of the struggles, but often not on a face-to-face basis.
Now, in your own office, this is something you face on a daily basis. You may find that you are uncomfortable asking for money, as is your staff. Unfortunately, you cannot stay in business without asking for payment.
There is another side to this as well. You as the office providing services to your patients have a contract with their third party payer. Your contract likely requires that you collect copays, coinsurance, and deductibles from your patients. Your patient also has a contractual obligation with their insurance company to pay those fees when accessing care.
Now, if you have a direct pay/cash practice, you don’t have those third party contracts. Nevertheless, you have an obligation to your practice, your staff, your patients, and yourself to collect money that is due for the services you provide.
With patients having to pay a greater percentage out of pocket for their care, it’s essential that you and your staff understand what you are obligated to collect, and how to do it.
If you do not, your business will struggle to stay “in business”. If you are not in business, your patients will be unable to access the care you provide. And you and your staff will be without jobs.
Okay, so how do you do this?
First and foremost, make sure you have appropriate financial policies and procedures for your patients and staff to follow.
- Payment Policy: do your patients sign a financial agreement when they come to your office? They need to be aware of their obligations to your office, how you collect, when you collect, and what happens if they do not pay.
- You will need to be familiar with the rules that are embedded in your third party contracts. So if you have not read your contracts, please read them now.
When you begin to craft a financial policy for your office, you’ll need to take into account what you will do for those who cannot pay, will not pay, or are very late in paying. Keep in mind what it cost your office to continually send out bills or have staff call patients with reminders.
Will you offer sliding scale payments? What about waived co-pays, deductibles, and coinsurance? Who will be eligible and under what circumstances? Again you need to be fully aware of your contract with third party payers when considering these options as well as the financial impact it will have on your practice.
Your practice policy and procedures should include procedures for staff to verify insurance at the time of each visit and how to collect any outstanding balances. Training your staff, including how to ask for money is critical. Scripts can help staff ask for money easily and respectfully and give them guidelines on how to handle resistance.
One example is to have your staff say something like: “Mrs. Smith, I see your copay is $35.00 for your visit. We accept cash, check, and credit cards. How will you pay that today?”
Your office needs to accept payment in multiple formats including cash and debit/credit cards. There are basically two main ways you can do this.
- Use something like Square, GoPayment or PayPal. All of them have card readers you can use on your smartphone or tablet. In general, there are no monthly fees and you pay $0.30 plus 2.9% per transaction. (Note: What’s nice about GoPayment is that it syncs with QuickBooks. However it is not HIPAA compliant, nor is PayPal. ) On the other hand, Square states that is is.
- Merchant Accounts. These you get from you bank or another service. Generally, the percentage you pay per transaction is less. However, there are all sorts of other fees including bankcard fees, batch fees, gateway fees, and more. Unless you are processing a large number of transactions, you are better off with something like Square.
Receipts can be given electronically with Square and GoPayment or they can be printed out. Of course, you can hand write receipts using a standard receipt book from your local office supply store. However, be away if you are sending an electronic invoice or receipt for services, you will need a Business Associate Agreement.
If you want to give your patient an itemized statement, you can likely do that by creating a template in Google Docs*, filling in the blanks. Alternatively, you billing system may allow you to print out receipts for patients.
(Go here to read more about Google Apps and HIPAA Compliance.)
What are you using to accept payment in your office? What are some of the sticky situations you are finding?