Who Is Responsible: You or Your Patient?

Too many practices make a crucial mistake…

In the spirit of being helpful and getting things done, they take on jobs that should be handled by their patients.

In the process, they assume far too much responsibility, financial and non-financial alike. This ends up costing the practice hours in lost productivity and ultimately lost revenue.

It’d be far better for practices to stick to their core tasks instead of assuming parts of patient responsibility.

But what is “patient responsibility?’

Frequently the term is limited to financial context: “Patient Smith has an outstanding balance of X amount of dollars.”

It’s an Umbrella Term

However, patient responsibility is an umbrella term and includes far more than the financial obligation of patients.

Here is just a short list of what falls under patient responsibility:

  • Patients should know and understand their insurance plan and health benefits. Even though health plans and benefits can be complicated and difficult to understand, it is the responsibility of the patient to know what benefits they have.
  • Patients should provide your office with accurate and up to date insurance information, such as bringing the correct insurance card or information to each visit.
  • Patients should inform your office of any changes to their insurance policy or insurance provider, without How else are you going to bill and get paid?
  • Patients should read and review all explanation of benefit (EOB) statements received from their insurance company. If there are questions about how a service was paid, it’s the responsibility of the patient to follow up.
  • Patients should responsibly manage their appointments with your office. This means that they cancel or reschedule if they can’t keep the appointment, instead of not showing up.
  • Patients should fill out all required paper work. It should be filled completely and upon request.
  • Patients should know if and when they need a referral or prior Ideally, they’d provide your office with this information before the appointment.
  • Patients should know their financial responsibility: including copays, coinsurance, and deductibles.
  • Patients should pay their financial obligations as appropriate and requested. They should be prepared to pay at the time of service or when a bill is received.

I know, it’s a long list of “patients should do…”

There’s A Gap…

The reality is that there’s a huge gap between what patients “should do” and what most actually do. Do you agree?

Most patients have no idea what’s covered by their insurance plan, how much the deductible is, or how much copay they have each visit.  Occasionally, some don’t even know the name of their insurance company.

But in all fairness, it’s not all their fault. Medical offices have spoiled patients, too often and for too long.

Many offices willingly try to do everything for their patients:

  • check their benefits
  • call on a referral
  • inquire about an outstanding reimbursement
  • defer a payment
  • send out appointment reminders
  • send out multiple bills
  • and the list goes on.

Granted some of it is self-serving…

Of course, you’ll check if a patient has coverage and benefits before you deliver the service. After all, you want to get paid.

But often, offices also call on benefits they don’t even deliver because patients have no idea if a certain benefit is part of their plan.

Two Examples…

Here are just two examples of how offices spoil their patients:

  1. Your patient with back pain could benefit from acupuncture, and you want to make a referral. But your patient has no idea if he has an acupuncture benefit. That’s when your friendly front desk staff steps in and offers to check his insurance coverage; something the patient could just as easily do himself.
  1. Another example of how practices “spoil patients” is this: deferring a payment or turning the other way if someone doesn’t have the cash or doesn’t want to pay.

But failing to collect payments is a huge mistake!

Even if just done occasionally, failing to collect could impact your practice in a big way. Not only do you stand to lose a big part of your overall revenue, but you could also end up in a heap of legal troubles.

Every insurance contract stipulates what you must collect from patients. And if you fail to do that, you are in direct violation of a legally binding contract.

Surprised or didn’t know? Don’t get caught off guard, learn what you must do.

Our program “Maximizing Your Front Desk Collections” shows you how to collect patient obligation upfront so that you’ll stay out of legal trouble and collect more of your revenue.

So, here I shared two every-day examples of how practices do things for patients they shouldn’t:

  • Determining other insurance benefits.
  • Not collecting or deferring payments

And of course, patient, like the rest of us don’t mind. Let’s face it, we all like it easy.

That’s why most people are more than happy to turn responsibility over to their provider’s office. But consequently, healthcare consumers have less and less knowledge about their benefits and the real cost of healthcare.

Empower Patients…

In years past this may have been ok. Benefit plans were far more generous and most all insurance was tied to employment.

But things are different today. Most insurance plans offer fewer benefits and require subscribers to pay a good chunk of the bill.

That’s why patients need to know what’s covered by their plan. And that’s why offices should do less of what patients can do for themselves.

When your office does less for patients, you’ll accomplish three things:

  1. You free up your office from taking care of things people can do for themselves and should pay attention to themselves
  2. You regain hours of lost productivity that you can channel into the ongoing work that needs to get done in your office. You also reduce the workload for your staff and yourself.
  3. You actually empower your patients. The more people know about their insurance, their health care benefits, and the real cost of healthcare, the better decisions they can make.

But see for yourself how you can accomplish more by doing less…


By Johanna Hofmann, MBA; regular contributor to the NPBusiness blog and author of “Smart Business Planning for Clinicians.

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