Money can be a touchy subject, especially for people in the helping professions, such as you and your fellow NPs.
The topic of money tends to be particularly challenging for new practices and providers.
You’re just starting your practice, and you’re eager to build your business.
Sometimes, you spend more time with your patients than you know you should, but you try to be there for them and want to help.
But you can’t do that for long…
Not if insurance companies or patients don’t pay what they owe you.
We won’t discuss insurance reimbursements here. That’s a separate topic and a discussion for another day.
However, what we will discuss is patient responsibility, including co-pays, co-insurance, and deductibles.
While patient responsibility may seem negligible compared to insurance reimbursement, don’t be fooled.
Even your average practice stands to lose thousands of dollars in revenue each year if it is not collecting co-pays, co-insurance, and deductibles.
Unfortunately, collecting the portion of the bill that falls to the patient is one of the most persistent and uncomfortable challenges for NPs and their staff.
But unpaid balances, if not appropriately collected, become lost revenue that is rarely recovered without a clear plan.
To make things worse, many practices tend to give their non-paying patients the benefit of the doubt. While it’s a generous response, it rarely works in favor of the practice.
And ignoring the problem doesn’t work either; it only makes it worse.
But even though there isn’t a 100% foolproof strategy to deal with the issue, there are steps NPs can take to minimize the problem.
#1: Set Clear Expectations from the Start
Develop a clear and concise financial policy.
Use this policy to train your patients, so they understand what is expected of them if they wish to continue visiting your office.
For example, how does your office handle no-shows? Will there be a fee after one or two no-shows?
Include what you expect of patients and explain the consequences if the “policy” is ignored.
For example, you may stipulate that all co-pays, co-insurance, and deductibles are due at the time of service and that your office will notify patients of outstanding balances when reminder calls or messages are sent.
Tip: Carefully consider how you want to handle these patient responsibilities. Because, depending on the insurance coverage and the service provided, some patients may have large co-insurance and deductibles, but may not be able to pay everything at once.
Will you offer them a payment plan, suggest establishing medical credit, or insist on full payment?
If possible, full payment at the time of service is the best option, as it becomes more challenging to collect balances over time.
Finally, make it a part of your intake process to review the financial policy with new patients. Have patients initial the most critical sections of the policy and provide them with a copy.
#2: Use Clear Communication
The best way to address non-payment is to prevent it through upfront collection and proactive and clear communication.
When an established patient calls to schedule an appointment, remind them to bring their co-pay (if applicable), and inform them of any outstanding balances due at the time of service.
When a new patient calls to schedule an appointment, inform them that your policy is to collect patient responsibility at the time of service.
#3: Verify Insurance Coverage
In the past, verifying insurance coverage before the appointment was difficult compared to today’s EHR systems.
Establishing eligibility before each visit is essential to ensure coverage is current and services are covered. Additionally, systems may also provide estimates of patient responsibility based on contracted rates.
While these numbers may not be entirely accurate, they provide patients with a ballpark estimate before the visit, allowing them to prepare or explore available payment options and plans.
Tip: Consider integrating a benefits verification service or assigning a staff member to verify benefits one to two days before scheduled appointments.
#4: Collect at the Time of Service
At the time of the appointment, your front-desk staff, in accordance with your financial policy, must collect all payments due before the patient is checked in.
If a patient says they don’t have the money to pay or makes excuses, you may offer to reschedule the appointment.
Situations such as these can become challenging and must be handled carefully. You must train your staff to handle these cases effectively and then provide them with the necessary support.
Time-of-service collections should be your priority. It is far easier to collect when the patient is standing in front of you than it is to collect 30, 60, or 90 days later.
If your practice doesn’t currently collect at check-in or check-out, now is the time to start.
Train your front desk staff to make this a routine part of patient flow, just as you would take vital signs or check identification.
#5: Send Prompt, Easy-to-Understand Statements
If a balance remains after the insurance reimbursement, send a bill as soon as the Explanation of Benefits (EOB) is processed.
The longer you wait to send out statements, the greater the likelihood of non-payment, for any number of reasons.
Delays may result in patients forgetting about the service and their responsibility or deciding not to pay due to the amount of time that has passed since the visit.
Statements should be:
- Clear about what the patient owes and why
- Free of technical jargon or confusing codes
- Include multiple payment options (mail, online portal, phone)
#6: Offer Payment Options or Plans
When patients face high deductibles or coinsurance, a payment plan can make it easier for them to follow through.
If you decide to go this route, make your terms clear by requiring a signed agreement, establishing a minimum monthly payment, and including an option for automatic draft.
For example, a patient with a $400 balance agrees to pay $100 per month over four months. You collect a card on file and schedule automatic monthly payments.
Alternatively, for patients with high balances, you may suggest establishing medical credit with a reputable company.
Consider using automated text, email, or phone reminders for upcoming payments with links to your patient portal or payment options when possible.
These reminders can be triggered:
- After a bill is sent
- One week before a payment is due
- One day before a scheduled card charge
#7: Follow Up Personally When Needed
When balances remain unpaid after multiple statements and reminders, reach out personally.
Assign someone in your office to call or send a secure message through the patient portal.
Keep the tone friendly and solution-focused when reminding of the outstanding balance… Sometimes, patients simply need a reminder.
#8: If Everything Else Fails…
Send the account to collections…
Don’t be afraid to work with a collections agency.
If you have exhausted all options and balances stay unpaid for 90 to 120 days, and all efforts have failed, send the account to collections.
Even though you may not recoup much or any money, you’re letting people know that you enforce your financial policy.
In Summary…
Unpaid balances and patients not paying medical bills are a reality in today’s healthcare environment, especially as more people are enrolled in high-deductible plans.
But it doesn’t have to result in a guaranteed loss for your practice.
Committing to collect payment at the front desk before the visit reduces the chance of non-payment.
You can protect your financial stability and maintain strong relationships with your patients by establishing systems that focus on clarity, open communication, and consistency.
By being proactive at every step, from before the visit to after the claim is processed, NPs can dramatically increase the chances of getting paid, all while showing professionalism and respect for their patients.
Ever had a problem with a patient not wanting to pay? What did you do to find a solution? Let us know in the comments…
By Johanna Hofmann, MBA, MAc., EAMP; regular contributor to the NPBusiness blog and author of “Smart Business Planning for Clinicians.”