The Executive Suite: Protecting revenue and patient relationships during the pandemic

Medical practices have begun to resume services and urge patients to resume care, especially patients who’ve put it off because of anxiety about COVID-19. While ensuring (and communicating about) patient safety naturally takes center stage, the revenue side of practice management needs extra attention, too. Patients may hesitate to visit your office not just because of fear of infection, but because of financial concerns.

Some patients face uncertainty about their job security. Some may have already suffered a job loss (and even a corresponding loss of insurance). For patients who are struggling financially, or are simply anxious about money, anything but urgent health concerns may be pushed to the back burner—even though this might increase the risk of more dangerous problems down the road.

Of course, practice managers and physician owners also have their own financial concerns to contend with. Generating and capturing revenue is crucial to ensure employees can be retained and the bottom line remains healthy, especially as government supports expire.

The high cost-sharing many patients face may seem like a formidable obstacle when patients are already nervous. But there are ways you can shore up your practice’s financial picture and collect more effectively from patients—without jeopardizing your patient relationships. In fact, with the right efforts, your practice may be able to improve both your financial picture and the patient experience.

Provide accurate information

One way practices can help reassure patients is by helping them get a handle on their costs. Often, the out-of-pocket owed is less than patients fear. Even when it will be more than they hoped, patients will be better served by a straightforward and honest conversation about costs.

Providing accurate information depends on staff training and technology. Be sure your schedulers are aware of how to access an up-to-date estimate of costs from your patients’ health plans. Proper training, including role-playing, can help staff become more comfortable with broaching financial terms.

Sharing this information with patients at the time of scheduling also provides an opportunity to set up a credit card on-file to process payments after services are provided. Storing a credit card (in a PCI-compliant fashion, with a maximum charge amount authorized by the patient) eliminates the need for the patient to hand over their card at the front desk—one less physical point of contact for patients to worry about. At the same time, knowing you can charge the account automatically, even if the payments must be spread out over a few months, helps ensure you’ll be paid in full.

Sometimes, patients may avoid care out of fear of costs when copays and deductibles don’t even apply. Make sure staff knows which services are typically covered as preventive, with no cost-sharing, or as follow-up visits included with a globally billed service.

Be sure you’re current on payer policies

AHIP (America’s Health Insurance Plans, the trade group for health plans) recently shared a detailed list of accommodations its members have made to help patients and providers cope with the pandemic. While some responses are common across most plans, such as waiving copays for coronavirus testing, individual plans in your area may offer unexpected extra concessions. For example, some plans are waiving copays for regular office visits or telemedicine. Knowing about cost-savings like these can be handy when trying to coax wary patients to book an overdue visit.

Waiving copays or discounting cash services that apply towards deductibles may be a violation of your contract, but it can’t hurt to check in with payers to be sure you can’t offer some flexibility to cash-strapped patients. In some cases, payers may be willing to allow such discounts (just be sure to get that confirmed in writing before proceeding).

You may also find that some of your patients will have swapped their employer plan for an ACA marketplace one if they’ve been laid off. Make sure your staff asks each patient what their current health plan is, and that it’s clear which networks your practice is part of. (Marketplace plans offered by large payers may or may not be part of your contract with them. Knowledgeable staff can help avoid unpleasant denied-claim surprises for both your practice and your patients.

Billing promptly and accurately is key

A surefire way to put your patient receivables at higher risk of non-payment is to bill your patients months after they visited your office. If the bill arrives long after services are rendered, your patient may have forgotten it was coming and believe it to be in error. That sets the stage for disagreement, unpleasant interactions, and extra handling and collection costs (at best), or even non-payment.

Ensuring your patient statements are delivered promptly starts with billing patient insurance quickly and accurately. With some payers short-staffed due to the pandemic, it’s even more important to get claims right the first time. It may be much harder to get assistance by phone or email.

Many practice management systems have rolled out more advanced claim scrubbing tools in recent years. Much more of the billing process can be automated than ever before. Make sure your billing team is up-to-date on all the billing features of your system and prepared to take advantage of them to get bills submitted and paid as quickly as possible. And make sure all clinicians understand that it’s more important than ever to complete documentation and sign notes so that claims can be generated within a day or two of services being provided.