patient collections Archives

Net collections: Are you waving the white flag?

The subject of net collections seems to be in the ether these days. (For the purposes of this discussion, I'm referring to net collections as the amount your practice is ultimately reimbursed for services it provides, i.e., your net reimbursement after adjustments or credits.) Though it's long been a staple metric, its usefulness in our high-deductible environment may be in doubt. Since net collections measures how much of what you're entitled to has actually been paid, an accurate calculation of it can be invaluable. But therein lies the rub. An accurate calculation of this "simple" metric is increasingly hard to come by. Practice management systems have gotten much better at tracking multiple fee schedules and comparing them against what we've actually been paid--this isn't the problem. The problem is that more of our reimbursement must now come from patients, so it may take months for any service to be fully reimbursed. If you run a report on net collections for a recent time period, this lag in reimbursement will suppress the average net collected for all your payers. If you're running the report primarily to keep an eye on your payers, this lag is enough to make the aggregate data all but useless for that purpose. The report will almost always "show" that your payers haven't reimbursed as promised, even when the reason is simply that it takes more time to bill patients and for them to pay. An executive at one of the larger groups we've worked at confessed to me that "we don't even bother with net collections reports anymore. Entering the fee schedules is a waste of time." While I can understand the frustration, I think there's a risk of throwing the baby out with the bathwater. There's a lot of value in calculating net collections. We want to know--no, we need to know--if payers are reimbursing as agreed. And when slow patient collections drag down the net collections figures, that information is also important to understand. What if patient bad debt is starting to climb? Net collections analysis can help you spot this and take action.

By Morgan|2022-01-01T22:51:43-08:00February 12th, 2020|

Teaching patients about their health insurance shouldn’t be your job–but it is

If you are frustrated by how confused patients can be about their insurance, and by the conflicts this confusion often leads to (especially about patient balances), you have good reason. Insurance is provided by employers, who theoretically should be able to explain it (it's an important part of employee compensation, after all). And it's offered and managed by insurance companies, who set and enforce the terms. There seem to be several good ways, logical ways to get information about insurance rules. So why do many patients misunderstand how it works? A few things are obvious. One is that health insurance can be very complicated. (It is complicated for those of us who work with it every day, even.) And the training and information patients have access to from their employers and insurers is simply not clear or accessible enough for many patients and many situations. This gap shouldn't be your problem. But it ultimately becomes your problem, since you'll have to deal with patients' confusion and corresponding reluctance to pay. All of which is a long way of saying that helping patients understand how their insurance works may not be something you should have to do, but it is something you're better off doing. And the earlier in the relationship you start the education process, the better. The clearer patients are on their financial responsibility before they receive care, the less likely they will be surprised by a large balance they didn't expect to owe. There is an old saw in marketing about how you have to repeat a message seven to ten times before anyone really absorbs it. The seven to ten is not regarded as a scientific analysis by anyone. But the idea that you have to repeat things, usually more often than you expect, and ideally via different media, is well accepted. (There's a reason you see and hear advertising by the same companies in different places and via different channels.) To this end, we often suggest to medical practices that they have some explanatory material at the front desk that covers common insurance issues--things like what

By Morgan|2022-01-01T22:51:44-08:00September 3rd, 2019|

Don’t believe the hype: patient portals aren’t “largely unused”

A provocative headline got my attention recently. It proclaimed that patient portals are "largely unused." It caught my eye partly because it didn't sound all that plausible -- and because taking such a headline at face value could be unhealthy for your businesses, dear clients and friends of Capko & Morgan. I decided to dig into the matter. The article text actually mentioned that 37% of patients have recently used portals. Could the author actually believe that 37% utilization is trivial? That seemed to be what they were saying, yet it's hard to imagine they believe that. (Would a 37% decrease in salary leave one's pay "largely" unchanged?) Perhaps, you may be thinking, this was just a forgivable, inadvertent misuse of "largely." But I tend to think not. This type of exaggeration is just too common in modern media, even in our world of the business of healthcare. I tend to think the headline intended to sensationalize. Yet even if that wasn't the intention, it's still not a benign error, which is why I'm calling it out. Mischaracterizing portal adoption has a hidden cost Clients often tell us they've held back on technologies that could make their practices more efficient because they're concerned patients won't use them. But that thinking usually means practices miss out on significant benefits, since the tools they delay adopting (or forgo altogether) could make interaction easier for patients or make their practices more profitable (or both). This tendency to hesitate has been especially true for patient portals, and it's often very costly. Somewhere along the way, the idea took hold that portals aren't worthwhile unless nearly every patient uses them. But this is not true. It's not even close to true. If even a small percentage of patients regularly uses a portal, those patients will benefit -- and their physicians will save time, too. (And that's strictly on the clinical side. Portals have the potential for even more dramatic benefits on the payment and administration side, even when utilization is very low.) What's more, relative to other recent technologies, portal adoption is arguably not that

By Morgan|2022-01-01T22:51:45-08:00December 20th, 2018|

Improving front desk performance

Chronic problems at the front desk are a way of life for medical practices in most specialties, and it seems there to little effort resolve these problems. The painful reality is that the demands on the front office are often unrealistic. It’s unlikely that the staff can handle a high volume of inbound phones calls at the same time they are helping patients check in and out, updating patient information, collecting patient payments, scheduling follow-up appointments, and answering patients’ myriad questions – and do it all well. No wonder a recent MGMA survey reveals that the front office has the highest rate of staff turnover in the typical medical office! Front office staff is set up to fail These tasks all demand more attention and time than your front office staff have. Since there is never enough time to give any task the attention it requires, front office staff is set up to fail. There is never enough time to get the work done and give patients the service they expect and deserve. It’s time to get realistic about front office workflow Start by understanding the distribution of tasks in the front office. Instead of front staff being generalists that all do same thing, divide the work in a way that makes each of them an expert and gives them sufficient time to manage their workload. Study the job description(s) for members of the front office team and diagnose workflow. Include the team in the process of improving the function of the front office. Compare the written job descriptions to the actual tasks and responsibilities of the position. Probe staff to get their input about workflow and what happens during the work day that makes the job difficult and demanding. Map out the current workflow, identifying bottlenecks and what causes them. Seek to divide and group tasks sensibly. For example, doesn’t it make more sense for patient inbound calls to be taken away from the front desk, so the patients can be checked in and out without interruptions that irritate patients or allow patients to slip out the door without

By Judy Capko|2022-01-01T22:51:48-08:00August 2nd, 2017|

Distrust of medical bills: another obstacle in collecting from patients

Did you happen to catch this New York Times Magazine article last month? It begins with a moving story of an uninsured patient who suffers a terrible brain hemorrhage. Thankfully, she gets timely, effective treatment -- but her condition requires many expensive services, including an air ambulance. Her bills totaled about $500,000. Although the patient had assets like a vacation home and savings, the amount she owed was greater. As the article describes the patient's profound stress in dealing with huge, unexpected bills while recovering, it seems clearly headed toward a case for single payer. However, it takes a rather astonishing twist along the way. The twist? The piece proclaims that little-known villains are secretly contributing to skyrocketing patient bills and healthcare costs: medical coders. "The guerrilla tactics of providers' coders," the article argues, involve deliberately manipulating physicians' codes -- i.e., diagnosis codes -- to create higher bills. If you are a practice manager, biller, coder, or independent physician reading this for the first time while sipping your coffee, perhaps you just spit it out in shock (like I did). Because while there may be billers and coders out there who have been urged to make up diagnoses to generate higher bills, I've never encountered one. I can only imagine "guerrilla coders" are exceedingly rare. The billers and coders we work with have enough to do just trying to get their physicians properly paid for the work that they've actually done (!). Physicians, billers, and coders have to work with the codes our entire industry uses to determine payment based on services rendered. If they aren't careful and don't check that all services are properly coded, practices (and hospitals) will receive less than payers have promised them for the work that they do. This is the problem billers and coders are trying to solve: Making sure their physicians and organizations aren't underpaid for services performed. That a trusted voice like the New York Times is promoting such a sinister impression of medical coding (among other inaccuracies in the piece) really bothered me. But something else bothered me more. Among the

By Morgan|2022-01-01T22:51:51-08:00April 24th, 2017|