Home Forums Discussions General Discussion Requiring a credit card on file

Does anyone require a credit card on file (at least for new patients). I know phreesia can do this, I was just wondering policy wise if any other practices had this implemented.

Thank you!

Ben

We don't do it yet. I was concerned about proper storage of the credit card data. Updox has the capability to properly (PCI compliant) store the information, so we will implement this in about a month when we complete our integeration of Updox.

It's a bad idea on many levels. Doctor-patient trust being the most important.

There is a thread about this that I started a few months ago. I think its title concerns giving credit.

Ben, check out the thread Stop Extending Credit for a few opinions about this. There is one surgeon who conveniently provided a copy of the letter he gives to patients about his policy. I'll probably base my letter on it.

Doctors, especially PCPs, have basically been hoodwinked and battered into a business model where you do not do the things other businesses do. A third party dicides what you get paid for your services. They decidehi which services should be combined into "one" service with no increase is price. Someone refuses to pay you for services you have already provided?? OH no, don't send them to collections!This has got to stop!

We have been sending people to collections for non-payment for several years now. It works, and the few patients that you lose are ones that you don't want anyway, since they do not respect you enough to pay for your services. They paid the grocery store. They paid the water bill. But they tossed your bill into the trash.

Last year we began a policy of having patients with unmet deductibles pay an "estimated fee" at the time of their visit. We've lost only 2 patients, but the policy creates a logistical nightmare mainly due to tracking and being sure to refund overpayments in a timely manner.

The doctor we share office space with has begun to require credit cards kept on file. He isn't losing tons of patients. I just wanted a nice PCI compliant method of storing them...preferably offsite. We'll start implementing next month.

I am also sick and tired of not being paid for services already provided. A patient who had ignored several requests to pay and had an over 120 day balance complained to our office that he was embarassed at the pharmacy when his prescription had not been refilled. I inquired why he was not embarassed to request refills from our office having not paid for prior services. He had no answer. I am seriously considering this credit card idea.

Agreed.

Wayne,

Can I ask you what collection agency you use and how it works? Do you get most of what you send out?

Thanks!

Ben

I really can't remember the name right now. I haven't sent anything in for quite a while, but I can think of one or two that I should. We didn't send much in, but we tended to get paid for the ones which we did. I do remember the checks. I'll try to check on it tomorrow

I'm really surprised to hear that sending overdue accounts to collections may not be universal. I thought every practice does this; I mean, what's the question?. We average probably 2 a month to a local collection agency.

The gyn around the block from us (we've known them for awhile) does not. Alot of practices don't. I find it ridiculous.

David,
We do use a collection agency, but the decision to do so is not always a "slam-dunk". The actual amount we collect through this route is miniscule; the agency rarely collects much money, and they keep a sizable percentage of what they bring in.
The downside is the ill-will generated by sending people to collections. You might question why I would care about the feelings of the deadbeats. Frankly, I don't, but I do care about the income from their procedures. So there is a calculation as to whether we want to potentially lose future business (e.g. income from colonoscopies) over a $30 co-pay.
We don't use a collection agency to bring in any significant income; we use it as a "consequence" for the deadbeats, and so that we aren't completely turned into doormats.

The credit card solution described here has a lot of appeal. One missing piece may now be provided by Updox's ability to securely store card numbers. The other missing piece (as I see it) is being able to reliably know what the patient's current status is with regard to co-pays and deductibles. In other words, if I could reliably know what the patient will owe, after insurance, then I would feel comfortable telling them we will charge that amount to their card. Right now I can't get that information very reliably.

There are many variables concerning this issue that you may need to weigh for your practice. Our situation is somewhat different than Jon's.

In primary care we don't have high-dollar-value procedures. Additionally, the copay sometimes is over 50% of the total reimbursement. An insurance company may say the "negotiated rate" is $65, and the person has a $40 copay. So for us the copay is a big deal and I'll go after them. But worse is the patients that have deductibles and don't want to the deductible. So they come in with serious and/or multiple problems and its a 99214. And the EOB says "patient responsibility--deductible." And the patient now ignores the bills and phone calls. This is someone who just isn't going to pay the bill unless forced, and I don't have any high-value proceedure that I can get from them. So I send them to a collection agency.

This has resulted in some ill-will, but the ill-will is from deadbeats.

I believe keeping the credit cards on file will actually improve our relationship with our patients. Over the last few days, I have been telling patients that beginning Aug 1 we will require this. So far everyone has been understanding. I'm sure I will lose some patients over this. But I've been told by some patients that their previous doctors, or doctors of their friends and family members already do this.

I thought it was a breach of contract to charge the patient upfront or before the insurance company tells you what the patient owes?

That's exactly why you want to keep the card on file. Then, when the EOB comes, you can charge what it says that they owe.

I just did a google on the term "credit card on file agreement." Amazing how many of these dealt with healthcare services of one type of another.

Wayne, I completely understand what you are saying. The patient portion of the fee for visits and procedures is increasing for all of us. It makes less and less sense for us to ignore or write-off the patient portion of the reimbursement.
I realize that doing procedures changes the equation to some degree, and I am sensitive to the fact that reimbursements are unfair and unduly favor the proceduralists. I didn't mean to understate the value of a collection agency; I was just explaining to David why some might hesitate to use one.

One approach is to wait for the EOB, as Wayne describes. Real time information on the patient's copays and deductible would allow you to collect what the insurance company says is due...at the time of service. That is why I said it would be valuable to have that information.

Jon, I understand and I did not take offense. It is similar to the discussion I had with the gyn around the block from us. Her practice manager has been resistant to the idea because of potential ill-will from patients and he's trying to get more repeat visits.

Here in NY, many (not all) women get their well woman exam from different gyns each year because they don't understand the importance of having someone that is familiar with your medical history. They literally won't know who gave them the exam the last year. So he has different issues to consider also.

We also use collections judiciously... the MD has to approve each one, and there are lots of extenuating circumstances that cause us to just keep on truckin', payment or not. Also, we are not sending $30 balances for collection. But, by the time someone has been seeing us for several months and owes a couple of thousand dollars, and has taken the insurance check and used it for a trip to Hawaii, I tend to get a bit testy. This happens more than I like.

David,
Your last scenario is illegal. Patients that receive insurance checks and fail to turn them over to us receive a stern warning. "Please note! We have been informed by your insurance company that you were paid $$ for services which were provided by us on (date). We have yet to been paid by you. Be aware, this is considered insurance fraud and is a criminal offense. Please remit the amount owed to us promptly or we will be forced to inform not only the legal authorities but your insurance carrier as well. " I have yet to have to follow though on this and I have yet to lose a patient over it. They know they are wrong.

Leslie,

Losing a patient that does that is the least of my worries. I'm intrigued by your letter. However, running that down is staff intensive, burns up lots of telephone energy ("What insurance check? I don't know no stinking insurance check!!"), and the part of our patient population who does this sort of stuff would probably respond with something like "Bite me!" Easier to turn it over to collections and fire the patient.

David,

Try it. It is one of the most productive and least time-consuming interventions we do.

Leslie,

For OON network payments who recieve checks, what they are doing is not illegal. The checks are made out to them and they have the right to cash them. Yes, they do owe you money and are obligated to pay. They can be sued in small claims court ( I have a lawyer chase large amounts) or be sent to collection. What they may do that is illegal is to not pay taxes on this money as they are getting a payment from the insurance carrier. They theoretically can be threatened that the infor will be sent to the IRS.

If the check was sent to them when you are in network, it is the insurance companies problem and they need to issue you another check.

Having a card on file will possibly mitigate this issue. However, if they are really crooked, they will contest the charges and/or cancel their card after this occurs.

I am specifically referring to in network. All OON must pay at the time of the visit.

OK, so if it is IN network, this is not your problem but is one for the insurance company and the police.

You are not paid and the insurance company needs to pay you. You have NO reason to contact the patient and the insurance company needs to reissue you the check, unless they can prove you cashed it. If not done in 30 days in NJ, they owe interest as well.

There is absolutely NO reason ( legal, ethical, or insurance contractural-wise)physicians or other healthcare providers should NOT be paid the fees that are do them. We are no different than other professionals who charge for their services ( accountants, bankers, IT people, plumbers, electricians, practice consultants, etc.) Anybody try to walk out of the grocery store with a gallon of milk and not pay for it? Is the store owner any less honorable when he demands payment before customers hit the exit. Of course not!
Also the idea that physicians should NOT press perfectly legitimate financial issues with patients is crazy. Those physicians can fall on their own swords, I'll keep mine standing in the corner.
If a patient tells me they just can't pay the bill in full, that's OK we can always work something out. Even if they pay $5-10/week, at least it is a token of good faith and they respect my services.

Now that's out of my system, can anyone recommend a location in Amazing charts to scribe a patients credit/debit card info that will keep it protected enough to store it there? How about the alerts and directives area and label it non-releasable info? Also I believe mentioned in other posts on this topic, this guarded data would not be used until all other mechanisms for payment have been exhausted.
I will not apologize for wanting to be paid what is fairly and contracturally do me and my staff.
Nate

Nate, you sound like me on my rant on the same thing. As I tell Alice, I'm not even an MD and I"m offended. I guess managing all of the financials and anything else not related to diagnosing the patient has made me biased.

We'll start collecting credit cards in a week or so.

Now, where do you keep the info? Nice Question.

Honestly, you should not keep it in-house. It should really be kept in a PCI-compliant manner. Updox does offer this as a 2nd tier feature. There is not a "safe" spot in AC or in most programs to do this. You can store it in Quickbooks, but its not "safe."

having $200k+ in loan debt makes business decisions concerning this easier. My usual response is you don't walk out of the grocery store with a gallon of milk without paying the cashier... Its unfair and unethical to constrain me to some sort of false perception that because I went to medical school and practice family medicine that I don't have bills to pay too and that I'm an economically blind philanthropist who just gives services away because it's the nice (I didn't say right) thing to do. I'm not a credit card company so I can't offer credit but we delightfully accept all forms of credit card (not 100% sure we take AMEX) already offered by all the major banks.

I find it incredibly ludicrous that I pay $50-70 for fuel in my car every few days, and our value as physicians is being negated to the point where gas is more important and expensive! Oh yeah, you have to pay for gas! We as physicians have definitely lost our ways and our profession has been disrespected to the point that instead of someone's health being most important, it is being minimized as a right and not a commodity! Our government and Democrats (Obamacare) are making this so evident it hurts! I am working on stopping to accept any government payers anymore and most of my area physicians agree! It is time to let the public know our value and stop putting up with this; our society values everything from homes, cars, athletes and watches, clothes and other commodities as more valuable than physicians and their health-even gas is more expensive! This is why I refuse to buy anything expensive nowadays being that my worth is so darn minimized I feel I am not going to contribute to our economy and spend the little that I earn! Just a rant!