Home Forums Discussions General Discussion Back balance incentives

I think I bring this up annually and then forget the responses. Forgetting the effect on the other employees, which wouldn't be a problem with our staff, does anyone give a percentage of collection of back balances to the receptionist.

A vast majority of our back balances our written off or sent to collections and settled by allowing a 50% payment. I would think it would be difficult to push for back balances at the window. I know it is their job. But, for instance, my receptionist is in trouble financially. If there were a back balance of $400.00, and she got 8% whatever she collected, $32.00 would be a pretty big incentive to be a little more pushy. Sure, that $32.00 is mine, but otherwise I may not collect it all.

Again forgetting the other staff (you could even give them a cut), and sending to collections and other ways of collecting, all things that don't always work, do you think this is viable. I mean if asking for $400.00 gives you a response of, "Oh I didn't know I owed that?" Why? And, then you show them their deductible, and they say, oh, wow. I'll send that when I get home. And, then they don't. But, if giving $32.00 or whatever percentage, gets you rest of the balance does that make sense? And, it helps the employee as well.

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What's wrong with requesting for payment before services rendered. Keeps your from wasting time chasing after small money. Also in many cases it turns out to be a lose-lose situation. That is patient owes money, they switch clinics rather than squaring off what they owe. You end up losing money owed and the patient, usually after they no call no show.

Most people simply pay their copays and expect their insurance to pick up the rest only for the insurance to pick up the rest. But, then they haven't reached their deductible, and we don't get paid by the insurance leaving a balance.

This is why insurance sucks.

And, like some, I don't feel comfortable going through and finding out what their deductibles are online and then asking for the total amount to be paid for that visit.

I hear you Bert

Unfortunately in my neck of the woods because we are reimbursed so little you have to call the insurances and speak with them directly in regards to the patient's insurance status prior to seeing the patient for every visit. Not doing so will result in having to shut the doors and close the clinic. Going online is not enough. Not doing so will result in the doctor getting paid randomly. One of the reasons is that insurances here play a little game called coordination of benefits. This info needs to be updated on a regular bases by the patient. If this is not done by the patient, who will not do it 50% of the time until they have to, and despite the patient legally having insurance because they are paying premiums through their work, the doctor does not get paid until the patient updates their info. What we have encountered is that once the patient has been seen they are no longer interested in their responsibilities to get the doctor paid, and as a result the office has to spend much time chasing the patient to update the info, and once this is done the office has to chase the insurances to get them to pay the bill. This as well as the other issues listed in my first post as well as the risk of retribution by patients if you send them to collections, retribution such as having your car or office windows keyed as well as your good name blasphemed through out the community and in the cloud, by an irate patient who undoubtedly will move on to another clinic once sent to collections. We find the only reasonable solution is following an orderly process across the board. Patient schedules, we confirm and patient gets seen, and we get fully paid. As a result we loose very little money or patients because of billing issues. Event though it takes effort, we find more rewarding to put the effort up front than afterwards for the reasons mentioned above. Its not to say this is a better way of doing things, but if you want to run a successful solo practice in our neck of the woods it's something that we are forced to do.

God bless

Dru

The nice thing about ACPM is it allows you to get the live eligibility check, and it will show you deductible balances - you don't have to go online for every patient.

We made the change in our office, and it was uncomfortable at first, that if a patient has a deductible, I collect the whole allowable UP FRONT. If they decline to pay what they will owe for that visit, I try to collect minimum 50% and if that's a no-go, I offer to reschedule them - sounds cold, I know, but it's working. Let me say, our patient AR Report has shrunk down CONSIDERABLY and very few people actually reschedule. But I also try to review their benefits with them before I even book their appointment, especially for new patients. I try to be as up front about the money side as I can. Most patient's seem to appreciate that I take the time to inform them of their responsibility to the office and they are more willing to pay if they know what they will owe.

Using the tools available in ACPM really has made my life easier as the only office employee - I'm not spending nearly the same amount of time and effort chasing people over money - I spend that time being proactive about collecting it in the first place.

It also helps that you can notate the account in ACPM for easy reference. For example, if a patient doesn't have a specialist deductible, the live check shows me and I can add a Patient Note, it's color coded and pops out at you when you open the chart. For Nerve Conduction Studies/Electromyographies, I log into the actual insurance website to check and see if they have a Diagnostic Machine Test copay/coinsurance/deductible. I created a Patient Note type for that too.

Giving your front office staff an incentive to collect the money is really generous and laudable and seems like it should be all the more reason that they would want to pursue every patient that owes a balance.

Thanks Dru and Trista,

I understand everything you say, and I wish we had the balls to do that. May I what specialty each of you are from. Primary Care being a speciality as well.

I think you could get away with that in FP or IM possibly, but in pediatrics, it would be hard. Especially, if at the time they came in. All sorts of laws, etc., but I think mentioning it to them on the phone would allow them to make the decision, happy or unhappy to go to an urgent care, etc.

It just seems if a child with a 103 fever and cough (looks well -- probably routine) were to be asked to reschedule, it would open you up to all sorts of issues. We had a case in Maine once where a college student walked into a doctor's office c/o symptoms (not even a patient). They turned her away. She died the next day in Influenza A pneumonia. We could argue that one as far as the responsibility goes.

I am certainly not turning down good feedback. Thanks for the advice on the incentive especially with particular staff (who do the front desk) and is really hurting.

BY THE WAY, DOES ANYONE REMEMBER THAT COMPANY THAT MANAGES PAYMENT PLANS THROUGH A CREDIT CARD SYSTEM WHERE THE PATIENT HAS TO ATTACH A CREDIT CARD AND AGREE TO A MONTHLY PAYMENT.

This way if it is turned down, you can release them, and if they stop the process, it is pretty much obvious. I don't like payment plans, because they start paying them, then stop or come in and don't pay again.

Neurology here. And Reimbursement in RI is ATROCIOUS.

"It just seems if a child with a 103 fever and cough (looks well -- probably routine) were to be asked to reschedule, it would open you up to all sorts of issues. We had a case in Maine once where a college student walked into a doctor's office c/o symptoms (not even a patient). They turned her away. She died the next day in Influenza A pneumonia. We could argue that one as far as the responsibility goes."

Agree you have to practice with caution. And the well being of the patient needs to come first. I may be digressing from the discussion but I believe its worth kicking the tires on this. The front office needs to develop the skill to discern between a complaint that can be life threatening from one that is not. From my perspective the "RED FLAG LIST" ain't that long and should be both memorized by the front office staff and posted in the front office. Also the policy should not IMHO be one that captures every penny owed. Having such a rigid policy will lead to problems. There should be flexibility based on each individual case. This being said I believe the majority of those who owe are not Red Flag Cases. Also when a patient can not be seen for what ever reason. You should not turn the patient away but offer an alternative such as presenting to the ER/Urgent care, or a discounted cash clinic with caveat being that if it is a red flag issue you inform the patient that their symptoms may represent a life threatening condition and they should present to ER immediately and offer them to call 911 on their behalf. If the patient is an established patient the office should follow up to insure patient has presented to ER. So for instance when a patient calls to schedule all "Red Flag Issues" are not scheduled but referred to ER right there and then. So if a patient wants to schedule for chest pain, acute neurological symptoms, acute headaches, new onset abdominal pelvic pain and yes fevers in children which can't be seen that day, we refer those and all other Red Flag issues to ER.

Dru

THe way we changed to doing it since last january is that we collect up front. You collect for a new patient visit or a follow up visit plus the braces/injections/xrays we would be doing right then and there. if they don't like it,they find care elsewhere..my AR is now very very very good and i am not chasing money!

Maybe we are saying the same thing, but a receptionist or any other front staff cannot be trained to do triage. Even if they are triage capable, the triage cases should follow the same route --> to the triage nurse working with the doctor who work together to make those decisions.

Our flow is that when a patient calls the office, the patient is always allowed an appointment either that day or at a subsequent day if they desire. This is a definite for any patient up to 11 am (in other words I do not want someone calling at 8:30 am and being told we can't see them. We also see any baby up to six months if a parent deems it necessary. Most of the time the parent will know if they want an appointment, but if it is questionable either they or our receptionist will message the triage specialist, CMA, who then gets back to the patient. Anything she advises the patient is sent to me for final approval. Or she sends it to me for direction. The triage nurse, as she is referred to, can make triage decisions, but the patient can still ask for an appointment. Obviously, if we can't fit them in, we refer them to the ED or give them instructions with advice to go directly to the ED or page me if the patient gets worse.

There is absolutely no way our receptionist is going to keep that patient who did not need to be seen away from the window based on her experience level. Plus, we do not want several people doing triage. Not to knock or belittle any other speciality, it is more difficult to triage the little ones. And, parents expect way more, trust me.

With all due respect to those in other specialties, dealing with patients with sprained knees is much different than dealing with patients with periorbital cellulitis. Or orbital. First, you certainly cannot deny a patient care for what they owe. If a patient is in for f/u of a shoulder and is told he or she must come back, no biggie. You simply CANNOT look a parent in the eye and tell them unless they pay for the full visit, they must reschedule. You just can't. You can write it down, have your biller call or write them and send them to collections, but once they are in your door, you are playing with fire. And, with the child's health.

Thanks for all the responses. It is what makes this board so helpful. So, please do not be offended by the following comment:

There are times (almost always with this subject matter) that a question will be something like (analogy), "We have days where there is a large predicted snow storm the following day. Do we give the day off with pay or not?"

Inevitably, some will give what they do, i.e. we do not pay for acts of nature or we pay them as it was not their fault they couldn't work, but some will say, that happened to us and we moved to south Florida. While that will work, it was not the original question.

The original question here was, "Does anyone think that incentivizing their receptionist by a percentage of all back balances collected, is helpful."

The methods given by very nice users doesn't answer the question it alleviates the need for the question. I realize they overlap somewhat, and I still learn from the answers, but so far, tcosta is the only one to comment on it.

Again, thanks to all.

"BY THE WAY, DOES ANYONE REMEMBER THAT COMPANY THAT MANAGES PAYMENT PLANS THROUGH A CREDIT CARD SYSTEM WHERE THE PATIENT HAS TO ATTACH A CREDIT CARD AND AGREE TO A MONTHLY PAYMENT."

Interestingly, In the charge screen in ACPM, there's a drop down for Card on File, but when I called ACPM to look into activating that option, they were surprised I asked because apparently no one uses that functionality; ultimately they said it's just a box and doesn't do anything.

Going back to the note types in ACPM that I mentioned before, I've created a note for this purpose. We offer to put a copy of a patient's HSA card or credit card of their choice on file, it goes on a paper form, and I flag the account with a note. They are kept in a non-electronic file in a secured cabinet so that, in the unlikely event of a breach, no one's financial information is compromised. I offer to work out a payment plan with the patient in advance in writing, which I can have the patient review with me and initial and then set up reminders to myself in AC on specific dates to call the patient and remind them I'm processing a payment for them and once it goes through, I send them a credit card receipt with an updated statement.

This method seems to work well, because I can ask the patient on which specific dates they want me to process the payments. So far, I've not had any payments bounce and when I do call the patient to remind them, they can always have me wait if things are tight that week. But at least we have an open channel of communication and a process they can feel comfortable with. Most patients would rather deal with me than with an outside company that might stick them with finance charges for paying over the phone.

Perhaps this type of methodology could be useful to your receptionists on patient's with a substantial balance? Just a thought.

I am going out on a limb here. If the front desk knows that they get NO incentive for collecting the copay for today's visit , but will get an incentive for collecting the copay as part of a balance in the future , they may not work as hard to get the copay today. And to reiterate what Bert stated previously; denying care to a patient that is in your office because they cannot pay a balance for a potentially serious and life threatening condition can open you up for a lawsuit. This means that you have to "eyeball" and question the caretaker about the patient's condition BEFORE letting them leave. I do not want to take that risk.
I like the suggestion above from Trista about having a card on file. However not many people like the idea of having their card information on file. Maybe getting a signed agreement with preset dates for payments and calling them for a onetime payment on agreed payment dates and collecting the card info for tat payment may be way around that problem.

I talked about it today with my biller. We were thinking don't give anything for the copay (as I know you meant), because most will just come in and pay it. Why should she get paid for that. But, if you gave $2.50 for a $25.00 copay, then if they pay it doesn't go toward a back balance. We also talked about what if a patient comes in and says I owe $400 for a back balance, why should she get anything.

But, if you go this route (and we likely will), there are too many issues with putting too many stipulations on it. She says, they came in for a visit, and I asked. Who's to say she didn't. Just look at it like it is part of her pay and part of doing business. I have spoken with my other staff and all are in favor and none of them are jealous that they don't have this opportunity. I also thought about her doing all the reminder calls and mentioning the back balnace. At first, I thought that this may turn people off, but it would get her to do the reminder calls twice and just get her totally immersed in back balances. Everyone has a part of their job that don't like. Paying them for it will likely make it bearable, if not something they like.

Trista is always extremely helpful. I like her method. I guess it could be hard also. The reason it is so helpful is that I hate payment plans. They send for two months and then they stop paying. What do you do? Send to collections. Dismiss them? Or they come in and don't pay a $105 visit. So, the three months of $20 did little.

What I was referring to was this company where a patient who was agreeing to a payment plan to stay out of collections or being dismissed after four invoices, would agree to putting their credit card information with this company. That company would collect and take a small cut. This method does three things. First, it reveals that the patient really intends on paying, second, you get the money monthly, every month, and third, if it is over the limit, they have violated the agreement. And, if they stop the auto payment, you know they are basically saying, "I have no intention of paying the balance."

I always tell my staff and remind myself to look at it like it was your own doctor. If I were reminded about my appointment, and they told me that I had a balance, I wouldn't think, "Well the nerve of them asking for their money."

Bert

We are saying the same thing. Also I want to high light the jest of what you are saying that I believe to be very important. That is one should practice medicine based on his/hers individual set of circumstances. Since one knows the ins and outs of the legal requirements in their neck of the woods and the inherent risks associated with their specialty and the risk burden in ones overall environment. And yes I believe pediatrics to be a special situation, since its not the patient's fault that the parent is not paying the bill.

Also just because we have reduced the work and pain in the #ss chasing money does not mean that we are making more, believe me when I say this. That being said I believe my pearls that I would high light would include have a policy that is not rigid and allow for some loss, especially with the patients who are your foundation, those who have been coming to your clinic for years, they have put money in the piggy bank. They will come across hard times and cutting them slack when they need it most, will in most cases not be forgotten. When this happens you truly become their doctor and should be proud of that fact. Another point is don't turn away patients but help them find a solution if you can't be their solution for what ever reason.

That being said I believe a very good idea that you have mentioned is when you call the patient for their reminder, at the same time remind them of their financial obligations prior to the visit, This may actually become law in many states. I would add contacting the insurance prior to the visit so you know what the patients financial obligations are and letting them know before hand. I understand you may be uncomfortable with this but its really not that big of a deal and may be worth a try. Also try to give the patient an incentive to pay something. In our business, meaning yours and mines getting paid something is better than getting nothing.

Sincerely

Dru

Thanks. But, the fact that reminding them about what they owe is uncomfortable makes asking them easier if you know you will get a percentage. On the flip side, I do have a problem with a patient coming in and being charged $100 on Monday, which they don't pay, then coming in Tuesday and paying it. The receptionist did nothing and still made money.

However, if you just accept that she will make money she may not deserve, the system may work. Like anything you have to track it. If for the last three months, you are getting $1000 in back balances, and then you are getting $1500 over the next three months, then who cares about some not being due to her working harder to collect.

I can see them getting in on a piece if it's aged out into 90+ days and you don't want to use a collection agency, but if the balance is in the realm of CURRENT (0-30 days) on a statement, NO, IMO they shouldn't be getting any extra incentive to do their job - especially when the charge is barely 24-hours old. If you're utilizing your staff to collect Outstanding balances that could otherwise be sent to collections (i.e. +90 days and over $125+), then sure, give them a cut. But you shouldn't have to pay them extra to do part of their job description: collecting current copays and coinsurances.

It sounds like you're being taken advantage of. That's your pay. Your staff is likely getting paid by the hour. The overhead is getting paid before you are. You're a better employer than I would be were I in your position; I work for someone else and would never think to ask him to give me a portion of back balances that he's owed.

Am I correct in my understanding of your collection incentive or am I misinterpreting?

No you are spot on as usual.