Medical Billing Expert

In a recent survey of more than 130 hospital leaders conducted by Becker’s, healthcare providers were asked to rank the challenges to their revenue earnings on a scale of 1 to 10. Among all the listed challenges, patient financial responsibility was assigned the highest score. This when contrasted with a Mckinsey report reveals a more interesting facet. The report says 52% of patients are willing to pay more if a clear estimate of care was provided to them. Similarly, 74% of insured customers indicated that they are willing to pay out-of-pocket medical expenses. The fact that emerges from this is that despite patient responsibility being a top concern, much of it can be mitigated by streamlining the process of collection from patients. But before we go into that, it’s crucial to understand what exactly patient responsibility balance is and what do providers need to do to improve their collection of these payments.

Understanding Patient Responsibility:

It’s now clear, that patient responsibility is the portion of medical billing that a patient needs to pay to meet their treatment costs. Just as patients with no insurance coverage need to shell out 100% of their medical bills, patients with an HDHP need to pay a deductible on their medical bills. And the reason why a greater number of patients are opting for HDHPs is because of the assumption that they may not require medical attention and hence should settle for a plan with lesser premium. In many cases this assumption stands belied leaving them with more medical expenses than they expected.

How to Determine Patient Responsibility?

Handling patient responsibility can become a lot easier if you leverage the right technology.  There is several medical billing software that come equipped with a prior authorization tool and patient cost estimator to assist providers compute patient responsibility beforehand. Billing software eliminates the need to wait for a claim to be denied or dial the insurance provider to know more about patient responsibility. The big plus of leveraging the right software is that you can intimate your patients of their responsibility no sooner they set up an appointment.

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Ways to Streamline Collecting Patient Financial Obligations

Patient financial obligations come with their own set of challenges that need to be handled with proper planning, to avert a healthcare service providing doesn’t turn into a loss-making process. Given below are some of the best ways in which you can integrate patient financial responsibility into your medical billing process.

Let the Patient Know in Advance How Much They Need to Pay

Most providers go wrong in just finding out how much a patient needs to pay and then not doing their part. Once they come to know about the patients liability, they need to get in touch with the patient in advance to give the patient enough time to meet their own expenses. When you contact the patient the things you need to make clear include the deductible amount, any co-pay and an approximate figure of the co-insurance to be borne by the patient. You need top covey in the same vein that there are chances of a variance in the final amount because of sudden changes in procedures.

The big advantage of helping patients understand their role in the coverage is that it helps to clear all confusion and ready them to fulfil their obligations. But before you talk to the patient, it’s important that you be aware of any restrictions (contract or state) that forbid you from collecting fees up-front.

Providers and ASC Must Convey the One Message to Patients

Sometimes providers and ASC send out different message to the patient. This should be avoided at all costs. Often, providers look to collect money from patients during their post-operative visits, and so don’t convey things upfront to the patient until the procedure is completed. However, this is not the case with ASCs. They have only one in person meet with the patient and so insist on collecting the fee at the first point of contact. This leads to confusion and sends the wrong signal. To avoid this, it’s important for the provider to talk about the ASC’s financial procedures and policies so that the correct information goes out to the patient from both ends. 

Collect the Amount to be Paid by the Patient on the Procedure Day

It’s always advisable to collect the amount from the patient before they leave the center. In other words, don’t leave any collection for the future. This should be the norm in case of patients who owe more to the provider than the payer. And this is normally the case when the deductibles are large and there is co-insurance on several third-party payor policies. In most such cases, collecting the amount owed at a later stage can be very time consuming and difficult.

                         “Today’s high deductibles are tomorrow’s bad debt,”

Provide Several Payment Options

This is the best way of winning the trust of patients. Some patients are not so well-off and would love to pay their dues provided they have few options available before them. Making options available fosters goodwill and they try their best to meet it. While enabling them pay with their credit cards is a good option, you can even consider giving them an EMI option after taking their history into account. For instance, a patient who frequents your healthcare service should by every account be offered this facility.

Keep a Payment Plan Ready

With rise in patient financial obligation, it’s imperative for providers to have a recovery plan in place to recover full money owed from patient. If the patient fails to pay their part up front, which is the case more often than not, having a short-term payment plan in place can make give them some breathing space. A payment plan of say 90 days can be helpful for both the patient and you.  For instance, if you are running a surgery center draw out a payment plan which will ensure you recover the immediate costs of the procedure upfront and all associated costs within a fixed time period. You can recover the rest of the amount, from the patient’s bank account or credit card. To enable these deductions, you may have to explain things out to your patients and get their signatures on the required documents.

Patient Revenue Stratification

Educate Patients about Healthcare Credit Services

Your medical billing process must have a proper and transparent payment plan alternative in place. If you are accepting credit cards, you may be charged a user fee by the bank.  Try not to collect the charge from the patient because the amount you pay is meagre compared to the money spent on collecting the dues. In other words, you get the entire amount owed, at the cost of a small fee, and the patient pays the credit company as per a pre-arranged payment plan. Patients can avail this facility based on their income and credit history and your role should be to encourage patients to sign up for such plans with financial institutions.

Encourage Direct Payments

Not all patients will be willing to sign up with a financial institution to pay their dues. This doesn’t mean that you let them go. A good way out is to have a direct payment plan ready for these patients. As per this plan the patient pays directly to you within a stipulated time. While having these plans broadens your options, enforcing them can prove time consuming and difficult. You can avoid this by making them sign a promissory note. This binds them to be regular with their payments.

Send Patient Statements

A good way to make patients responsible about their obligation is to send them statements on the money owed. Ideally you must send the first statement no sooner than the patient responsibility is clear. Make it a point to send follow up statements regularly after the initial statement. If the statements do not get you a response, you can call the patient to remind them. Thereafter you can hire the services of a third-party agency to get back your dues.

In an age where a large portion of your revenue is to be collected from patients you cannot afford to overlook any amount that is due. We say this because there is a tendency to ignore small amounts when there is large claim balance pending.  This habit gets entrenched in your process with time. The fact of the matter is every unrealized amount impacts your accounts at the end of the year. It’s better to have a team in place accountable for patient financial responsibilities, payment plans and collections. In case you find it hard to maintain or manage a payments collection team you always have the option of outsourcing medical billing it to a third-party partner. This is the best available option to put all your payment collection woes to rest.

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MedBillingExperts is a US medical billing company that specializes in assisting US-based healthcare providers make their billing practices more accurate and reliable. Our streamlined medical billing services have helped our clients stay on top of their revenue cycle. Our end-to-end service includes collecting and verifying insurance information to reduce the chances of incomplete claims to double checking all related medical codes for errors. 


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