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Why I Don’t Want to Pay My Doctor: A Patient’s Perspective

A recent visit for an annual physical left me feeling angry, cheated, and worst of all, broke. After expecting a twenty-dollar co-pay, I was shocked to hear the administrator at the front desk utter, “And, today, you owe, $275.” My eyes grew big, almost popping out of my head, “Excuse me?” I questioned. “I’m sorry; you haven’t met your deductible yet” she explained with a smile. “I’ve seen worse,” she added. I was confused and overwhelmed by the various thoughts flooding my head. Wait a minute, I have great insurance, an awesome job, and set that money aside for a fun weekend trip to Charleston, not to give to you, I thought to myself. Of course I couldn’t tell her that. I reluctantly handed over my debit card, turned around, and waited to see my doctor. I felt slighted in some way. Why didn’t someone tell me this before I booked the appointment? Why isn’t my insurance paying for this? Do I really owe that?

Surprise Bills Are the Worst Kind.

While $275 may not seem like a lot to some, it was a shock to me, and something I wasn’t prepared for. This is an all too familiar story and a large reason why medical practices need to increase patient engagement and communication amongst practitioners. It’s beneficial to set clear expectations in regards to the patient’s financial responsibility before the appointment is even scheduled. It’s vital for everyone involved – the insurance companies, the medical practice, and especially the patient to understand what is owed. Patients are consistently confused about what they owe. Last year, 42% of consumers said they were confused by the bills they received from their providers.

If I Don’t Understand, Do I Still Have to Pay It?

Who wants to pay a bill when they aren’t sure they “really” owe what is listed on that bill? A friend of mine who recently had a baby, shared that she received multiple bills from various doctors. Now, eight months later, the bills are still being altered, corrected, and worked out by her insurance company and the hospital. Meanwhile, she’s been sent to collections, and now has a healthy baby and an unhealthy financial situation. According to the Medical Billing Advocates of America, 8 out of 10 hospital bills contain mistakes.

I Have to Pay for My Dinner, But Not My Doctor?

Due to a change in FICO scoring, medical bills now weigh less on your credit score, thus patients have even less of an incentive to pay their doctors. Working for a medical billing software company has shown me how much patient debt some practices are writing off. Meanwhile, doctors are becoming banks that provide financing for patients that are trying to pay their medical bills. Sometimes it takes patients years to completely pay their doctors, while the patients who are unwilling to pay their medical bills, or just simply can’t, are written off as bad debt with little to no repercussions for lack of payment.

Give Me Options, like Paying Hospital Bills Online

I want to pay my bill, but I’d rather do it online. My phone bill, my rent, my car payment, and even my power bill get easily through my providers' online portal. Just like choosing an affordable phone plan, residence, automobile, or setting up fixed utility payments, I should be able to pay hospital bills online. I enjoy the convenience of setting up automatic payments on a schedule that I choose. Unless it’s a personalized greeting card, I absolutely hate getting mail, where most of it ends up in either the trash or the shredder. I’m not alone! 93 percent of consumers would pay online through their provider’s or a health plan website. Providers need to understand, as a patient, we need multiple payment options and most of us, would rather pay you online.

The Struggle is Real, and How Patient Payment Plans Can Help

Even with insurance, many patients are struggling to pay medical bills. The Kaiser Family Foundation reported that one-third of Americans struggle to pay their medical bills. With increases in high deductible plans, the rising costs of prescription drugs (nearly 123.7% from 2000 to 2013), and stagnating income, it’s no wonder I’m more likely to go into bankruptcy from my medical bills than by supporting my shoe fetish. High deductible plans aren’t going away. If you don’t currently have patient payment plans options for your patients, you need to. There are many great options available to help patients pay their medical bills. Practices need to start offering these options to their most difficult payers; their patients. Just be sure to vet out these programs to ensure they have your patient in mind, and won’t hit them hard with high interest fees if they default on payments. Imagine recently launched HonorCare®, a flexible, interest free option for patient payment plans. As a patient, and someone who works closely with providers and medical practices, this is a wake up call for providers to start offering patients more payment plan options, continue increasing patient engagement, and provide patients with the most accurate explanation of what they owe.

Now, let it be clear that I’m not saying it's acceptable to not pay your doctor. My goal is to provide a unique insider’s perspective from both a patient who has experienced frustrations and confusion surrounding medical bills, and as a professional, whose daily job is helping providers and medical practices with patient collections.

Maximizing Patient Collections

It’s a challenge that gets more complex every year—how to cost-effectively address patient collections, whether they are true self pay or pay after insurance has been applied.  The increasing cost of health insurance has resulted in the proliferation of high-deductible plans as an option to lower premiums; this has resulted in increased patient responsibility which has ballooned the least efficient financial class.  Fortunately, there’s also more technology than ever to help address the situation.  What’s the best way to combine the two in order to turn your practice’s greatest financial liability into one of its greatest assets?

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While there will always be true self-pay patients, we’ve tried to accommodate patients that fall outside this category with separate fee schedules, cash discounts, and payment plans. There is also a growing population of “may as well be self-pay” patients who owe money after their insurance has taken their discount, these clients have larger balances due to high-deductible insurance plans.

While the mantra of the billing companies used to be “we can’t afford to work the patient pays”, that intonation has been flipped on its head—you can’t afford not to.  If your practice is an active ImagineSoftware user, there is a potential gold mine in your patient tickler.  Here are some tips to put your practice on a healthier financial future:

In an imaging center setting, there is an obvious need for accurate patient responsibility estimations that you can collect at the time of service.  It’s a fine balance—you want to collect as much as possible without creating a credit balance problem on the other side.  You have a few options:

  1. Calls/website visits to the patient’s insurance plan to determine how much they may owe at the time of service
  2. 3rd party solutions that do that work for you or consider
  3. Imagine’s Patient Responsibility Estimator. To the degree possible, this estimation work should be done a day or two prior to the patient’s arrival.  Too far in advance, and you may have an inaccurate estimate, but allow enough time that you can have that information ready by the time the patient arrives. 

While imaging centers are no strangers to payment arrangements/plans and time of service discounts for true self-pay, there are now more options in terms of financing that may make sense for your higher dollar procedures.  

For hospital-based practices, the job of patient collections has always been tougher.  Your radiology bill will be one in a sea of many and you receive (frequently inaccurate) billing information after services have been rendered, so time is of the essence. You want to bill patients for their portion of the bill as quickly as possible.  While there is a philosophy in opposition, I disagree with deductible “holds” (where the patient is not billed for a pre-determined period of time so other organizations receive the deductible denials) for a couple of reasons:

1) If you received incorrect insurance information from the hospital in the first place, holding the bill can only hurt you in the race to timely filing. 

2) The radiology bill in comparison to the rest of the patients’ bills will be relatively small.  It’s easier for them comprehend paying $150 than $15,000 so there is a likelihood you will be paid earlier. 

3) Our jobs are complex enough that we don’t need to add a time element into the mix.  The job is (relatively) simple: receive the study - code the study - submit the bill - post the payment - send the bill.  The faster you can do this keeps the study top of mind.  Patients (and practices) don’t like calls of “what is this bill from 2018 for?”  Deductible holds made more sense in an era of patients’ (lower) deductibles being met in January.  Unfortunately, those days are over.

ImagineSoftware is an industry leader in terms of the ease of use for backend processes—in this case, the patient tickler and mail return queue.  Based on prior consulting work, we found that a good patient collector can net your practice several hundred thousand dollars.  However, by leveraging today’s technology available, that number can only increase. 

By working the patient tickler, you can prioritize high dollar studies and use ImagineDiscovery to determine if the self-pay patient may have unreported insurance coverage.  Our Propensity to Pay feature can lead you to collection activity—if the patient has an A or B rating, work those first to maximize your collections.

And speaking of saving time, ImaginePay alleviates the patient payment posting burden on your posters, historically a cumbersome amount of manual work for relatively small dollars.  Now the patients can pay online, and a file runs in your system nightly that auto-posts the payments for you. 

Just a couple of small operational tweaks and the leveraging of technology can make the burden of collecting patient payments a less Herculean task.  Due to increasing deductible responsibilities, the self-pay population of your practice can no longer afford to be ignored and can, in fact, result in measurable increases in net collections for your doctors.

3 Steps to Reduce Patient Data Waste

Inadequate patient matching and duplicate record creation is an increasingly complex and expensive issue that many healthcare organizations face. As healthcare shifts from a service based to a value-based model it has become more important than ever to capture patient data correctly to ensure accuracy and eliminate duplicate records.

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When patients are identified incorrectly it not only places the patient’s safety at risk, it also places an undo financial burden on the healthcare facility. Duplicate records cost the average hospital $1.5 million annually, and the healthcare system over $6 billion annually. Is your practice impacted by inadequate patient data? If so, here are some steps you can take to help your organization:
1. Adapt to a location intelligent system

The retail industry has pioneered this technology with their online checkout using auto-complete to fill in shipping and billing addresses. Did you know that healthcare facilities can now leverage this same technology to prevent incorrect addresses proliferating their systems? Location intelligence with address verification allows organizations to authenticate and standardize address information before the patient submits their forms. Type-ahead technology ensures their data will be standardized and verified by the USPS, which improves match rates by up to 3% than before. When employed, ImagineDiscoveryTM reduces manual demographic corrections and helps you find duplicate insurance information as well.

2. Ensure your billing system employs a self-learning/ai solution

Having a system that understands how your organization works is key in reducing waste and increasing efficiency. A rule based intelligent system should, by design, improve over time to not only further record matching accuracy, but also alleviate data reconciliation burdens that are piecing together fragmented, disconnected patient information sources. AI algorithms are able to adjust themselves based on the feedback provided by your staff as they help to remedy the ambiguity between two or more records. Meaning that as your staff adjusts and corrects processes, the system will in turn learn from their intervention and start making the changes on its own. Using this type of AI will ensure your patient’s data is matched appropriately, thereby reducing the provider’s risk of misdiagnosis or redundant orders for imaging or treatment. ImagineSoftware employs ImagineAppliance® and ImagineAITM, which are both self-learning systems that record the operations your staff makes inside the program and adapts to take the repetitive nature out of everyday tasks.

 3. Mobile Friendly Patient Systems

Over 95% of American’s now own a cellphone, of which 77% own a smartphone. With the appropriate controls, firewalls and servers in place, the patient can actively manage and engage with their healthcare records online. By having the ability to update their address, phone number and email address, patient matching efforts can be supported by the user at key stages rather than just at the point of enrollment. Utilizing the patient’s smartphone as a point of entry is a promising approach to improve the accuracy of demographic data received from individuals. Mobile friendly technology combined with location intelligence gives your organization two powerful tools, that if combined can impact your patient matching on a large scale.

These solutions are relatively easy to adapt into your practice if you are already working with a skilled and knowledgeable revenue cycle management system. If your billing practice already employs one of these solutions, it should be fairly easy to add on a module to help streamline your process. For ImagineSoftware users ImagineAppliance®, ImagineAITM and ImagineDiscoveryTM easily plug into your existing ImagineBillingTM solution to help streamline your processes and help you identify duplicate records automatically. Get in touch with us today to see how we can reduce waste and improve your bottom line.