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Asking for the Money and Getting It: A Self-Pay Strategy

by Jasmine Gee, Director of Product Marketing

While it might not be the health care buzz term of the moment, “self-pay” is a hot-button issue for nearly all providers—especially as patient payment responsibility represents an increasingly larger part of a practice’s revenue. I’ve worked with thousands of caregivers and health care professionals, to help them thrive financially in an environment of tremendous change, and self-pay remains an elusive constant. Compared with co-pays (which almost never get written off and have an average of 16 days in accounts receivable), self-pay takes more than four times as long to collect, with a whopping 18% ultimately getting written off.

Have you ever thought about self-pay from the patient’s perspective? A 2011 survey of patients offers the following insights:

  • 32% don’t know their payment responsibility when they leave the office
  • 70% are interested in making payments online
  • 63% would use a payment plan if it was made available

To fully tackle your self-pay issues, you need clear rules of engagement, a fabulous technology platform, and the full effort of your entire organization. Here are some best practices for addressing these realities as well as your patients’ needs:

  1. Create a self-pay policy
  2. A well-written policy maintains clear communication with patients about fee issues and promotes better relationships with patients. From an operational standpoint, a firm policy ensures that all staff do the following:

    • Handle fee issues consistently
    • Provide support for collection efforts
    • Avoid legal pitfalls in patient billing and collection

    Keep your self-pay policy straightforward and simple, broad enough to apply to virtually every patient. Make sure your staff and providers are on board with it, and have your patients review it—you may also choose to ask patients to sign it as an agreement.

  3. Use technology to incorporate efficiencies and automation into your self-pay efforts
    • Implement a pre-authorization or credit/debit card storage policy to bill clients immediately
    • Consider accepting credit cards, checks, and HSA/FSA cards
    • Offer an online patient portal so patients can make payments online
    • Contract with a live operating service to accept payment outside of business hours by phone
    • Use real-time adjudication
    • Put payment plans to work for your practice
    • Offer automated credit card plans
    • Consider establishing a pre-payment policy

    Your health information technology (HIT) vendor should be working with you to provide all of the aforementioned tools and processes: From pre-visit scheduling via a patient portal, all the way through follow-up, such as automated calls and e-mails.

  4. Make self-pay collection part of your practice workflow
  5. It is important to help your staff put self-pay best practices into effect. Convey the importance of collecting self-pay amounts and identify and appoint collection “aces,” who can best speak with clients.

    Also, provide scripts for your front desk staff to help them ask for co-pays, deductibles and previous balances. When recruiting new staff, remember that asking for money is a talent. And finally, explore incentives or recognition opportunities to reward your staff’s self-pay achievements.

When all else fails, employ a collections agency. Doing so will require you to review all patient balances each month, and send to your agency any accounts that have aged over 120 days. You’ll also need to monitor your collection agency’s recovery rate and customer service skills, to make sure that they are being both courteous and effective.

These strategies will go a long way toward making self-pay less of an art and more of a science, for your organization and, most important, your patients.

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