One of the quickest ways to improve the revenue cycle is to get better at collecting time-of-service (TOS) payments.  TOS payments generally include copays, deductibles, coinsurance, and outstanding balances. 

Copays should be the easiest to collect. The copay amount is usually displayed right on the insurance card, and your practice is contractually obligated to collect it at the time of service. Deductibles and coinsurance are more challenging, particularly in the primary care setting. This is because the necessary services are usually not known prior to the visit.  Nevertheless, copays and deductibles (or at least a portion of the deductible) should be collected when the patient checks in.  I discuss deductibles in another posts on this site.  In this post, however, we will focus on outstanding balances. 

Years ago, our practice set out to improve the collection of outstanding balances.  To help track this, I created a pivot table that displayed the account balance for each patient that was checked in on a particular day and the payments collected at that time.  There are a couple of things to keep in mind when creating this report. 

First, we are interested in the account balance, not just the balance associated with the patient checking in.  I run a pediatric practice, so we are interested in the total balance on the account – which includes balances for siblings as well.  Therefore, it’s important to understand how the PM system handles account balances. 

The second thing to understand is that balances are dynamic.  Once a payment towards a balance is posted, the balance no longer exists in the system.  For this reason, the report must be run daily, before the prior day’s payments are posted. In some cases, you may be able to modify your PM system so that it captures and stores the balance at the time-of-service.  

Below is a screenshot of a pivot table that shows a list of patient visits on a given day, the associated balance at the time of check-in, and how much was collected – grouped by front-desk staff member who checked in the patient.  As you can see, there are several other columns displayed as well. We will get to those shorty, but let’s first focus on the most important information. 

First, column C simply shows the visits, or encounters, for the day.  Column I contains the name of the front-desk staff member who checked in the patient and took the payment (notice how the first column is grouped by this person).  Column J shows the balance due at the time of service, while column K shows what amount was collected. 

We need to be aware that there are certain situations when the patient balance may not be accurately reflected. For instance, sometimes the patient may have a credit card on file that hasn’t yet been run. In other instances, the patients may have COB issues that impact the reflected patient balance. For example, in some states, there is no out-of-pocket cost for Medicaid patients. Therefore, if a Medicaid patient has a balance, we know something isn’t right. For this reason, I included the payer associated with the encounter in column E. 

With some PM systems, you can obtain the date the balance became the patient’s responsibility.  Column G of the report contains that date.  If the date of patient responsibility happens to be the same day the patient came in, that could indicate that insurance payments/adjustments were entered after the patient came in. Because the report is run for a particular day, the system would show the balance due on that day regardless of whether or not it was visible to the front-desk staff at that time. 

Another column that I’ve included is the copayment amount taken on that day (column L).  In some systems, collected copays result in an unapplied payment in the system. This can create a patient due amount until the payment is posted. Because our focus is on outstanding balances, we aren’t interested in capturing the copayments on this report.

Each month, we summarize and present the results to the staff.  Just by monitoring the process and sharing the results, we’ve a significant increase in our collection rate. We go one step further and pay the front-desk staff a portion of the collections if they achieve the established goal each month.  Needless to say, the front-desk staff are enthusiastic about collecting and look forward to the results each month.