Deductibles aren’t going away.  In fact, they seem to just keep increasing. Therefore, it’s imperative that medical offices figure out a way to collect as much of the patient’s out-of-pocket responsibility at the time service. 

In a specialist office setting, the procedures that will take place during a visit are known. This makes determining the amount to collect fairly simple. In a primary care office, however, it becomes a bit more challenging. The main reason is that we don’t always know what services will be provided during the visit. 

There are several other factors that make collecting deductibles more difficult at the time of service. For instance, patients aren’t used to having to pay a deductible at their primary care provider’s office, nor are offices in the habit of collecting them. This precedent needs to be changed. 

While we could spend a great deal of time discussing how to change the mindset of the practice and the patients, this post will highlight how to setup an effective system for collecting deductibles and how to monitor the performance of your staff. 

Determining How Much to Collect

Ideally, the entire deductible for the services performed would be collected at the time of service. To accomplish this, however, the following steps would need to take place prior to the patient leaving.

• All services would need to be captured and documented in the chart
• Checkout staff would need access to all of the contracted rates for each payer,
• A coder or experienced biller would need to be available to assist with claim adjudication. 

This is not always feasible, particularly in primary care. So, why not at least try to collect a portion of the deductible? 

In primary care, E/M codes are typically the most commonly billed CPT codes for most visits. Therefore, if you typically bill a level 3 E/M visit for a sick visit, request a portion of that at the time of service. 

The key is to make sure that the amount collected is not over what would be allowed by the payer. This will help you avoid needing to issue refunds. A quick analysis of the reimbursement for these CPT codes by your top payers should give you a good idea of what to collect. 

Expanding on this idea, you could even come up with a different rate for each payer. However, that adds to the complexity of the process. In our practice, we simply have one rate for each visit type. Thus, our front desk staff only needs to know why the patient is coming in (i.e., sick visit, consult, etc.) and if the patient’s insurance policy has a deductible. 

Eligibility and Insurance Verification is Key

An important step in this process is making sure there is an efficient system for determining the patient’s insurance eligibility. This has to be determined prior to the patient’s visit so the check-in staff can appropriately collect. At my practice, I’ve designed a check-in template that helps with this process. It first determines if there is a deductible for the policy. It will then display the deductible amount based on the visit type for that day.  This not only provides the necessary information for the check-in staff, but is the basis for the report that we use to monitor the collection performance of our staff.

Monitoring Performance and Share the Results

In order to have an effective collection process, you must be able to monitor the performance of your staff. Below is a screenshot of the deductible report that I run in our office, built with Excel’s PowerPivot functionality. The report shows all of the patient encounters for a particular timeframe, what should have been collected, and what was actually collected.  The report is grouped by check-in staff member. 

This kind of information you just can’t get from the canned reports in your PM system. The great thing about working with BI tools, such as Excel or Power BI, is that you can build logic into the measures and queries to extract the information that you need. For instance, this report is programmed to know what should be collected for each visit type.

We also require our front-desk staff to enter a reason if the deductible wasn’t collected. This holds the front desk staff accountable for not collecting. It also provides us with a way to follow up with patients who don’t pay. If a patient refuses to pay, for example, the account is noted, and our billing office follows up with the patient/family to go over the policy. In some cases, we may even expedite the collection cycle. 

Notice that the report is grouped by front-desk staff member and shows all the encounters checked in for that month. Column B displays what should have been collected, and column C displays what was actually collected. Under each encounter number, the reason for not collecting is provided. As you can see, we don’t collect if the patient has a credit card on file or if the patient has an HRA. 

Once you have the report and start tracking the data, share it often with your staff. The collection rate will improve just by the fact that your staff knows they are being monitored.

Interested in this topic? View my other post on collecting outstanding balances at the time of service.