The following are practical guidelines to help make the process of billing patients directly as professional and efficient as possible.
1. ESTABLISHING AN OFFICE POLICY
Develop an office policy that is simple, clear and consistent. Include:
- those services for which patients will be direct billed and the fees for those services
- any exemptions or special considerations, such as seniors or low-income patients, and,
- bookkeeping and collection procedures.
Once an office policy has been established, it should be put in writing and distributed to staff.
It is important for staff to understand why you bill for uninsured services, and the role they have to play in dealing with patients who have questions about your policies. In situations where patients have questions or concerns about your policies you should be available to deal with them directly.
It is a good idea to schedule regular meetings with your staff to update and remind them about the direct billing process, to answer their questions and to gain feedback on their experiences with patients. This will help you to evaluate the success of your policy and procedures. It will also aid in identifying any emerging problems before they become serious enough to negatively affect your staff or patients. Also, don’t forget to ask your staff if they have suggestions on how to make the private billing process run more efficiently.
2. KEEPING PATIENTS WELL INFORMED
Most difficulties between a physician and a patient on the issue of billing for uninsured services arise from a lack of clear communication. Many patients simply do not realize that there are some services their provincial health care plan does not pay for, and they may become upset when presented with a bill.
To prevent this from happening, you must ensure that your patients are well informed about uninsured services and your direct billing policy well in advance of providing services.
Posters displayed in your office are often a good way to introduce your patients to the concept of direct billing. Posters, however should not be used as a substitute for more direct methods of informing patients of your fees. It is recommended that patients be provided with an information sheet or booklet that states your current fees. And, of course, the most important thing that you and your staff should do is talk openly with your patients about why some services are billed to them directly. Many people will accept and indeed, may support the need for paying for uninsured services. In the end, a patient can then decide whether or not to have the uninsured service provided.
Consider developing a Patient Information Booklet or information sheets for your more common uninsured services.
These can be an important tool for your practice, patients, your staff and you. Ultimately, it will save you and your staff the time and trouble of repeating answers to commonly asked questions.
A patient information booklet may include information such as:
GENERAL INFORMATION:
- Office Hours
- Telephone hours
- Test or x‑ray procedures and availability
- Prescription refill instructions
- After-hours procedures
- Other office policies
DIRECT BILLING INFORMATION
- A brief description of the direct billing concept
- Services that are billed directly by you
- Procedures for third party forms/reports
- Payment policies
It will be important to periodically review an information booklet or sheets your prepare to ensure they remain up to date.
3. PAYMENT AND COLLECTION POLICIES
Whenever possible, you should collect payment at point of service. The longer an account remains unpaid, the more difficult it becomes to receive payment.
Remember, too, that the easier you make it for your patients to pay, the higher your collection success rate will be. Therefore, you may wish to consider accepting credit cards or debit payments, in addition to accepting cash payments. (Contact your bank for start-up and operating information.)
Collecting overdue accounts will likely be a new role for your office staff, and may not be a very welcomed part of their jobs. You need to clearly demonstrate why this is important and help your staff find ways to do this with ease.
Your staff need to know that you want them to be straightforward in dealing with the issue of collection of accounts with patients but that you never expect them to be aggressive in trying to collect accounts. Also, you should be willing to intervene and deal directly with a patient if there is a long-standing problem in collecting an account.
In order to successfully collect on accounts, you must have an organized system in place. Accounts should normally be billed on a 30÷60÷90 day schedule. Payment should be due at time of service, with interest charges being applied to outstanding accounts after 30 days. If payments are not being made, letters and telephone calls by staff should be used to prompt patients to pay. The staff person making the telephone call should ask if the payment was made. If not, a verbal commitment to pay should be obtained. Because it can be easy to forget what was said during a busy day, written records of calls should be made.
At some point, it may become practical for you to speak to a patient whose account is in arrears. It may make sense to determine if the patient has a concern about the service they were billed for or if they have financial challenges that need to be accommodated.
4. COLLECTING OVERDUE PAYMENTS
No matter how generous a payment plan you provide, some patients will deliberately try to avoid paying and you may need to take collection action. This is a fact of business life.
Before taking collection action, you or your staff member should contact the patient to find out why they are not paying. If the patient is genuinely dissatisfied with the service or undergoing unexpected hardship, it may be better for you to write off the bill.
If dissatisfaction with the service or hardship is not the case, a collection agency may be your preferred route. While you can realistically expect an agency to collect only a portion of your outstanding accounts, the fact that an agency has been called indicates to a patient that, like any other business, yours will not tolerate delinquent accounts.
You should wait no longer than 120 days before turning the account over to a collection agency. Waiting too long makes the agency’s job more difficult and allows outstanding accounts to decrease in value.
Always check references when selecting an agency. You need one that is firm in dealing with delinquent accounts, but your professional reputation is too valuable to retain an agency that employs “borderline” collection tactics. Physicians remain ethically responsible for the conduct of the agency during the course of debt collection.
Once you turn an account over to an agency it becomes the agency’s job to collect the account, and you should no longer contact the patient about it.
Of course, before initiating the use of a collection agency to, you will want to weigh the merits of taking this action against the inevitable impact on the goodwill that existed with the patient in question.
As an alternative to turning an account over to a collection agency, or as a final step, you may wish to take a delinquent patient to Small Claims Court. For information on the filing and conduct of a small claims action, contact your local Manitoba Court of Queen’s Bench Small Claims Court office, or visit the Manitoba Courts Small Claims division website.
