Dealing With No-Shows, Nonpayers, and Other Office Problems


November 05, 2013

Collecting Payment: The Rising Deductible Rears Its Head

High-deductible programs are creating a growing problem for practices. At the time of service, patients typically have no idea where they stand against their deductible, and therefore don't know whether the visit will be paid by insurance, or whether and how much they should pay. Practices lose significant time submitting the claim and waiting to find out whether the deductible has been met and then having to bill patients, who may not pay immediately -- if ever.

More practices have started keeping the patient's credit card number and authorization on file, said one primary care practice manager. That way, when the practice gets information from the insurer and learns how much the patient owes the physician, the practice can charge that amount immediately.

"This way, if the deductible isn't yet met or we need to charge the credit card, we have the card number on file. We notify the patient 2 or 3 days in advance to let them know that a charge will be coming through," said one manager. Some patients, who may be reluctant to leave their credit card number, will authorize up to a certain amount to be charged to their account.

Still, there are many patients who do not have a credit card. "If a patient doesn't have a credit card, we spin the desk around and show them on the screen: 'Here is a credit card company that we work with.'" There are companies that will issue cards (with low credit limits) for people with bad credit or no credit history. "The challenge is that it takes the right person to persuade that patient that it's in everybody's best interest for them to have a credit card," says one biller.

A number of companies provide real-time claim adjudication and create ways to get immediate patient payment. "One company has you store the last 4 digits of the patient's credit card in the data cloud, and the patient has to re-sign to give permission for it to be stored every year, so that helps the patient worry less about someone having their number on file forever." Some companies, after instantly verifying the patient's insurance eligibility, help you set up recurring payment plans with the patient.

Practices that don't use real-time claim adjudication say they often check the insurer's Website, which may provide information about whether a certain treatment or procedure is covered. "For big-ticket items, we find out in advance whether that procedure is covered, and if not, we collect up front," says one office manager.

Some offices have set up systems in which before scheduled visits, they check to see whether any of the upcoming patients have an outstanding balance; if so, they phone these patients the day before the visit and remind them to come prepared to pay their bill. "If their bill is more than 6 weeks outstanding and they do not pay it, they will not have their appointment," says one manager.

Employees Dissing the Practice on Social Media

Occasionally, employees air their complaints about the practice or physician online. Typically, another office staff member sees it and notifies the physicians.

One practice saw an employee's Facebook post about how much she disliked working there. "We didn't dismiss her, but we developed an office policy that we will not discuss our organization negatively on Facebook or anywhere on the Internet," says one. She noted that once the policy was officially in place, other employees were pretty eager to police each other.

"One employee called in sick and said she had back trouble, but then she posted pictures of herself at a park, on a roller coaster," said a practice manager. "The other employees were quick to forward that post to management. Employees are pretty quick to rat each other out."

"Why Can't I Work From Home?"

In some offices, the billers, coders, or other personnel sometimes ask for permission to work from home. Some offices allow it for some people, although one person said, "No one gets that option until they've worked there for years and they are a known quantity as far as their work habits and responsibility, and their productivity is a known quantity. I tell staff that work-at-home is not available to everyone. I say it's a special privilege, and that's just how it is."


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