The AMA’s National Health Insurer Report Card for 2013 provided powerful reinforcement for the need for physician practices to master time-of-service collections: average patient responsibility is now topping 20% for all but one payer evaluated in the survey, and some were approaching 30%. Even Medicare is requiring patients to contribute about 25% of the cost of their care.
Now the unveiling of the health exchange plans in some states, including here in California, underscores the point further. All of the new Covered California plans include cost-sharing to keep premiums affordable, including copays for all visits except the annual wellness exam. Modern Healthcare reports that other state plans that have been revealed also feature significant patient responsibility. For people new to purchasing insurance and using it to gain access to care, the patient responsibility portion to providers (on top of premiums they may be unused to paying) may come as a surprise and cause confusion. (After all, patient responsibility payments routinely confuse people who’ve had such plans through their employers for years!)
If collecting copays and other patient responsibility payments at the time of service is not SOP at your practice, you’re leaving money on the table — and could soon be giving up even more profit that is due your practice. Plus, if copays are routinely waived or ultimately written off, you’re probably violating the terms of your payer contracts — and, with more new members joining plans that require patient cost-sharing, plans could be expected to be even more attentive to these violations as the exchanges roll out. It’s time to finally master front desk collections!
(If you need help understanding how well your front desk operation is managing these collections, or with rolling out new procedures, Capko & Company can help with a one-day billing and collections review — contact us for more information.)