When we work worth practices in adult primary care, OB/GYN, and pediatrics, we often recommend they consider proactively recalling patients for preventive visits. Because preventive visits are usually reimbursed entirely by insurance with no patient cost-sharing, helping patients stay current with preventive care can be a win-win for patients and the practice. A preventive visit recall effort can also help your practice address challenges like:

  • Lower demand and productivity during the first quarter of the year, when patient deductibles reset
  • Summertime revenue shortfalls because of lower visit volume
  • Excess demand for pediatric check-ups during back-to-school and back-to-camp seasons
  • Disengagement of patients who have lost touch with the practice and aren’t monitoring their own health
  • Uncertainty about whether some patients are still connected to the practice

Recalling patients for preventive visits allows you to better balance the demand for your clinicians’ time. If you add more preventive slots and book them during times when your practice is slower, you’ll also add predictable revenues. Your patients will benefit, too, because they’ll see their physicians when the practice is less hectic and more appointment options are available.

When practices reach out to patients to book an overdue preventive visit, it’s usually a marketing effort that is well-received. Often patients hold off on booking a check-up because they are unaware that many preventive services are covered without a copay—so they’re delighted to hear that an annual physical is something that won’t cause financial pain.

There is one avoidable snag in booking preventive care that often trips practices up, however, and it’s a pitfall that puts patient relationships at risk: Not all services that could be provided in a typical check-up are considered preventive from a billing perspective. That can lead to “surprise” patient costs and bills. These unexpected costs can be very upsetting. Even though the causes are usually just innocent oversights, some patients will feel they’ve been cheated or deceived.

One way unexpected out-of-pocket costs occur is when a problem is discovered or revealed by the patient during a preventive visit. If the problem requires additional work or tests, that usually means an additional service will be billed to insurance, and a copay or perhaps even a deductible charge will be owed by the patient.

Tests that are recommended as preventive care by the physician, but not included in the ACA’s list of required preventive screenings, are another common cause of surprise patient bills. Many considerations that are not captured in the ACA* requirements will influence what screenings a physician recommends for an individual patient, such as her own health history, social history, and ethnic background. Even geography can play a role: vitamin D testing and skin cancer screenings, for example, may be essential in some regions, depending on the regular sun exposure patients are likely to experience. Lead testing** for children and expectant mothers is a similar example, since lead is a higher risk in neighborhoods with older housing stock.

Costs may accidentally be triggered when physicians aim to offer patients a more convenient, in-office alternative to going to a lab for a particular test—or a newer test that is less invasive, faster, or less painful. Patients will usually appreciate these advantages, and be thankful their physicians are aware of innovations to improve their care—except when an unexpected bill negates these positive feelings.

Usually, the additional costs that arise during a preventive exam are relatively small. The risk to the patient relationship comes mainly from the expectation that the visit would be entirely free of charge, and the annoying surprise of getting a bill afterwards. But preventive care payment confusion is, happily, mostly preventable. The key is to prepare staff to explain to patients that some services may not be covered 100%—and make it easy for patients to understand what their payment obligations may be.

In addition to training schedulers and front desk staff to remind patients that unexpected services or some tests may come with an out-of-pocket cost, it’s a good idea to create a summary sheet that can be presented to patients at their visit and posted on the practice website. A one-sheet with a simple table showing what might be recommended and whether it is likely to trigger an expense makes it easier for patients to absorb the information while waiting to see their clinician—and if the patient is concerned about costs, he’ll be prepared to ask the doctor if the tests are essential or if a covered substitute is an option.


*Changes in preventive care reimbursement may be on the way as the new administration considers its position on the ACA. But many commercial payers reimbursed preventive visits with no patient cost-sharing even before the ACA. It’s possible preventive care visits will still be free to most patients even if the ACA is changed or repealed. We won’t know until changes are announced for sure. But of course you can count on us to blog about it once we know more about the impact of ACA change on preventive care policy.

**For more information on lead testing you can perform right in the office during a preventive visit, visit leadcare2.com. And check out another article I wrote about preventive care scheduling while you’re there.

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