Collecting at Time of Service

More than once, I’ve come to the check out window and been told that I’m all set, and that I will be billed later. Fine with me – but now the practice has to chase down the patient and collect money that was owed at the time of service.

As a general rule, it’s perfectly acceptable to ask for payment of co-payments and deductibles at the time of service. Deductibles are a bit difficult unless you have current data as to where the patient stands with their deductible. This is particularly the situation in the first few months of the year. So, even collecting the co-payments that will be the patient’s responsibility regardless of the deductible situation will aid the practice’s cash flow.

These days, of course, you are likely to be seeing more outright requests to pay a bill over time. Ask the patient to agree to a schedule - $50 a month will work through most bills pretty quickly. Not only have a lot of people lost jobs, but there is a lot of concern and uncertainty about future income – and reasonably so. You still have the cost billing, but you are extending a courtesy and goodwill. Healthcare bills are not cheap, and are not necessarily planned for nor can they be postponed. Given the situation, agreeing to a pay out is reasonable. For truly elective services, however, it is better to insist on payment at the time of service, if not upfront before using your services.

On a related note, it is incumbent upon you to accept credit cards. I’ve written before of the experience I had with an anesthesiology group in Charleston who didn’t take credit cards. In my case, they waited to be paid. Credit cards are very common; they are generally available when cash may not be. We have a health savings account this year, and the preferred method of payment is a debit card. Here again – the practice gets paid promptly, and I can take advantage of the highly touted consumer directed health plan (advice: the hype is even more misleading than I thought).

Implementing a collection at time of service policy will take some time. When making appointments, tell patients that you will be asking for payment. At first, if the patient balks (such as saying they don’t have their checkbook) let it pass, but tell them that you are asking for payment from now on. Over several months, you should see your collections rising and A/R dropping. At some point, of course, collections will flatten, the timing of collections stabilizes.

Collections are always a challenge within a practice, as you balance the desire to help patients with the business side. You want your staff your staff to remain compassionate and caring, and they are often the best people to work with your patients to collect with compassion.