Improving Your Medical Billing: Three Easy Steps to Getting the Co-Pay Upfront - Every Time

By Kathy McCoy  |  January 24, 2011

3 Easy Steps to Getting the Co-pay UpfrontWhen you collect a co-payment, you know it’s in your contract with your payer. However, it’s not uncommon for some patients to question the need to make a co-pay, or say they can’t afford to make a payment, both of which can be very challenging to your front desk staff or office manager. As co-pays have become a larger portion of a practice’s revenue, making sure your practice collects co-pays has become vital. For optimum success, you want your office staff to collect co-pays upfront from every patient, every time they come in for their appointment.

 Collecting Co-Pays Upfront: The Numbers Don’t Lie

Co-pays represent a significant amount of practice revenue. For example, a solo practitioner whose average co-payment is $20 and sees 20 patients a day collects $400 of co-payments daily. That translates to over $80,000 per year. For the group practice, this number only gets higher. Your front office staff should be held accountable for collecting co-pays and you may want to consider an incentive program to reward them for their success. You can set goals and expectations and track the results easily. Let your staff know that collecting co-pays upfront is essential to the success and growth of the practice and that positive results will benefit them financially when it comes time for their annual reviews.

Here are three easy steps to make sure your practice is collecting the co-pay upfront every time:

1.      Communicate the Co-Pay Information When Scheduling Appointments
Having a highly trained and motivated front office staff that books appointments is paramount to the success of your practice. Booked appointments increase your production and revenue, whereas lost appointments present significant risk to your practice growth and bottom line. An important part of the appointment-booking process is confirming the patient’s insurance information and reminding them to bring their insurance cards and co-pays to their visit. Ideally, you want your front office staff to verify eligibility while they have the patient on the phone, and with the right medical billing software, they can confirm the co-pay amount at that time. If a patient has questions about co-pays, they can be answered during the call. This can save your office valuable time because patients will show up for their appointments with an understanding of your insurance co-pay policy, and be ready to make their payment. It is also beneficial to place a sign inside your office that says something like this: We collect your co-payment at the time of service as required by your insurance company. Of course, it’s also a good idea to put your insurance co-pay information on your practice website. 

2.      Explain to Patients the Importance of Making Insurance Co-Pays
When a patient expresses displeasure with having to make an insurance co-pay, be empathetic and informative. Let them know that in today’s uncertain economy, it would be great if they didn’t have to make a co-pay, but that not collecting it violates your participation agreement with insurance companies and would be considered fraud. This reinforces crucial brand attributes for your practice such as trust, honesty and integrity in the minds of your patients. Next, patients appreciate a smile and a warm and friendly tone when discussing financial matters, particularly those dealing with medical insurance, so make sure your front office staff is sensitive to their needs and treats them like a valued friend or family member. If a patient can’t make a co-pay at their visit, don’t discuss this at the front desk if other patients in the reception area can hear the conversation. Have a staff member take them to a private area to discuss payment arrangements.

3.      Provide the Answers Your Patients Need for Their Co-pay Questions
Following are common questions that patients ask regarding insurance co-pays, along with recommended responses that your office staff can use. Of course, these responses can be modified as your staff sees fit, or be personalized to better suit your practice. It’s a good idea to modify these for your practice as necessary, then distribute them in writing in staff. It’s also helpful to do some role-playing among staff members so they become comfortable with the questions and responses.

Q:        Why does my co-pay cost so much?
A:        Good question. Your co-pay amount is determined by your type of insurance and the overall cost your employer pays for. Some co-pays are different than others.  

Q.        Do I have to make a co-pay today?
A.        Yes, you need to make a co-pay before services are provided. We need to collect co-pays or deductibles because that’s how insurance companies reimburse us. We have a contract with your insurance company, and we are required to collect co-pays in order to remain compliant with that contract.

Q.        I can’t make my co-payment today. Can I pay later?
A.        I’m sorry, but we need your co-payment at the time of your visit. It’s part of our contract with your insurance company, and we need to adhere to it.

Q.        What exactly is a co-pay?
A.        Collecting co-pays is a standard business practice in the medical field. Practices like ours collect them to fulfill our contract with your insurance company.

Q.        How do I find out my co-pay amount?
A.        Let me see your insurance card to see if it’s indicated there. If it isn’t, I will gladly check online or call your insurance company to find out.

Q.        What about elective procedures?
A.        You will still need to make a co-pay. If your elective procedure isn’t covered by your insurance, you will need to make an additional payment. I will check online or call your insurance company now to find out if you are covered.

In the event that a patient comes in for their appointment and has no way of making a co-pay, you will need to refer to your individual office policies to determine the most appropriate plan of action. Many healthcare practices offer payment plans to assist patients with financial hardship. It’s important to have a policy in place and to make sure all staff members are familiar with it and able to answer questions.

These simple steps can help your office staff collect co-pays upfront and without any hassle or confusion from patients. The end result can be a more efficient and productive office, improved practice growth and greater profit.

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