Visionary Spotlight: Tracy J. Kenniff, MBA, OCS, practice administrator at Eye and Lasik Center in Greenfield, Mass.
What She Did: Overhauled her practice’s collections process so that they now collect 98 percent of self-pay money up front.
The Challenge: “We found that collections issues came about when patients were responsible, particularly for big ticket items,” Kenniff says. “We ended up with a few who paid on the day of Lasik who bounced checks or had other issues, leaving us without the payment.” The practice had to spend precious staff time and energy tracking down post-surgical patients.
With Lasik being an elective procedure, Kenniff had to find ways to maximize collections without alienating patients. With “patient experience” becoming more and more important to how both payers and patients perceive value, she chose to focus on the customer service benefits of collecting up front—and to express those benefits to patients.
“Our top priority for our patients is to create the best experience and not wanting them to fret on the day of the procedure,” Kenniff says.
The Strategy: Request self-pay amounts before surgery rather than waiting until after a surgery takes place, or even waiting until the day of the procedure. Implement a policy that requires patients to pay in full for their portion of any procedure a full seven days prior to the service.
You probably already know what most insurers will pay for the procedures your practice performs most often (if anything), so you can easily establish the up-front payment that you’ll be collecting from the patient.
In other situations, you may have to carve out the patient’s portion of a procedure. This can happen in instances such as cataract surgeries with premium lens implants (PLIs). “The PLI is the out of pocket expense because the cataract surgery itself is covered by Medicare,” says Kenniff. “Those types of combination procedures have the same policy—seven days prior to procedure we require payment in full.”
You don’t want to surprise your patients with your collections rule a week before their surgery, so you should let them know about your payment policies as soon as they join your practice. But that’s not the only routine that will help you collect—you should also prevent denials by verifying insurance up-front, and questioning patients about their coverage if you find any glitches.
At Kenniff’s practice, any self-pay patients, regardless of procedure (with the exception of refraction) must sign a form stating that they understand they’re fiscally responsible for a specific amount of money.
How You Collect Can Enhance Patient Experience: “We have a team of people in the clinic who work on prior authorizations and confirm insurance,” Kenniff says. “If a new patient is going to be coming to our office, we try to pre-verify their information; if we can’t, our team will call the patient and say ‘We’re planning to bill insurance for your exam and we tried to get a prior authorization; however, it says you don’t have coverage. Is there another insurance we can bill?’”
In addition, your front office staff should know to ask whether a patient has medical insurance versus vision insurance, she says. “We have people who work in billing who have given several key indicators to the call centers, and they say to the patient, ‘Typically, with that insurance, you may have a vision plan as well,’ and that triggers it for the patient to check on other coverage.”
Once the insurance coverage is established and eligibility is confirmed, Kenniff’s practice calls the patient and tells them their copay and deductible on the phone so they’ll be prepared to pay it on the day of the service. “We identify patients for follow-up appointments whether they’re insured or self-pay, so we can remind them a week before the visit what their estimated payment will be.” Most patients perceive these reminders as good customer service—one more concrete sign that they’re dealing with a well-run practice that cares about them.
The Hard Choices: There may be times when this policy requires you to get tough with patients. “There’s been a hard line that we needed to follow and a few times where we have had to postpone a patient’s surgery by about a week in cases when we didn’t get payment. It is a necessary evil in order for us to be able to keep up with our policy,” Kenniff says.
The Result: Kenniff’s leadership has overhauled collections at her practice. “We pride ourselves in collecting 98 percent of self-pay money up front,” she says. The other two percent come from situations like emergent care involving patients who don’t have insurance or other unforeseen issues.
And because her back office no longer spends as much time chasing down self-pay money after the surgery, they have more time to work claims and expedite money from payers. “We pride ourselves that every office claim gets in within 48 hours—usually 24—and all surgery claims get filed the day of the surgery.”
Parting words of wisdom: It’s all about “changing the culture of your practice,” Kenniff advises. “It doesn’t happen overnight.”