After your employees, an orthopaedic surgery practice's two most valuable resources are time and money. In the United States, nearly 40 percent of insured adults are on a high-deductible health plan (HDHP). As a result, an increasing percentage of receivable (A/R) balances are the patient's responsibility. When improperly managed, these balances are difficult to collect and consume large amounts of the billing staff's time.

A survey of AAOS/KarenZupko & Associates, Inc. (KZA) workshop attendees illustrates what successful practices are doing to leverage technology, implement time-saving protocols, and proactively collect patient balances.

Promote the online patient portal for pre-registration
The key to collecting for services starts with capturing complete and accurate demographic and insurance information. The practice uses this information to verify eligibility, retrieve benefit information, and estimate the patient's responsibility for the upcoming appointment. Half of the survey respondents offer their patients an online portal so they can pre-register for an appointment.

In the absence of an online patient portal, practices can collect the necessary information during a phone call prior to the patient's appointment.

Collect patient balances at the time of service
Orthopaedic practices offer a number of services, such as imaging and injections, not covered by office visit co-pays. If there is an unmet deductible, these costs may be the patient's responsibility. Successful practices anticipate probable services. When scheduling an appointment, they inform the patient of the estimated charges. At check-out, based on the actual services provided, they calculate the patient's responsibility and collect at the time of service.

Before a time of service collection process can be implemented, set up and staff training are required. First, the practice must gather their payor fee schedules and create a chart of allowables for the most common office services. Then, they must provide staff with credentials to payor websites where they can retrieve benefit information. Staff will need training on how to read and interpret benefits and calculate the patient's responsibility. Most importantly, the provider must supply Current Procedural Terminology (CPT) codes before the patient checks out.

Collect pre-surgery scheduling deposits
To combat growing patient A/R from surgical procedures, successful practices estimate the patient's responsibility and request a deposit prior to scheduling elective surgery. More than half of survey respondents in 2017 said that they require pre-surgery scheduling deposits in their practice (Fig. 1). In other words, it is becoming the norm to collect from patients prior to surgery.

Here is how this works. When the doctor makes the decision for surgery, the surgery coordinator is notified (often through an "order" in the electronic health record) and given the planned CPT codes. The surgery coordinator verifies benefit information online and quickly creates an estimate of patient responsibility. Prior to scheduling, the surgery coordinator meets with the patient to discuss his or her financial responsibility and collects a deposit. The deposit required may be a flat amount, a percentage of the amount due, or the entire estimated amount due.

Offer multiple payment options
Providing patients with out-of-pocket cost transparency is a big step towards taming patient A/R, but don't stop there. Successful practices provide convenient payment options.

Many patients with an HDHP use a health savings account (HSA) or a flexible savings account (FSA) to pay for these services. HSA and FSA cards are processed through your merchant terminal the same way as regular credit or debit cards. The patient will often require an itemized receipt proving the funds were used for a covered medical expense.

Healthcare financing plans offer patients another option when they are unable to pay the entire balance. Some 28 percent of survey respondents offer CareCredit® or another healthcare charge card to help patients pay large deductibles (Fig. 2). These plans allow the practice to get paid in full up front (less a processing fee) while also permitting the patient to make affordable monthly payments.

Of survey respondents, 35 percent offered automated recurring credit card payments to patients who do not qualify for financing. Check with your merchant processing service for this feature. It stores the encrypted card information and charges the card a specified amount on a set day each month.

Utilize modern payment technologies
A survey conducted by HIMSS Analytics found that 52 percent of patients prefer to be billed electronically versus receiving paper statements; yet almost 90 percent of providers still bill patients via traditional snail mail. Many practice management systems offer the ability to email statements and/or send statements through the online portal.

The HIMSS Analytics study also found that younger patients show a stronger preference toward automated and electronic payment options. This includes putting a credit card on file with the office and authorizing a one-time charge up to $200, and it includes online bill pay through a patient portal. A total of 50 percent of AAOS/KZA survey respondents offer online bill payment, up from 28 percent in 2014.

As patient out-of-pocket costs increase, practices must be proactive at collecting in the office at the time of service and prior to surgeries as well as offer a variety of convenient plans and technologies.

Amy Boyer, MBA, is a consultant with KarenZupko & Associates, Inc. Ms. Boyer has 15 years of experience working with physicians in private practice, hospital-based practice, and academic settings. She specializes in practice operations, revenue cycle, and the use of technology to improve productivity. Ms. Boyer frequently advises residents and young surgeons about employment agreements, compensation, and practice start-up issues.

Disclosure: Ms. Boyer is a consultant with KarenZupko & Associates, Inc., which partners with the AAOS to develop and deliver content for the AAOS coding and reimbursement workshops.

References

• www.beckershospitalreview.com/payer-issues/cdc-nearly-40-of-us-adults-have-high-deductible-health-plans.html
• http://info.navicure.com/rs/669-OIJ-380/images/Navicure-Survey-Report-2017-Patient-Payment-Check-Up.pdf