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Accurate payment records, up-to-date insurance information and assertive staff can help you to increase your cash flow.

Fam Pract Manag. 2000;7(2):17-18

Although the best time to encourage patients to pay is when they are in your office, many staff members probably are not comfortable asking for money, and obstacles within your practice may actually discourage patients from paying their bills. By helping your staff improve their communication skills and by redesigning or honing your systems, you'll get payment at the time of service more often.

Signs don't work

While some practices post signs in their waiting rooms asking patients to notify the staff about any changes in their demographic or insurance status, in my experience such notices are usually not effective. The same holds true for signs requesting payment at the time of service or, worse, signs requesting payment in advance. Besides, imagine the message this sends to patients as they stare at these signs while they wait to see you. The most effective and discreet way to encourage patients to pay is to ask for payment after you have rendered services.

Respect patient privacy

With regard to discretion, the front desk is not the place to request payment. It offers little privacy, which can make the situation awkward for both the patient and the receptionist.

A better place to hold sensitive discussions is at the cashier counter, which should be located where patients must pass it on their way out. (If your office design makes it easy for patients to slip out the door, you might consider redesigning your patient flow so that a staff member escorts each patient to the cashier counter after his or her exam.) For your patients' sake, make the area as private as possible. Pay particular attention to eliminating tasks that may distract the cashier, such as answering the telephone, or tasks that inhibit communication between the cashier and the patient. Be sure to provide sufficient counter space so the patient can easily write checks or set down a purse, wallet or patient education material. When a discussion requiring more privacy becomes necessary, have a member of your business staff, your office manager or a patient account representative available to discuss the matter in a private office nearby.

Information, please

Your staff cannot ask for payment if they don't know how much to ask for. The cashier should be able to discuss total charges for the day's visit and the portion of payment expected. Without this information, the cashier may be reluctant to request payment. The patient may even be asked to pay more than is actually owed, only to have your business office refund the overpayment.

When requesting payment, the cashier should give every patient a point-of-service statement that reflects the day's charges, payments, adjustments and any outstanding previous balances. If your computer system can't produce this information, the cashier should give the patient a copy of the current encounter form.

A succinct approach

Clear communication is crucial when requesting payment. Your staff member should maintain eye contact while greeting the patient and assertively (not aggressively) asking for payment. For example: “Mr. Doe, your total charges for today are $58, of which your co-payment is $10. I see you also have a previous balance of $28. How would you like to take care of that $38 today?” If the patient balks, asks to be billed or protests that he had never been asked to make payments after previous appointments, the cashier should gently remind the patient of your practice's policy of payment at the time of service. [For more information, see “Implementing a Policy for Same-Day Payments,” FPM, February 1999.]

If the patient does not make full payment, the cashier should circle the balance due and ask the patient to mail a check later that day. The cashier can give the patient a return envelope and even add a stamp for good measure.

Accepting credit cards

Credit cards make it simple for your patients to pay at the time of service. What's more, they get your practice out of the finance business. Your bank can set up a merchant account for you. A few fees are involved, but they may be offset by what it would cost you to bill the patient and wait for payment. You will probably have to pay to open the account and pay $500 or more for a credit card terminal or transaction software. After that, you'll incur a discount fee of about 2.5 percent or less of the charges, plus a few cents per transaction. A $10 co-payment might cost you 25 cents or so in fees. Patients can use their credit cards to arrange periodic payments for ongoing services, and they can even authorize you to automatically charge amounts not covered by their insurance plan. [For more information, see “Is It Time You Started Accepting Credit Cards?” FPM, October 1996, page 22.]

Should you discuss money?

Many physicians consider discussing payment issues directly with their patients an unthinkable breach of doctor-patient etiquette and medical ethics. They think that it can taint the doctor-patient relationship and cause patients to discontinue treatment. Other physicians concerned about cash flow or the viability of their practices do ask patients to call their insurance plans to expedite payments or to make direct payments.

Should you decide to discuss payment with your patients, make it clear how their financial situation will affect treatment. For example, you may say, “I'd like to make you aware of a problem we're having with your insurance company. It's not your fault. We've been trying to work with them, but we haven't gotten anywhere. They may be more responsive if they hear from you.”

If you wish to make it clear that you cannot continue treatment if the patient does not arrange for payment, you might say, “I am concerned about the problem we are having with your account. If we cannot arrange for payment, we may have to ask you to obtain care elsewhere.”

It's never easy to discuss money, but clear and direct communication will help improve your practice's finances while minimizing hurt feelings.

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