Over a quarter of healthcare leaders say they have changed their patient payment plan policies in the past year in response to the COVID-19 pandemic, according to a recent Medical Group Management Association (MGMA) Stat poll. Of the 27 percent who made changes, many said they are collecting more payments at time of service, adding new payment methods, and enforcing no-show fees. The poll was conducted Feb. 2, 2021, with 673 applicable responses.
Those changes and more may be necessary as the economy recovers from the COVID-19 public health emergency. With approximately 10 million jobs lost since the beginning of the pandemic, many patients have lost both income and insurance. According to an August 2020 estimate by the Economic Policy Institute, as many as 12 million Americans lost their health coverage during the pandemic. And the Congressional Budget Office (CBO) doesn’t see joblessness going away quickly, either. They expect only about 521,000 jobs to return monthly throughout 2021, leaving the jobless rate below pre-pandemic levels until roughly 2024.
Patients also are worried they won’t be able to pay their bills. According to a survey conducted by AccessOne back in December, 66 percent of Americans said they are very, somewhat or a little concerned they won’t be able to afford medical care in 2021. Nearly half of the respondents, 49%, were concerned about their ability to pay for unexpected medical bills of less than $1,000.
So what can medical practices do to encourage and help patients to pay their balances during an economic recovery? Here are a few suggestions.
Don’t assume anyone can or can’t pay.
Between high unemployment and high deductible health plans, patients may be overwhelmed financially. On the other hand, government stimulus plans may have kept some patients solvent.
“I’m not going to assume everybody can pay or everybody can’t pay,” says Karen Zupko, president, Karen Zupko & Associates, during a recent MGMA Insights podcast, “[but] I’m going to have to train the staff to ask questions to figure out where in this puzzle that particular patient fits.”
Consider carefully how to have those payment conversations.
For patients with large balances, have the payment discussion before the next appointment. Inform them of the total due and set up payment arrangements before they arrive at the office.
Also, create a space for these sensitive financial conversations to take place. Patients may not be comfortable discussing finances in the office waiting room where other patients could overhear, Zupko says.
Finally, invest in staff members who are having those hard payment conversations. During a recent MGMA webinar discussion, several panelists suggested rethinking the front desk staff positions, which typically suffer from “high turnover, lower pay and little education on collections.”
“I encourage everyone [to] invest in that position,” says Nan Gallagher, JD, principal, The Nan Gallagher Law Group, “— a little more salary and training can go a long way to boost collections and improve patient satisfaction.”
Make payment options familiar, easy, and accessible.
A great patient portal will not only allow patients to fill out clinical forms in advance, it also gets patients familiar with the platform for making payments after the visit, Zupko says. Also, switching from paper statements to online payment options will feel comfortable to most patients who are increasingly using nontraditional payment methods such as Zelle, Venmo, PayPal, ApplePay, CareCredit, and more in other parts of their lives.
“Not only does an online payment option increase the likelihood of payment, it reduces calls to the billing office, freeing up staff to work on other accounts,” says Amy Anderson, MBA, a consultant with Karen Zupko & Associates, Inc.
Cameron Cox III, MHA, FACMPE, president and chief executive officer, MSOC Health, also recommends that practices invest in patient portals and payment platforms that are easy for the patient, not just the provider.
“You’re seeing the rest of the world adapt,” Cox says. “With the pandemic, it’s requiring us to push for more digital solutions to facilitate payments.”
Unfortunately, a 2019 MGMA Stat poll found that only 5 percent of healthcare leaders offered these payment options in their practices at the time.
Review your financial hardship policy.
Some patients simply will not be able to pay their medical bills. Anderson recommends working with your compliance officer and/or healthcare attorney to develop or review your financial hardship policy.
Many practices use the federal poverty level (FPL) guidelines to help identify who qualifies for a write off. According to MGMA, most healthcare organizations use 250 percent of the FPL as the cut off for qualifying for some type of charity care or hardship credit.
“We have to be realistic: If I’ve been laid off and I’ve lost my health insurance, sending me to collections or browbeating me in some other way is just not going to be productive,” Zupko says.
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