All policies and procedures should be consistent and clear for everyone to understand. Office staff will need to notify patients of the policy to collect the full amount of the patient’s responsibility at the time of service. The office should make sure they understand this policy when they are scheduling appointments and make it a part of their script to let the patient know what to expect when they arrive at the office.
A Team Effort
Collecting the deductible and co-insurance at the time of service may prove difficult, but if office personnel are properly trained, then it should be a smooth transition. All co-pays should be collected prior to any services rendered by the physician or other healthcare professional.
It’s vital for rheumatology practices to create and enforce a policy specifying that the collection of co-pays is required from all patients before services are rendered, unless other arrangements are made prior to the appointment. Although some practices prefer to handle co-pay collection as part of the checkout process, it’s recommended that co-pays be collected in advance of the encounter. The best time to collect co-pays is when patients are in the office. Once they leave, collections become more expensive and more difficult. In fact, with forms, envelopes, stamps and staff time—the cost of collecting the co-pay after the fact can be nearly as much as the amount of the co-pay itself! The cost associated with any collections process, including staff time, is estimated at $1–2 per claim.
Co-pays can account for 20% of revenue in a rheumatologist’s office and if all co-payments are not collected, this could be a vast revenue loss. Not only will this hurt the practice overall, it also has the potential to jeopardize the physician contract with the carrier. Many contracts state the physician must collect the co-pay from each patient under their plan. Physicians are bound by the Office of Inspector General’s regulations, as well as private contractual obligations, to collect co-pays. Failure to collect co-pays is a violation of the False Claims Act. Providers who do not collect patient co-pays are subject to prosecution for fraudulent billing under federal law. Penalties include a maximum fine of $25,000, five years in jail or both for physicians who are found guilty of not collecting co-pays.
The key to running a successful practice is to handle it like the business it is. Physician offices should know that patient co-pays, deductibles and co-insurance are income sources for the business. Profit is not insignificant, because it enables a physician to keep the doors open. Co-pays are a big part of a practice’s revenue; don’t leave them on the table or let them slip away.
