Medical Practice Increases Revenue 18% By Streamlining Patient Billing

By Scott Westcott, Contributing Writer

As patients incur more out-of-pocket healthcare expenses, they are becoming more price-conscious. Medical practices such as Urology of Greater Atlanta are responding by retooling the revenue cycle to determine patient responsibility and collect payment up front.

In the not-so-distant-past, many patients carried what Cheris Craig, chief administrative officer at Urology of Greater Atlanta, jokingly calls a “magic card” for health insurance. Often, with that insurance covering the vast majority of medical costs, most providers didn’t spend too much time or money evaluating their revenue cycle or improving their billing process to account for patient responsibility.

Fast forward to today. The average per-person deductible for employer health plans more than doubled from 2003 to 2013, according to the Commonwealth Fund. That increase has spurred healthcare providers to reassess their patient billing and collections procedures.

“It definitely appears that patient responsibility is only going up,” says Craig. “Consequently, patients are becoming savvier about costs. Medical practices need to respond to that.”

Reactive Patient Collections Lead To Bad Debt
The new dynamics of healthcare costs have led to increased demand for price transparency from consumers (see “Improving Price Transparency With IT” on page 22) along with more provider accountability to assure compliance with the ACA. As for providers themselves, what were once viewed as little-noticed back office functions — accounts receivable and collections — have moved to the forefront in running an efficient and profitable practice that maintains a tight revenue cycle.

At Urology of Greater Atlanta, Craig realized that improvements needed to be made to ensure a more efficient revenue cycle at a practice that generates approximately $10 million in annual revenue. The practice had a good foundation on which to build, having already instituted a policy of taking copayments at the time of service and offering payment plans to help facilitate payments of larger amounts. However, Craig and her team concluded the next best step was to introduce a system featuring automated tehnology that would not only help drive improved profitiability and more consistent cash flow but also benefit an overworked five-member billing team.

“Our staff was constantly being pulled in a million different directions,” Craig says. “We pretty much had a manual collection system whereby we just hoped patients would send their money in every month. When people didn’t pay, we’d send a collection letter. Some we wrote off as bad debt. It was a very reactive system.”

Gaining Physician Buy-In Is Key
The first step toward a more proactive approach was to get buy-in from the practice’s seven physicians, some of whom had their own perspectives on the best way to improve the payments and collections process. Craig helped build consensus by sharing success stories from other practices and doing her homework regarding the types of technology platforms available, as well as the unique capabilities they offered.

Urology of Greater Atlanta ultimately went with Navicure Greenlight, a system that automates the vast majority of the payment cycle. Greenlight features an integrated revenue cycle management process that facilitates time-of-service collections, including co-pays and unmet deductibles, as well as automated payment plans. It also allows the staff to securely capture patients’ credit/debit card or bank account information, then to process charges once financial responsibility is determined after claim adjudication. Once the payment is collected for the specific date of service, the patient’s payment method is deleted and cannot be used to process any additional dates of service. The process is repeated with each date of service.

“We promote it by emphasizing you don’t have to pay today,” Craig says. “You pay what you actually owe at the point at which that financial responsibility has been determined.”

Yet before Urology of Greater Atlanta could fully tap these benefits, Craig said both the staff and physicians required training on how the system worked and how to answer patients’ frequently asked questions. “When it comes to patients, the hardest part is getting them to understand how insurance works,” Craig says.

Educating Patients Is Essential
The system was rolled out in two phases, the first being to implement changes on the surgery side of the practice. Beginning Sept. 1, 2014, surgery patients were informed of new payment procedures when scheduling surgery. That rollout proved to be relatively smooth, with very few patients questioning the process after they were walked through the new approach.

However, the same cannot be said for the point-of-service practice where many longtime patients were coming in for routine exams. “That was met with some resistance,” Craig says. “It was a new process, and people weren’t used to it. So, we deployed extra resources to assist those patients who were really confused or boisterous.”

The practice also publicized the new policies on its Facebook page and Web site — which also includes downloads of several forms related to the policy — and confusion diminished over time.

With the new technology automating payments from start to finish, the practice revamped its processes to maximize efficiency and incorporate a more consumer-friendly approach. For example, previously, patients signed a form agreeing to pay the outlined estimate before scheduling surgery or a procedure. While the practice attempted to collect some funds, the patients typically weren’t billed beyond their co-pay until a claims payment was received. Now, the patient’s financial responsibility is thoroughly reviewed prior to scheduling their procedure, and the practice collects a co-pay, full payment, or partial payment. If patients don’t take care of their bills up front, they are asked to enroll in the automated payment plan.

A Win-Win For The Practice And Patients
The automated payment plan has benefited both practice and patients, Craig says. Previously, staff relied on the practice management system to generate a coupon book. Patients then mailed their monthly payments along with the coupon. Now, patients provide a debit/credit card number or bank draft information at enrollment, and their card or account is charged at predictable, predetermined intervals. Patients can choose a three-, six-, or 12-month plan depending on the amount of their bill. “To help patients, we also offer budget-friendly options such as 90 days same as cash,” Craig says.

While it is still too early to fully measure the financial benefit of the new system, on the surgery side Craig says the practice is tracking an 18 percent increase in revenue, while collection costs are declining significantly. In addition, her billing team is more effective and can focus on proactive and current efforts as opposed to chasing down delinquent payments.

“The 150-day overdue bucket was the one no one wanted to deal with. Now, with automated systems, our accounts receivable backlog is going down. The focus now is to collect everything when it is fresh.”

The practice is also adopting e-statement technology — eliminating the vast majority of bills delivered via snail mail. Craig estimates a savings of $2,000 to $3,000 monthly in reduced paper and mailing costs.

“The whole mail-a-statement-and-wait-for-a-check process is not very efficient,” she says. “Now we can bill electronically, and people are set up on automatic payment plans. Overall, the system has made us more efficient, provided peace of mind, and significantly improved the revenue cycle.”