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Surgery Center Best Practice: Clearly Communicate and Confirm Patient Financial Responsibility Prior to Day of Surgery

Ambulatory surgery center industry experts regularly preach about the difficulties ASCs face when attempting to collect co-pays and deductibles following a procedure and patient discharge. If the payment isn't collected up front, there's a good chance the surgery center will never collect it or will only collect a small fraction of what is owed. ASCs should not assume they will collect from patients on the day of surgery unless the patient is told how much they will owe and can come prepared to cover that cost, says Rob Morris, vice president of marketing and new business development for GE Capital's CareCredit, a third-party payment plan provider.

 

With increasing deductibles and co-pays, ASCs are asking for more money directly from patients, making it even more critical for surgery centers to inform patients of their responsibility as early as possible to allow the patient to secure the funds needed to cover the facility fee.

 

An effective way of doing so, and one Mr. Morris has seen some of his clients use, is to parlay the routine phone call made to patients a few days in advance to discuss the particulars of their procedure and responsibilities leading up to it into a discussion concerning the patient's finances. The topics discussed during these calls typically include insurance verification, patient history, confirming time and location of the procedure, what the patient can eat or drink prior to surgery and what the patient should bring to the ASC. After those responsibilities are discussed, the patient is then transferred to a member of the business office to discuss what they will owe for the facility fee.

 

"That phone call is a good qualifying opportunity," says Mr. Morris. "Patients are often surprised that they'll be charged separately by the ASC. They might assume the cost is included in the surgeon's fee."

 

This approach is used by Upper Cumberland Physicians Surgery Center in Cookeville, Tenn., according to Pat Brown, business office manager for the ASC.

 

"We tell them that it is an estimated cost and we're very adamant about saying this is for the facility, this is for us only," Ms. Brown says. "We remind them that they are still going to have a bill from the doctor's office and anesthesia office. Sometimes they are aware of it, sometimes they're surprised by it."

 

Confirm patient's understanding

Mr. Morris says there are a few important steps to take to ensure patients truly understand their financial responsibilities to the ASC.

 

"ASC should have a financial policy and follow it," he says. "They should say to the patient, 'You're going to owe us $1,100. We accept cash, check or credit cards.' Give them an opportunity to commit to one. If they say they're going to come in with a check, [the business office staff member] should repeat that.

 

"It's the same thing done at a restaurant when a waiter repeats an order," he says. "Reinforce with that patient through a verbal commitment that they'll be there that day with the $1,100."

 

If there's time, send a letter

If Upper Cumberland Physicians is able to determine the approximate facility fee patients will owe well in advance of the procedure, the ASC will usually send a letter indicating the amount and telling patients if they can't pay the amount in full on the day of surgery to contact the facility.

 

"If the letter goes out and we don't hear from them, we generally assume they're going to pay in full because it states it right in [the letter]," Ms. Brown says.

 

Offer payment alternatives

Ms. Brown says patients will often express concern about their ability to use traditional means of payment (cash, check or credit card) to cover the facility fee, which is why Upper Cumberland Physicians has two payment plans it can set up with patients in advance of the procedure.

 

Upper Cumberland Physicians' preferred alternative is a third-party payment plan (which, in this ASC's case, is CareCredit). The third-party payment plan is essentially a healthcare-dedicated credit card which allows a patient to pay off what they owe over a 6-60-month period. CareCredit plans start for patients at Upper Cumberland Physicians who will owe $300 or more.

 

"It gets the patients off of our books and we don't have to worry about them and I don't have back-door collections to worry about," says Ms. Brown. "If I get them on CareCredit, they're CareCredit's problem."

 

Upper Cumberland Physicians has a second alternative for patients: an in-office payment plan.

 

"The in-office comes into play if they really insist they don't want CareCredit or if they try to apply for it and they're denied," Ms. Brown says. "Then if it's under $300, we'll try to break it down for them for up to four months, with the first payment due on the day on service."

 

She says the in-office plan is a last resort. "The ones who set up the payment plan with us, if they owe $100 and then only send us $50, now I have backdoor collections going on and I have to work a little harder at it," she says.

 

Regardless of what payment options an ASC offers patients, all facilities need to take a proactive approach to collecting payment before a procedure is performed.

 

Learn more about CareCredit.

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