Posts Tagged patient collections


It’s Not Too Late to Launch CCOF on January 1st

Plan Your 2017 Collection Strategy Using CCOF

High Deductible Plans and CCOF Are Becoming Mainstream

When we first starting teaching practices how to implement credit card on file (CCOF) in their practices in 2010, only a few practices had ever heard of it. Today, we get calls weekly from practices who need help collecting patient balances, especially from patients with high-deductible plans, many whom do not understand how their plan works. Note that almost 25% of persons covered by employer health plans are enrolled in high-deductible plans, and almost 90% of enrollees in the healthcare exchange (Affordable Care Act Marketplaces) have a high-deductible plan!

The time-honored tradition of sending patients monthly statements and allowing them to pay on their own timetable has increasingly become untenable for medical practices, especially small practices that have limited financial resources to wait out patient payments. Physicians are paying their staff, medical supplies, utilities and rent monthly while waiting for insurance plans to pay in 30 to 45 days and patients to pay anywhere from 60 to 120 days or more past the date of service.

Having the Talk With Patients

Credit card on file opens the patient payment dialogue by changing the conversation from “We’ll send you a bill when insurance pays their portion” to “Once we receive the insurance Explanation of Benefits (EOB), we’ll charge your card for the patient-responsible balance. If the balance is over $____, we’ll call you to discuss your payment.”

On January 1st, the deductible starts afresh for most plans, and any practice not using credit card on file to collect those deductibles is in for a particularly tough quarter – what I’ve always called “The Black Months”. With the size of deductibles however, many practices are in for another tough year. Contrary to plans of the past that applied the deductibles only to very high-priced services or hospital events, many deductibles apply to office visits, medications, labs – essentially every healthcare service one can have. Some patients will never meet their deductible and will be paying your practice out of their pocket for every service all year long.

Is 2017 the year you streamline and improve patient collections?

It’s not too late to get it together to launch your program now to be ready for the new year. Here are the steps:

  1. Integrate software that allows you to keep patient credit cards on file on an offsite, secure, third-party server as an add-on to your current merchant services (credit card processing). Call your current credit card processor to see if they have CCOF, but be careful – there is a lot of confusing language around the CCOF part and CC processing charges. My recommendation for CCOF software is here.
  2. Educate patients on the change. Inform and educate patients about your new policy between now and when you launch.
  3. Rewrite your financial policy to include CCOF. If no one ever reads your financial policy, now is the time to make it simpler and clearer.
  4. Educate the staff. Explain why you’re making the change, how it works and how to communicate with patients that might have questions.
  5. Change your patient scripts to include CCOF language when you schedule and confirm appointments.
  6. Get rid of patient statements. Decide how you will handle current patient statements to clear those balances. You eliminate statements when you implement CCOF.
  7. Determine your philosophy. How are going to deal with patients who say they don’t have a credit or debit card, or refuse to give you their card to place on file? Most practices will lose a few patients, but it is always less than you expect. Most patients who refuse are patients who never intended to pay you anyway!

I ask physicians this question:

If you collected the same amount of money each month whether you saw 500 patients who paid you part of what they owed, or 350 patients who paid you everything they owed, which would you prefer?

Of course, every physician would love to see less patients, having more quality time with each patient! What’s wrong with having a practice full of patients who agree to pay you what they owe? FYI, CCOF does not mean you cannot also serve patients who need help with medical expenses – that’s a different conversation!

For more information and help, see our CCOF page here, or watch this 30-minute YouTube video here.

NOTE: I use the term “credit card” in this article, but you can accept, if you so choose, debit cards, health savings account cards, flexible spending account cards – even gift cards.

Posted in: Collections, Billing & Coding, Day-to-Day Operations, Finance, Innovation

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The Single Most Important Thing You Will Do to Improve Your Accounts Receivable in 2013

If you could improve your patient collections from $600 a week to $6000 a week, would you do it? Of course you would! These numbers are from a Manage My Practice client who is collecting between $2500 – $3000 per day in a solo primary care physician practice with the Credit Card on File program.

Establishing a Credit Card on File program in your practice will significantly increase your practice’s cash flow, significantly decrease your accounts receivable, and reduce your patient collection expense immediately! (more…)

Posted in: Collections, Billing & Coding, Day-to-Day Operations, Finance

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How to Develop a New Financial Policy For Your Practice: A Short Course

I’ve had lots of questions about financial policies since I did a webinar on patient collections last year.  Here’s a short course on developing a new financial policy for your practice.  The topic is addressed more comprehensively in my book.

I dislike financial policies that are long and wordy.  I prefer a simple format that everyone can understand and use.

The format I recommend is one with three columns titled:

  1. Your Plan
  2. What You Do
  3. What We Do

Here’s an example of how the three columns would read:

Your Plan


What You Do

Pay your deductible ($155 for 2010) and co-insurance (20% of the allowable.)

What We Do

We will file Medicare for you.

I use the front of the financial policy to list all the variations of plans that the practice accepts.  For instance, the Medicares might include:

  • Medicare
  • Medicare/Medicaid
  • Medicare/supplemental policy
  • Medicare Advantage Plan (HMO/PPO)
  • Medicare Advantage Plan (PFFS)
  • Medicare secondary (MSP)
  • Railroad Medicare

Lump together any like plans that you will treat the same.  Then decide what you will expect from the patient at time of service or after, and what the practice commits to doing. Don’t forget to address patients being seen out-of-network and self-pay patients.

I use the back of the policy to cover everything that you would like the patient to sign off on. This could include:

  • Receipt of Notice of Privacy Policies
  • Receipt of Advance Directives/Living Will info
  • Agreement to Financial Policy
  • Assignment of Benefits to Practice
  • Guarantee of Payment

When you put a new policy in place, you have a number of options to educate patients. Here are some:

  • Put the policy on your website.
  • Send a copy of the policy to all new patients.
  • Discuss the policy when you call patients to remind them of their appointment.
  • Discuss the new policy at check-in and/or check-out and let patients know it will be in effect at their next visit.
  • Circle the patient’s plan on the front, have the patient sign the financial policy on the back, and give them a copy to take with them.

How you decide to educate the patients will depend on how much time you have between making the appointment and seeing the patient and the type of practice you have – primary care versus sub-specialty.

Also, don’t forget to educate your staff.  If they have not had to discuss money before, they will need some coaching and some practice.

If you’d like a free copy of my sample financial policy, shoot me an email at

Posted in: Collections, Billing & Coding, Day-to-Day Operations, Finance

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A Sneak Peak at My New Book: Step-by-Step Instructions for Collecting Patient Balances in Your Medical Practice

From the Introduction:

It has never been more urgent or more difficult to collect patient-responsible balances.  The combination of high-deductible health insurance plans increasing in popularity and the massive loss of medical benefits creates a pressing need for medical practices to re-evaluate patient collections.  A strong collections program and the timely collection of patient balances are critical to the viability of the modern healthcare practice – important to the communities served as a source of patient care and a contributor to the local economy.

Healthcare has traditionally been a care-first and collect the money later type of business.  Traditionally, payments from insurance companies were enough to keep medical practices viable, and many practices did not worry about patient collections.  Today, the financial responsibility for payment for health services is swinging further and further toward the patient, and often without many patients  understanding what is happening.

The Practice Should Assume Responsibility for Being the Insurance Expert for the Patient
Learn the payers, learn the plans, and help the patient understand what coverage and financial responsibilities they have.  This book does not focus on filing claims, but insurance cannot be separated from the total payment process.  To know the patient-responsible portion, the practice must know what the insurer/payer will pay.  The ideal relationship is one where the patient relies on the practice for straightforward, non-biased information about paying for healthcare.

Disclose All Fees and Terms of Service Before the Patient Incurs a Financial Responsibility
Patients have the right to know your prices, compare your prices with other healthcare providers and make an informed decision about spending their money.  It is part of the practice of healthcare that the patient acknowledges (whether they have the means to pay or not) that they have received something of value.

Remember ”“ Your Practice Is In the Business of Compassion
Patients are not buying televisions or cars from you, they are buying the most important thing in the world ”“ good, quality healthcare services and advice.  Whether you believe that healthcare is a privilege or a right, always temper patient collections with the knowledge that paying for healthcare for themselves or their loved ones is a personal and often emotional transaction.

The Book: “The Smart Manager’s Guide to Collecting at Check-Out” $39.95

Released this Monday, November 16th, the book is only available for download here on this website.

This is not your traditional textbook!  It is an eBook  – downloadable in minutes and ready to start using immediately.  It contains bookmarks that make it easy to jump to specific sections,  and you can print only the pages you want.

This book will help any type of medical practice develop a front-end collections program.  The 30 day program can be intense, but for most medical practices, the need to start a patient collections program is so pressing that the sooner the program can be launched the better.

The book addresses the components of setting up a front-end collection program that is ready to launch in 30 days.  Depending on the resources (people, time, energy) that you have in your practice, your program could launch in more or less than 30 days.  Your timetable could change if you have significant barriers or insufficient resources, or if you elect to take the planning more slowly.

An integral part of the book is the calendar that you will use to complete the program within the time frame.  I supply the steps, the worksheets, the templates and the 30 day calendar, and you add or subtract days as needed.  The steps are in order for a reason, but you should rearrange them based on your practice’s needs and resources.

Packed with templates, worksheets and examples, this book leads you every step of the way through designing a program appropriate for your practice or healthcare entity.

In conjunction with the book launch, I will also be unveiling my brand-new website!  My tech guy has outdone himself in designing a more user-friendly and intuitive site.  See you on Monday!

Click here to view “The Smart Manager’s Guide to Collecting at Check-Out.”

Posted in: Collections, Billing & Coding, Day-to-Day Operations, Medicare & Reimbursement

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Guest Post: MGMA’s Bill Jessee Discusses How MGMA Can Help You Meet 4 Key Medical Practice Trends

By William F. Jessee, MD FACMPE
MGMA President and CEO

Spend one day in the shoes of an MGMA member and you’ll experience the challenging, changing environment of a practice administrator. Our industry is always in flux: new healthcare information technology to implement; new CPT and ICD codes to bill; new insurance plans to support. MGMA is changing, too, to support new and current members and help them thrive in the face of change.

While 70 percent of our membership remains directly employed by medical practices, new member trends indicate that about a quarter of all MGMA members who joined in 2009 came from other types of healthcare organizations, including integrated delivery systems (IDS). Also this year, more than half our new members are 45 or younger. More current and new members are attaining or have attained Master’s degrees.

As our membership changes, so does the state of healthcare. Members frequently ask me about current healthcare trends. Here are four we’re watching and what MGMA is doing to support our members during these changes:

  • Larger systems, influenced by the government, to become the norm

In 1975, 68 percent of physicians worked in one- or two-person practices (1).  By 2005, that proportion had fallen to 32 percent and has probably declined more since then (2).  I think group practices will increasingly merge to form larger groups, integrate with other specialties to form multispecialty groups or become fully integrated with hospitals (our new membership numbers reflect this) in order to compete in the marketplace.

Also, much of the Federal reform legislative language favors larger, more complex practices, e.g., incentives for implementing electronic health records, electronic prescribing and quality reporting.  Penalties for not adopting new technology could hit smaller practices harder. There is even talk of exempting physicians in systems from any Medicare Part B payment caps that might otherwise apply.

  • Hospital-owned groups already on the rise

MGMA’s physician compensation survey data indicate the proportion of physicians working in hospital-owned groups has steadily grown over the last several years. Both primary care and specialties are affected. The economic reasons for this are clear: Between 2001 and 2009, the Medicare conversion factor rose only 1.1 percent, while the consumer price index rose 24.2 percent; and median practice operating costs (for multispecialty groups) went up 43.1 percent. No matter the business, it’s a challenge to remain a viable, free-standing practice when revenue is flat and expenses increase by 6 percent or so a year.

This year we’ve ramped up efforts to provide practice management support for organizations that are part of  IDSs. In our various print and electronic member publications, we’re featuring more stories and examples of what it takes to successfully run these health systems, and we recently published a book dedicated to the topic. At the MGMA 2009 Annual Conference, Oct. 11-14, we held IDS-specific sessions that drew more than 900 people, proving this aspect of practice management is here to stay.

  • Practices increasingly collecting from patients

MGMA polled members earlier this year about their top challenges, and collecting from self-pay patients landed at number four (3).  As high-deductible health plans, health savings accounts and uninsured self-pay patients have increased in recent years, collecting the patient’s share of the bill has become a greater challenge. MGMA is completing research on patient collections and we will release results early next year.

  • Healthcare reform on the mind

We couldn’t forget about this topic. Impending healthcare reform legislation means even bigger changes to come ”“ ones that require adaptation so healthcare management professionals and their organizations won’t become irrelevant.

No matter what the outcome, health insurance is likely to expand, and new taxes and/or payment cuts seem likely. MGMA is monitoring the latest developments and sending weekly e-newsletters to members through the MGMA Washington Connexion (membership required.)  Our public policy and advocacy staff in Washington, D.C., is advocating on behalf of medical practices and has sent numerous comments and letters to Congress and the Administration regarding proposed legislation, especially to assure that administrative simplification measures are included in any bill that is eventually passed.

1.    Goodman L, Bennet E, Odem R. Current status of group medical practice in the United States. Public Health Rep., 1977;92 430-433.
2.    Cook R. Finances driving physicians out of solo practice. American Medical News, Sept. 10, 2007.
3.    Schneck L, Margolis J. Medical Practice Today: What you have to say. MGMA Connexion, July 2009, Vol. 9, No. 6, p. 28.

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