Financial Assistance Service Team - F.A.S.T.


Increased Patient Liability, And Its Impact On Your Bottom Line

Posted by Frank Johnson on December 6, 2016 at 4:20 AM Comments comments (0)

New Research Examines Self-Pay Patients and the Changing Healthcare Industry

Written by: Doug Johnson

New research from athenahealth examines a key challenge facing healthcare providers today: patient pay, which now represents 18% (and growing) of provider revenue.

Patients are responsible for paying more of their medical expenses than in past years. This is due in large part to the significant increase in high-deductible health plans (HDHPs). According to the athenahealth whitepaper, one million Americans had a HDHP in 2005. That number had risen to 17.5 million Americans by 2014, and as many as 40 million Americans are projected to have HDHPs by 2018.


One major issue is that bills are often not paid in full. According to the research, half of healthcare providers are unable to collect at least $23,000 per year. For groups with multiple providers, this lost revenue adds up quickly - $230,000 for a group of 10, $460,000 for a group of 20, and $1,150,000 for a group of 50.


What should you do if this affects your business? The following steps to collect more patient pay are suggested by athenahealth:


Determine your current “Patient Pay Yield” by dividing patient charges in a given month by patient payments collected within five months of service.

Other measures to consider include time-of-service collection rate, self-pay days in accounts receivable, and amount of bad debt write-offs.

Identify the tactics to help increase patient pay that “make the most sense for your practice’s unique situation and needs.” The paper provides detailed suggestions within four areas of focus:

Staff training and accountability: If you thoroughly train collectors on the best ways to collect and communicate with patients, your firm will likely see an increase in collections. Keep an eye on everyone's performance and reward those who do well.

Pre-visit collections strategy: Take time to review a patient's account before discussing payments if they have a large outstanding balance. Try to estimate a patient's financial obligation as best you can - if you communicate this information to the patient before a procedure, it increases collection rates.

Time-of-service collections: Offer payment plans to patients with big balances, so that they can pay more easily over time. Being flexible in this way leads to an increase in collections. Collect down payments when the total cost of a procedure is unclear. If a patient agrees to it, keep their credit card on file and allow them to check-in digitally with an option to pay their outstanding balance online.

Ongoing collection efforts: Follow-up with patients to discuss payment on unpaid accounts - if you fail to collect after reaching out, send the account to a collection agency.

Additionally, athenahealth suggests the following key considerations when choosing tactics:


How would you best describe your organization? If you’re larger, it’s important to have a consistent approach. If you’re smaller, focus on reliable and low-effort tactics.

If patients visit you infrequently, focus on getting paid up front. Those with high-cost visits should offer payment plans and follow up with patients.

Consider the level of insurance coverage of your patients.

Consider whether your patients carry large outstanding balances.

insideARM Perspective


Self-pay and the changing relationship between patients and their medical bills has been the subject of more research recently, as covered by insideARM.


The Healthcare Financial Management Association (HFMA) found the following:


Patient payment is rising, with hospitals seeing a 10% increase in self-pay dollars during the past five years.

More hospitals have mandatory pre- or point-of-service collections processes for outpatient services, with that number rising from 9% of hospitals in 2009 to 32% in 2015.

About 20% of respondents indicated “high capabilities for pricing and patient education related to billing and administrative expectations,” showing there’s plenty of room for hospitals to educate patients more about this topic.

About 17% of respondents indicated “high capabilities for pre-service automation, forecasting, and prioritizing financially eligible patient accounts."

When it comes to engaging patients about paying for their health care, respondents rated pre-service pricing as the most important priority.

When it comes to engaging patients about paying for their health care, respondents rated pre-service pricing as the most important priority.

HFMA also included numerous “Focus Areas for Self-Pay Process Improvement” for healthcare providers to consider when determining their self-pay policies and procedures, such as:


Use patient-friendly communications and consistent messaging.

Give patients access to payment estimates at or before time of care.

Engage with patients early about issues and options when it comes to paying the bill.

Ensure patients have access to financial counseling.

Learn, benchmark, and share best practices.

When is "enough", really enough?

Posted by Frank Johnson on April 28, 2010 at 4:28 PM Comments comments (0)


James T. Herst


Experience is often the best teacher. When working with clients, I find that the most appreciated lesson I can deliver is showing how to determine when to deem an account delinquent.


Too often, businesses start thinking "delinquent" 5 to 15 days past due. Yet, most credit managers admit that they can suspect who will be past due.  Thus, it only seems logical to suggest that chronic abusers should be identified and isolated at the time credit is granted again -- when the next order is received. This is when the collection process should begin.


Here's how:

  • Upon receipt of the order, place a call to remind the customer of your terms and ask if these terms will present a problem.
  • Upon shipment, place another call to let the customer know that the invoice is on the way, and emphasize the due date.
  • A third call, to verify the receipt of the goods and invoice might also be appropriate.
  • Finally, place another call five days before the invoice due date and ask the customer "Are you thinking about the money that is due next week?"
  1. Once you deem an account to be past due, or even suspect that it will be past due, begin collections activity immediately.
  2. Select a date beyond which you will no longer work with the account for collection on your own. (It has been my experience that any collection effort extending beyond 45 days from the date you initiate recovery efforts will be wasteful.)
  3. Make four or five contacts on your own, up until the date you have selected. These contacts should follow a series of clear steps that you have determined in advance. These steps, taken in sequence, represent a firm, relentless, professionally executed path toward internal recovery.
  4. If the account is not paid by the date you have selected, seek third party assistance. A good third party collector can be an adjunct that enhances you and your business. There is no stigma in using this service as long as the collector you choose acts professionally. In addition, handing the account to a third party collector leaves you time to begin working on newly delinquent accounts or generating new business.


Paying off collection account and credit history

Posted by Frank Johnson on April 28, 2010 at 4:03 PM Comments comments (0)

If you have an account in collections and pay as agreed, does your credit rating go up? Well...

By Sheryl Harris, The Plain Dealer

April 25, 2010, 12:00AM


The Question: They say the best thing for your credit report is to pay bills on time. I draw a pension but am unemployed, so I'm behind on a lot of bills. Some have gone to collections, where I've made payment arrangements. Since I'm paying those as agreed, am I considered to be paying on time?

Also, some things will "age out" of my credit report this year. Will my credit rating go up because the report lists fewer bad accounts, or go down because they haven't been paid?

--Roger Norris Painesville


The Answer: If you work out a payment arrangement with your original creditor and pay as agreed, your creditor will report your payments as on time.

Even if you've messed up in the past, if you can get on track and make your payments on time, every time, your credit rating will go up.


Collections, though, are a different matter.

Having an account go into collections creates a scuff mark on your credit report until the debt is paid off, says Jeanne Morton, who helps people mend poor credit in her work with the Cleveland Housing Network.


Debt collectors don't report monthly payments – which is probably good news to many debtors.


Morton says you're doing the right thing by attacking those old debts. "You're better off taking responsibility and dealing with it instead of trying to find a way out," she says. "There are too many things that wind up following you. Debt, you want to get out of your life."


If your debt has been sold, you may be able to settle for a fraction of what you owe. If you negotiate a lower settlement, ask the collector to give you something in writing that confirms that your payment will settle the debt in full. Otherwise, the remaining debt could be sold and you'll get new rounds of collection calls.


Derogatory information like charge-offs and collections accounts must be removed from your credit report seven years after the creditor notifies you that you're delinquent or puts the account in collections, according to the Federal Trade Commission.

Bear in mind, collectors can still try to get you to pay a debt even after it can no longer be reported. (There's a different clock for that.)


There are some exceptions to the seven-year credit-reporting rule. Bankruptcy information can stick around 10 years.


Unpaid judgments, the Federal Trade Commission says, stay on your report seven years or until the statute of limitations runs out, whichever is longer.


Be vigilant about checking your credit reports, because you have a right to have wrong information corrected.


Will your credit improve once bad accounts age off?  It depends.


If you still have some well-tended old accounts, maybe.  But if all your accounts are in collections and get wiped off your report, you might end up having no credit history, which can make it almost as difficult to borrow as having a poor credit history.  So as you try to get squared away on your debts, start working toward re-establishing good credit.

Consumer Wise Building good credit is a slow process.


Start with the basics.

• Request your free annual credit report to make sure it's correct. To get your free reports, you must go through the three credit bureaus' shared site,, or call 1-877-322-8228. You're entitled to one free report from each bureau every 12 months, but if you find errors, you can get an additional free report when your report is corrected. You'll need to provide your Social Security number to get your report. Don't waste money buying your score.

• Take care of your existing credit accounts and loans. A ding on your credit in the past counts much less with lenders if you can show that you have steadily been paying on time, every time, ever since. Make paying down high credit card balances a priority, and try to avoid high-cost credit like cash advances.

• Open a savings account with a credit union or bank and then add a checking account, taking care not to overdraft. It's sometimes easier to get a credit card or loan from an institution with whom you have a good history.

• Learn to manage money so you don't fall back into bad credit habits.


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