Patient Financial Services: Challenges & Opportunities in Patient Payments

The combination of increased premiums, higher deductibles, and larger coinsurance payments have many patients and families struggling to cover their share of healthcare costs, resulting in difficulty making payments, and in some cases, delays in seeking care. The Kaiser Family Foundation 2021 Employer Health Benefits Survey found that more than 85% of covered workers have an annual deductible of $1,669, which is 13% higher over the past 5 years, and 68% higher over the past 10 years. In addition, the survey found that for most, coinsurance rates are currently 19% for primary care, 20% for specialty care, and 20% for hospital admissions, representing another challenge for individuals and families facing increased costs across the board.

Physician practices, hospitals, and health systems are also facing the challenge of collecting a higher proportion of payments from patients directly, a transition from traditional care models where the vast majority of payments have been in the form of reimbursements from payers. In addition, efforts to increase transparency, provision of care estimates and compliance with the No Surprises Act all weigh heavily on patient finance and revenue cycle teams already facing resource constraints.

Patient Estimates & the No Surprises Act

To understand the cost of care planned, many patients are provided with estimates, which may or may not accurately reflect the ultimate bill, due to changes in provider plans at the time of treatment. While every effort is made by patient estimate teams, not all treatment plans progress as they might on paper, resulting in changes to bills, denials from payers for un-authorized care, and in some cases, higher coinsurance payments required from patients. Compliance with the No Surprises Act also becomes quite difficult and complexity only compounds as healthcare professionals take into account the evolving interpretation of the rule, as well as state-specific regulatory requirements.

Patient Education, Financial Counseling & Payment Plans

Addressing the issue of increased self-payments from patients, many hospitals and health systems are deploying a combination of education, counseling, and payment plans in order to ultimately collect payments from patients. Educating and counseling patients on responsibilities including deductibles, co-payments, and co-insurance creates a greater understanding and in many cases increases the level of satisfaction by patients. In addition, many providers are initiating discussions surrounding payment plans at the earliest stages of care planning, giving patients a low-cost route to paying for care over a longer period of time through financing opportunities.

Automated & Online Self-Payment Opportunities Increasing A/R

Providing patients with multiple avenues and methods to pay balances due, as well as automated communications through multiple channels including phone calls, text messages, emails, and patient portals are all being leveraged in order to collect patient payments in the most convenient way for patients. Many hospitals and health systems are seeing increased engagement in payments through expanded portfolios of payment options, while maintaining paper billing and even cash-payments for patients uncomfortable with online or digital payments.

Patient Financial Services – an Online Event

The Patient Financial Services event taking place live online this October 11 & 13 will provide attendees with an opportunity to collaborate and share best practices on these topics, and more, in an engaging and condensed online format. Interactive small group discussions led by experts from UC Davis Health, Brigham and Women’s Hospital, Olympic Medical Center, and more will delve into these topics creating a unique chance to collaborate with peers from the comfort of your own office. Registration through the Hopin platform is $50 for healthcare executives and $200 for solution providing partners.

Join us, to become part of the equation for change.

Leave a Comment

Your email address will not be published. Required fields are marked *