Patient-First Billing: Key Challenges and Strategies

Jan 01, 2023
Article Background

Patient-first billing is becoming increasingly prevalent as more patients find themselves responsible for higher payments, due to either a lack of insurance or high-deductible plans. There are steps healthcare teams can take to simultaneously ease the burden on patients and collect more payments.

Traditionally, medical billers have focused primarily on payer reimbursements, with less attention paid to the minority of patients who self-pay for their medical bills. Today, though, more patients lack insurance or are saddled with high-deductible plans, increasing their payment responsibilities. Collecting debt owed can be challenging in the best of circumstances, but it’s especially difficult when healthcare accounts receivable (A/R) teams must work directly with patients versus payers.

Challenges Associated With Patient-First Billing

It’s usually easier to collect from a payer than a patient, which is why providers tend to focus their attention on payers.  Confusion about a medical bill may be one of the biggest problems of patient-first billing. Patients may not understand how to read their medical bill or find themselves confused about how much they owe — so they simply don’t pay. Patients also may be surprised by or disagree with the charge amount, which leads to additional conversations and more delays in payment. The longer it takes a patient to pay their bill, the greater the likelihood that the healthcare team will need to send the amount to collections for further assistance. Unfortunately, the more a patient owes in this scenario, the less likely they are to pay, further compounding the A/R issue.

Easing the Challenges of Patient-First Billing

There are several ways to ease the challenges presented by patient-first billing. One of most important steps is to ensure charge transparency, which is the premise of the No Surprises Act. The No Surprises Act seeks to protect patients from surprise bills, often associated with emergencies or treatment by out-of-network providers.

Other measures include:

  • Have a patient liaison explain charges pre-service, make follow-up calls, and answer patient questions or concerns.
  • Collect 50% of the anticipated charges before treatment.
  • Use paperless billing to reduce administrative burden on staff members.
  • Customize billing according to a patient’s situation, offering multiple payment options.
  • Make it easy to pay through various channels, such as online patient portal or text-to-pay.

These steps are a great way to alleviate the burden from patient-first billing, but for some healthcare providers, they may not be enough. It’s often difficult for healthcare providers to keep up with rising patient debt, constantly changing medical codes and regulations, and staffing shortages. That’s why many providers and practices choose to outsource their accounts receivable and other administrative tasks to an experienced third-party revenue cycle management (RCM) team, like TruBridge.

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Advantages of Outsourcing RCM

Healthcare is, by nature, a high-stress and high-volume profession. Providers and healthcare staff are busy keeping up with healthcare trends and innovations, as well as focusing on patient care, outcomes, and satisfaction. Having to worry about RCM tasks can distract them from their mission and take up valuable time better spent on hands-on patient care.

A third-party RCM partner can serve as an extension of your team, following up on self-pay obligations early, efficiently, and effectively. Your RCM partner can audit your patient billing practices and procedures to find inefficiencies, redundancies, and ways to improve processes. They also can reduce your health team’s burden by answering patient inquiries and minimizing complaints. Plus, because your RCM partner is focused solely on your accounts receivable needs, they will be keenly in tune with the current rules and regulations aimed at keeping you in compliance.

If you are looking for a partner who can help you take control of your patient-first billing, we can help!