Reprinted with permission for six months from MGMA. MGMA Connection, Vol. 16, No.7.
02/08/17
Fi n a n c i a l M a n a g e m e n t
Reassessing patient
collections policies
In this era of the continual shift of financial re-
sponsibility to the patient with higher deductibles
and delayed payment of coinsurance, the standard
approach has been to collect from patients before
scheduling surgeries to protect the practice and
eliminate the need for collections after the surgery
is completed.
However, extenuating circumstances may cause
you to reconsider collecting surgery deposits at the
time of scheduling. Our practice is a part owner of
a hospital where we treat about 90% of our cases.
We discovered that the hospital typically bills
for its services within 24 to 48 hours, whereas it
usually takes our physicians 48 hours or more to
submit their charges to the billing department.
The billing department then reviews the notes,
checks the coding levels and reviews for accuracy
before submitting the charge.
The history of our claims submission processes
indicates that our charges are normally submit-
ted between five and seven days after the date of
surgery. One could say that we have an issue with
taking so long to get our charges out, but believe
me, I have tried to shorten it with minimal success
from the physicians.
We have been quite successful with getting
about 90% of our patients to pay estimated surgery
©2016 MGMA. All rights reserved.
New media for your profession MEMBER PERSPECTIVES
charges. We have also found that nearly 100% of
the time, the hospital is paid before the practice
so the deductible falls to the hospital charges. The
By Rick Weymier, MBA,
FACMPE, MGMA member
early part of the year is when deductibles reset, ACMPE
Fellow
thus it would make sense to be especially diligent
at this time to capture surgery deposits.
During the first quarter of 2016, we ended up
refunding about 90% of the money we collected
for surgery deposits because the hospital claim
was paid first. Following are the takeaways from
our experience:
1. Perform a detailed analysis of your hospital and
ambulatory surgical center (ASC) relationships
to identify their claim submission protocols.
2. Assess your refund activity to see what percent-
age of refunds relate to your surgery deposit
process.
3. Consider implementing a process to wait five to
seven days based on what you find out from the
first recommended step.
4. Revise your policy to consider collecting only
the coinsurance portion assuming that the de-
ductible will be met through other providers.
5. Implement a process to run a daily report of all
post-op visits where there is a patient balance,
and meet with that patient at time of check-in to
settle any balances. »
MGMA Connection • September 2016 • p a g e 2 7
 Reprinted with permission for six months from MGMA. MGMA Connection, Vol. 16, No.7. 02/08/17
Fi n a n c i a l M a n a g e m e n t

MEMBER PERSPECTIVES New media for your profession

»
6. Create an expanded financial policy so that when you
schedule a surgery, you inform a patient that he or she
is not required to make a surgery deposit, but needs
to affirm a commitment to pay any amounts due upon
notification from the practice that the claim has been
processed and there is a balance due, if applicable.
7. Consider adding this to No. 6: In lieu of a surgery
deposit, request a credit card number from the patient,
who authorizes you to charge remaining deductibles or
coinsurance upon receipt of the explanation of benefits
(EOB).
This might not be applicable to every practice, depend-
ing on processes and relationship with the hospital or
ASC. But there can be positive results from modifying the
surgery deposit process, such as:
1. Streamline front-end. The work of posting deposits, seg-
regating them from revenue until the EOB is received
and issuing refund checks is eliminated.
2. Avoid credit card fees. Many refunds are made by
refunding a patient’s credit card. Some credit card
processors charge a fee when you take payment from
a patient, but there is no accommodation when you
refund the money.
3. Improve patient relationships. Many times the hospital
pursues the patient balance instead of the practice.
We are going to revise our processes for the next 90 days
to stop collecting deposits at time of surgery scheduling,
continue with the five- to seven-day lag before submit-
ting charges and enhance our patient responsibility form.
We anticipate that this will free up a minimum of one
full-time-equivalent to devote to other, more productive
activities.
Rick Weymier can be reached at
rweymier@wbcarrellclinic.com.

Learn more about this topic with our e-book, “The Physician Billing Process: Navigating Potholes on the
Road to Getting Paid, 3rd edition,” mgma.org/store, Item E8912.

p a g e 2 8 • MGMA Connection • September 2016 ©2016 MGMA. All rights reserved.