August 2000 Bulletin

Good relationship eases bill collections

Tell patients you have a commitment and patient has a responsibility

By Renee Cornwell

Bill collection is everybody’s business, from the receptionist in the front office to the physician in the examining room.

And it begins with how "you talk to patients about money when they first walk into the office," says Renee Cornwell, a consultant for accounts receivable management.

In some offices, the first person to talk about money is the receptionist, says Cornwell, who addressed the annual meeting of the BONES Society in May. The receptionist may simply say, "Mrs. So and So, your co-pay is.... How are you going to take care of that today?"

Many offices have signs that say, "Payment is expected at the time of service."

"Do you want to communicate to your patients when they walk into the office that money is the most important concern you have?" Cornwell asks.

Instead, she suggests displaying a large sign on the wall that states the practice’s commitment to the patient. It might read something like this: We at this clinic have a commitment to provide service to this community and value you as our patient and look for a long-term relationship with you.

"That’s a short version of a commitment," Cornwell says, "because in reality a doctor wants to be seen as a competent, compassionate, committed physician, involved in his community and meeting the needs and services of the people that he serves. He doesn’t want to be known as the money-grabbing doctor who has gold in his pockets."

Cornwell believes that the first important step to setting the foundation for a good collection policy is to be positive with the patient. "Whatever brought him in, regardless of his ability to pay, you are very glad he walked in the door," she says. "The patient will be more positive when it comes to talking about money.

The second step is that the patient should receive a copy of the practice’s credit policy. "The patient should also get a form that he signs and gives back to you about his patient responsibility," Cornwell says. "Why? It’s a relationship. The doctor wants to see that patient and all of his family and friends for a lifetime. So the patient has to feel that you want him there, and it’s not wrong to talk about money when we’re up front and very clear about those issues."

She urges the staff to be discrete about patient information and physicians to communicate fully with patients about treatments and to leave financial arrangements to staff. Often these issues are the catalysts of dissatisfaction and arguments about payment of bills.

Most people who end up in the collection process did not set out to defraud the business, Cornwell says. Accounts wind up in the collection, generally, for two reasons. One, there was a breakdown in communications—something happened within the interaction of the visit, the procedure or the process that either the patient didn’t understand or that hasn’t been resolved. Two, there has been a change in circumstances, such as sudden unemployment. The patient intended to pay, but doesn’t have the money and is too humiliated to give that information freely so he or she ignores telephone calls and letters from the practice. Only a small number of patients set out to receive services with no intention to pay.

The patient has known he or she owed the money from the day of the first visit. "Wouldn’t it have been a good idea for him to begin paying on that co-pay then?" Cornwell asks. She provides this example of how to handle the financial arrangements:

"A woman tells you her husband was in the doctor’s office yesterday and it looks like the surgery is going to be scheduled on the 15th and she needs to know how much it will cost. So you begin to ask the questions about the insurance. How do you finish that conversation, after you’ve asked about the insurance? [You say,] ‘Your portion will be 20 percent of approximately $5,700. How do you intend to take care of that? We accept Master Card or Visa. Do you want to do that today?’"

The patient may ask, "Well, do I have to pay it all?" Cornwell responds, "Well, that’s typically how we handle it." She adds, "Now, am I going to make exceptions to that rule? Everyday."

Cornwell’s philosophy on collections 60-days due: "It doesn’t matter whether you’re working for the bank or whether you’re working for a medical clinic, when we make the first contact, we all want the money today. And, if not today, I want to know how much and when and why I need to wait so I can act appropriately.

"Using effective interviewing skills and proactive listening you can determine what arrangements are necessary, if any, or if it needs more aggressive collections activity. You may discover, based on the information you learn, that you want to adjust the account or you may even decide to write it off. The difference is that you will make your decision from an informed position rather than a pattern of broken promises and/or no response at all to your collection activities."

She offers this approach: "Hi, Mrs. Jones this is Rene Cornwell at XYZ Orthopaedic Clinic. I’m calling because it’s come to my attention that you have an outstanding balance with our clinic that’s in our 60-day column of $260. Our policy is payment at the time of service, but perhaps we needed to bill insurance or you weren’t capable of paying it that day so I just wanted to make arrangements with you. How do you intend to take care of the $260? We do accept Master Card or Visa."

"Well I can’t pay you the full amount today," says Mrs. Jones. "How much are you short?" asks Cornwell.

If she asked how much the patient could pay, the response might be "$20." But she asked how much the patient was short and the response might be, "Oh, well, I could probably send you $150."

Cornwell continues by asking when she could expect the remainder of the bill and when Mrs. Jones gets paid. She then schedules the second payment for a specific date that it will be in Cornwell’s office. If the payment doesn’t arrive, Cornwell makes another call. "The approach now is to discover why; after all they have had more than 60 days to pay or make satisfactory payment arrangements," says Cornwell.

She continues the conversation with Mrs. Jones: "Well you know I’m really limited by the arrangements that I can make with you. My policy is payment in full at the time of the visit, but I really went out on a limb to make arrangements with you and if we engage in arrangements again, I have to know that it’s not something that you can forget.

"Would it be easier for us to just put it on your Master Card or Visa? That way if you needed to make smaller payments, you could just do it with them and you’d have this bill taken care of. Your balance is $260. How do you want to take care of that today?"

Cornwell recommends a policy of payment in full within six months of the service, no matter how big the balance. Within six months, a lot of things can happen. People can lose a job, get a divorce, have a baby or encounter other changes.

There’s a good chance that the patient will need to come back to the practice for another problem after six months. "I don’t want to have a balance outstanding on a previous procedure when a second need arises," she says. The patient may decide to go to another doctor, rather than return to the first practice and be asked to pay the bill.

Renee Cornwell is a consultant in Springfield, Ore.

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