Getting money over the front counter

Episode 19: Getting Money Over the Front Counter

In our last episode, we talked about powerful questions that your front office staff can ask to be sure they are getting the most accurate information into your billing system for clean claims.

Today, we’re going to talk about the most powerful question they can ask to collect money over the front counter.

We’ve trained our patients over the years that they don’t have to pay for their visit for several months AFTERWARDS… wow… I don’t know of any other industry that allows its customers such lax payment terms!

In doing this, you are effectively making interest free loans. Don’t.

We always recommend that our clients have their revenue cycle and front office teams scrub schedules ahead of time, identify patients who have outstanding balances over $50 and FLAG them for the front office staff. Revenue cycle and front office staff should work together to make sure they will address any patients with overdue balances.

When patients check in, your staff should say quietly and respectfully, “Hello, X, we’re so glad to see you today. It looks like you have an outstanding balance of $75 with us – how would you like to take care of that today?”

You’ll note it’s not a yes or no question, it is “how” would you like to take care of that. It’s assumed that they will, and you’ve now powerfully moved them to a different choice point: how will they handle it. Not will they pay it today.

Many front office people are uncomfortable asking for money – will patients get mad or push back? The vast majority are happy to handle it and will hand over a credit card without another word. A very small percentage of them will balk and push back.

Here’s what we recommend for them:

  1. Create a script for your front office folks including the fact that your insurance company contract requires you to collect the copayment or coinsurance from the patient as part of their benefits
  2. Empower your front office team to tell a patient that if they’re unable to take care of an outstanding balance today, they can have the patient speak with your billing office or manager who can arrange a payment plan for the patient
  3. Have a policy for your staff if a patient refuses to pay and SUPPORT them! It’s important to let them know clearly what your policy is and that you have their back.
  4. Also tell staff they do not have to tolerate any patient who is rude, disrespectful, or using profanity. They can be invited to leave and come back when they’re in a better space. This is especially important for your team to feel safe and appreciated. The front desk isn’t always the most fun place to work.

Best practice is to get a credit card or other form or payment on file for EVERY patient. Be kind, customer-oriented, and FIRM. They are receiving a service of value from you TODAY. They should expect to make payment for that TODAY. Not a few months from now… those days are over.

Part of this is incumbent on you as the practice owner. Make it VERY easy for patients to pay you. It’s best to have multiple ways in which they can do so: online portal, credit card on file, and as a last resort, checks or cash.

We also recommend that you harness the power of text messages – as we said in a previous episode, use them to make appointment reminders and confirmation, AND for sure, use them to send patient statements. There are many HIPAA-compliant tools out there and this speeds payments up!

Texting may seem a bit advanced to you, but I strongly encourage you to get that in place. And, I’ll put on my patient hat for a moment for a special note that if you don’t yet have an online payment portal, you are well behind in the industry, and you are missing many opportunities for patients to pay you. My daughter’s dentist does not have an online payment option. Since I can rarely find my checkbook anymore, my only other option is to write down my credit card number and mail it in (not happening for obvious security reasons), or call them during business hours and give them a payment over the phone. Needless to say, I’m usually in meetings most of each business day, so that payment may not get paid as timely as if I had an easier way to pay them – at say, 10:00 PM – when it occurs to me to handle that.

So, once you have a credit card on file for every patient, how do you take that to the next level? We strongly encourage a workflow that has your front desk gathering a signed authorization from each patient to charge their card up to a certain limit when the EOB is returned from their insurance company. This requires a form and some training for your front office. Again, this is a huge convenience for the vast majority of your patients. Like me, they don’t want to be bothered by another bill, and if they can pay via text, or authorize you to charge a card ahead of time, most folks will be happy that you asked.

The workflow for this includes scanning in that signed form, or better yet, having them sign electronically, and then once their EOB is processed by your billing team, you can message them what their outstanding balance is. If they’ve already authorized an amount higher than that, you can thank them for their authorization, and let them know that you’ll process that payment in two days’ time, which gives them an opportunity to contact you if they want to make other arrangements. This saves the time and money of sending out statements and speeds your cashflow immensely. And again, the vast majority of patients will see it as a service enhancement.

This shift does ask a bit more from your front office, and as we said in our last episode, the front office is frequently a tough place to work. You’ll want to be sure you have good systems in place, good training, good scripting, and above all, excellent support of your front office folks when they’re trying to do the right thing.

Your practice management system should be able to tell you what the total amount is that should be collected by each staff person each day based upon who they checked in. You can use this to reward highly performing staff, and to provide extra training for those who need it. This is a vital role to the overall health of your practice, and I encourage you to get more involved…stop by during the day to see how they’re doing… say “thank you” to them for all of their work… and above all else, support them as they have a pretty hard job.

Join me for our next episode, where we’ll talk more about Deductibles, Coinsurance and Copayments.

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