Two-thirds of Physicians Responsible for Own Pay Cut

A survey released June 15 by NaviNet Inc. suggests more than two-thirds of all physicians will receive one of the biggest pay cuts this year because of their own doing.

A National Association of Healthcare Access Management (NAHAM) report shows the probability of a provider collecting the full amount of patient payment drops to less than 20 percent after the patient leaves the office. And yet, 49 percent of the 1,279 physician practices, medical billers, and billing offices who participated in NaviNet’s May 2009 survey confessed they are unable to estimate the amount due at the time of care other than a predetermined co-pay. Thirty-one percent of surveyed providers said they lose revenue due to uncollected patient payments.

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“For health care providers, managing revenue must be as much a core competency as the delivery of services, and needs to become more proactive and disciplined,” said Vi Shaffer, research vice president at Gartner. “With patient self-payments on the rise, verifying eligibility/necessity, accurately estimating obligations, and then cost-effectively collecting the patient’s portion of the bill at the time of service is becoming quite crucial.”

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What are the 51 percent of surveyed participants doing to identify their patient’s financial responsibility at the time of care?

According to an AMNews report on amednews.com (Elliott, July 20), some practices use tools to estimate the patient’s share of the claim. Others hire a firm to work out the amount owed at the time of care. And some just pick up the phone and speak to the patient’s insurance company directly.

Another option is to use real-time claims adjudication. This can get sticky, however, if you’re not familiar with all the various insurance policies. Not all insurance company contracts allow physicians to collect more than the copay until after a claim has been adjudicated.

“Staff have got to be trained to understand the various programs that insurance companies are offering their patients,” Kenneth Hertz, a principal in the Medical Group Management Association’s Health Care Consulting Group told AMNews. “And they need to understand how to read insurance cards.”

A workaround, some practices recommend, is to limit the number of insurers you accept. Others say you can accept all insurers if you require patients in unapproved plans to pay up front.

The key, experts say, is to train patients to pay this money and staff to ask for it.

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