Use Patients’ Complaints to Improve Your Practice

Turn patient woes into corrective action.

By Judy A. Wilson, CPC, CPC-H, CPCO, CPPM, CPC-P, CPB, CPC-I, CANPC, CMRS

Most healthcare professionals dread handling patient complaints. I used to hate it when I’d receive a page, saying that someone with a complaint wants to speak to the office manager. I’d think, “This is a waste of time. If the person is already mad, nothing I can say will make a difference.”

I couldn’t have been more wrong.

Most people who complain just want to be heard. More importantly, perhaps, complaints are an opportunity to resolve ongoing problems. For example, consider how the following list of complaints might improve your office policies.

The physician is always late! Why should I have to wait so long? My time is valuable, too!

This is something many of us have said ourselves. If your office gets many such complaints, consider reworking your scheduling so patients don’t have to wait an unusual amount of time to be seen (patients shouldn’t have to wait longer than 20-30 minutes). If the wait time is longer than normal, be sure to inform the patient when she signs in, so she doesn’t think you’ve forgotten about her. Above all, patients want to be informed and feel they are being taken care of.

Why am I getting a bill? I have insurance. You filed the claim wrong!

Present your billing policies up front, before services are provided, so no patient questions are left unanswered. Explain that your practice files with insurance as a courtesy, but the bill is ultimately the patient’s responsibility. Except where the practice is specifically contracted with the insurer, insurance is primarily a contract between the patient and the insurer. In every case, you must have policies in place, and you must communicate those policies effectively, so each patient knows what is expected of him or her at the time of service.

I’ve never had a co-pay before. Why now?

If you’re hearing this complaint, a policy of collecting co-pays has not been followed in the past (meaning, someone has not been doing his or her job correctly), and the patient is upset by the “new” requirement.

Explain to the patient that you are very sorry she was not given that information at the time she made her appointment, but your policy states that all co-payments must be paid at time of service. Be sure all staff are aware of the policy and that they explicitly communicate it to patients before services are rendered.

Remember: Not collecting co-payments at the time of service can cost your practice large sums of money each year.

Why can’t you just write off the rest of the bill? Aren’t you paid enough?

Patients must understand it’s a HIPAA violation to routinely wave co-insurance and co-payment on a patient account, and practices must make a good faith effort to collect due payment. The patient is also contracted with his or her insurance company to be responsible for applicable co-pays and co-insurance.

Proactive Is Better than Reactive

When hearing a complaint from a patient, listen until that patient is finished. If you interrupt, you’ll only compound the patient’s frustration (and yours). If you’re hearing the same complaints again and again,  it’s not the patient who is at fault for getting upset—there’s a problem in your practice that needs to be fixed. If you’re not willing to improve your procedures, you’ll lose business (and referrals) to practices that do.

Complaints such as these can be prevented by well-trained staff and strong, consistent office policies communicated to patients prior to their visit. It’s not always easy, but you should look forward to complaints and use them to your advantage to improve your practice.

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Judy A. Wilson, CPC, CPC-H, CPCO, CPPM, CPC-P, CPB, CPC-I, CANPC, CMRS, has been a medical coding/biller for over 35 years. For the past 21 years, she has been the business administrator for Anesthesia Specialists, a group of nine cardiac anesthesiologists who practice at Sentara Heart Hospital. Wilson has served on the AAPC Chapter Association board of directors from 2010- 2014 and the Bryant & Stratton College board of directors in Virginia Beach, Va. She is an expert ICD-10 trainer for AAPC and a PMCC instructor, teaching classes in the Tidewater area. Wilson enjoys helping others become certified and offering continuing education opportunities. She has presented at several AAPC regional and national conferences and the AMBA conference. Wilson is a member of the Chesapeake, Va., local chapter.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 402 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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