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How to Determine Patient Responsibility and Collect Patient Payments

As more patients opt for High Deductible Health Plans (HDHPs), providers are seeing a rise in patient responsibility balances. 

This is a problem for providers because instead of relying on the insurance company for reimbursements, they are reliant on the patient to sustain their practice revenue. It is important that providers find ways to collect on these balances in order to generate revenue. What exactly is a patient responsibility balance and how can providers improve their collection of these payments?

Defining Patient Responsibility:

Patient responsibility is the portion of a medical bill that the patient is required to pay rather than their insurance provider. For example, patients with no health insurance are responsible for 100% of their medical bills. A patient with an HDHP is required to pay on their medical bills until their deductible is met and it is a higher amount on average. More and more patients are choosing HDHPs thinking they will not likely seek medical attention that year. The result ends up being that they have to see their provider more than they initially think, leaving them with more medical expenses than anticipated.

How Can You Determine it?

Determining patient responsibility is simple with the right technology. Medical billing software with a prior authorization tool and patient cost estimator make it possible for providers to determine a patient’s responsibility towards their bill for services. In the past, providers would have to wait until their claim was denied or spend time on the phone with their insurance provider to figure out what the patient would owe by the end of the visit. These features of quality medical billing software help your practice determine that number in moments, helping to inform your patients of their patient responsibility balance before they ever leave the office.

How RCM Services Can Help You Collect Payments:

Whether it is a past due payment, or your patient is still in the office, the utilization of RCM services can help you collect more on those patient responsibility balances.

1) Credit Card Processing

In today’s age, patients need to be able to pay with a credit card or they will not likely pay at all. An integrated software solution can help your front-line staff process credit cards from the front desk, increasing the number of patient payments you collect in the office. Integrated software can also make it possible for your patients to process credit card payments through their patient portal. Your best chance at collecting a payment from a patient who is ready to pay is via credit card processing.

2) Outsource Difficult Collections

By outsourcing difficult collections, you hand over time-consuming patient responsibility balances to billing experts. Your RCM services vendor can help work with your patients, offering them the empathy and confidence they need to pay on their medical expenses. This will free up the time of your staff to work on more patient critical tasks.

3) Claim/Denial Management

The quickest way to make sure you get your payment is to partner with an RCM services vendor who can effectively manage your claims and denials. With the right vendor, your practice can achieve 99% clean claims and grow your revenue. Even though you cannot always keep patient responsibility balances from happening, maximizing your clean claims will make sure you are optimizing your reimbursements from payers.

In the ever-evolving landscape of healthcare, the surge in High Deductible Health Plans (HDHPs) has placed a spotlight on patient responsibility balances, presenting a significant challenge for healthcare providers. As patients bear a larger portion of their medical expenses, providers find themselves in a precarious position, relying on patient payments to sustain their revenue streams. Understanding and effectively managing patient responsibility balances have become paramount for the financial health of medical practices.

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