Respiratory Solutions

Collecting More Co-Pays

• By Ty Bello
• Jun 01, 2010

As respiratory and sleep therapy providers, you strive to provide the best service and products the industry offers. You constantly push the envelope by introducing new therapies that will satisfy the needs and demands of the patients entrusted in your care. For all of this, you expect to be paid. Go figure! Rendering service and actually getting paid for it shouldn’t be such a stretch. And this article will detail a strategy to collect what is owed you, in particular, the patient co-pay.

The typical home medical equipment interaction begins with you, the clinical staff member, doing your part by providing education, support and products to a patient in the home. All that is left is turning over the customer to the billing department and receiving the insurance reimbursement. But wait! There is more! We forgot the co-pay.

Here is where the roles and responsibilities of clinicians need to overlap with billing personnel so the company can benefit from all future collectable revenue — and what company couldn’t use more of that. I know you’re a clinician and not a biller. But if you allow me to share an easy way to help your company collect co-pays without pressure that’s integrated in your process of providing care, would you help? Of course you would.

The top three reasons patients don’t pay their co-pays for services rendered are as follows:

1. Patients did not understand that they would have co-pays.
2. The company can’t locate the patient after initial setup.
3. Staff members really don’t know what to say about co-pays or when to say it.

This article will help you address No. 1 and No. 3. If you can’t locate the patient after initial setup, collecting your co-pay is the least of your worries. What about the asset you just lost!

Unless you have a plan in place to talk to patients early on about their co-pay responsibility, it will more than likely go unaddressed. You must focus on the timing, the frequency and ultimately the message that needs to be conveyed concerning the co-pay. To help you achieve this, use the CORE method of communication. Discussions about co-pays must be Clear and happen Often; they must be Reinforced by all team members and maintain an Educational tone.

You must be sensitive to the timing of the conversation and also consider talking to someone other than the patient, such as a family member or significant other. There is an order to presenting information about the co-pay. If you bring it up too soon, you are perceived as a money-hungry vulture. If you bring it up too late and without the appropriate emphasis, you will not meet the goal of collecting the co-pay. The message must be precise and direct, yet empathetic with and considerate of the patient. Remember, this is likely the patient’s first experience with HME.

With so much at stake, writing a script is essential. By scripting the message, a company ensures that every team member will be saying similar things. There is no way to be certain that everyone will say the same thing, but if the message is without much variation and without apology, the company stands a greater chance of collecting the co-pay. Also, scripting does not mean that you or others should be robotic in the presentation. The script is just a guide.

You can make collecting co-pays more likely by building a bridge that patients can relate to. Again, this is probably their first experience with HME, but not with medical providers, such as doctors or pharmacies, where co-pays are common. We have all seen the sign at the doctor’s office that says: “All Co-Pays Must Be Paid Upon Service. Thank You! — Dr. Smith.”

This is the bridge. Patients understand co-pays for doctors and pharmacies, and by drawing that picture for them, they will understand your co-pay, too. Here is an outline for a script that includes the bridge.

Start with the basic elements of the transaction:

• Get information you need from the patient
  • Time and date of discharge
  • Any special directions to get to the residence
• Explain what your service intentions are
  • Type of equipment
  • Service and care
  • Time and date of delivery
  • Any other instructions

Now move to medical insurance coverage:

• Confirm the patient’s current insurance coverage
• Let him know that you have verified insurance already
• Explain that HME is similar to a doctor’s visit
  • State that there is a co-pay involved
  • Give the dollar amount
  • Ask the patient or family member how they will pay for this at setup and share the payment options (cash, check or charge)
• Clarify all of the previous information and remind them about the co-pay

This method will make co-pays easier to collect. And it’s a direct, no-hassles approach most clinicians can support both before and after care and services are provided. However, the process does not work unless companies are committed to starting it during the first conversation with the patient and continuing it every time through the order fulfillment process while remaining sensitive to every circumstance.

When scripts are in place, team members are accountable and in agreement to bring up co-pays with patients Clearly and Often. They Reinforce the message and make it Educational. Using this approach, I am confident that you and your team will realize success and a steadier flow of co-pay revenue.

This article originally appeared in the Respiratory & Sleep Management June 2010 issue of HME Business.