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Patient Statements: A Guide for Billing Success In 2020

Patient statements are not a real mystery to the average medical practice. Here is a simplified overview of the life cycle of a medical claim:

  • A physician sees a patient, documents the visit and creates coding for charges
  • The billing staff creates the charges, adds the modifiers, and submits the claim to an insurance payer for payment
  • The payer determines what will or will not be paid, generates an EOB and sends it back to the practice along with payment or an explanation of why it was not paid, plus any adjustments required by the practice
  • The practice adjusts the claim based on the EOB and shifts any financial responsibility to the patient when instructed to do so
  • Periodically, (usually monthly), patient balances are calculated and patient statements are generated, then mailed to patients
  • The patient statements are received, reviewed, then paid by the patient either by check, phone payment or credit/debit card

Pretty simple… right? What could go wrong? Honestly, plenty can go wrong. My goal is to help you get paid in a timely manner and keep your patients happy at the same time. This can be more challenging than it sounds, but by implementing a few easy steps it can be accomplished.

Your Patient Statements Are Generated Monthly…Right?

I know it seems like a silly question, but in my experience as a healthcare consultant I’ve learned that I always need to ask. Why monthly? Well, because practically everything a consumer is required to pay is billed on a monthly basis. It is important to establish consistency when dealing with financial matters. This will help to avoid uncomfortable misunderstandings with patients. Maintaining a regular schedule when your patient statements are generated is much more important to patients than you can imagine.

Who Is Responsible For Your Statements?

In smaller private practices the responsibility may be delegated to someone with very little experience in patient accounts receivable.

Patient statements billing is not a task that should be delegated to the least experienced administrative staff in your business.


This is especially true if the staff member is “wearing many hats” and they are spread very thinly with their priorities.

When Are Patient Statements Created?

I recommend patient statements be created on a weekly basis to shorten the time between the visit and the request for payment.

 

Weekly creation of statements can be a difficult concept to understand if you don’t have a practice management software that allow you to create “rules” to determine statement creation. Even though you may be sending statements monthly, that does not mean you should only create patient statements every 30 days.

Make Sure You Have The Right Software Tool

Almost all modern practice management software will have a method of knowing when the last statement was sent to a patient. If it does, then it should also have the ability to exclude statements from being printed too often.

When setting up the statement rules, I always recommend limiting statements to printing once every 28 days. This allows statements a couple of extra days for printing and mailing. When setting up your statement rules, be aware that if a manual statement is generated between batches the “countdown clock” restarts for another 28 days.

If your practice management system does not have this type of capability, you might consider outsourcing your statement processing or investigate the possibility of upgrading your software.

Manual vs. Electronic Patient Statements

I’ve run across a few practices who insisted on manually printing and mailing their statements from the office. I can’t begin to describe how counterproductive I find this. Based on all the statement processing I see offered today, it does not make financial sense to have someone in-house doing this work.

If you want more control than you would get with outsourcing, then generate your statements and then send them to a processor for printing, stuffing, and mailing to patients. Processing electronic patient statements is wildly more efficient and I highly recommend it.

All processors should be using the USPS NCOA and the USPS API database to identify and correct addressed that are not deliverable due to change of address or incorrectly stated addresses.

Your practice management software will likely have some form of this built in. Technology has evolved to the point where a minimum of mail is returned. Still, you should run a report monthly and review for anything that is a recurring error.

If you are still asking yourself, “Which way should patient statements be mailed?” Stop overthinking it! Electronic transmission to a statement processor who will do the heavy lifting is the only option that truly makes sense.

Give Patients Multiple Ways To Pay Their Bill

Sending patients a statement every 4-5 weeks is only part of the battle. Now you have to provide them with ways to pay their bill that suits their lifestyle. Yes, some people still use personal checks and “snail-mail”, but our society is becoming more comfortable every day with online and other payment methods.

Provide Exceptional Phone Support For Patient Financial Questions

If you have not done so already, establish an exceptional phone support experience for patients. Put protocols in place for as many frequently asked questions as possible and update them as situations change. Train your agent(s) to make phone payments quick and simple.

Get The Most From Your Merchant Card Services

Utilize all technology that is available. Find out if your merchant services provider offers a “plug-in” for your practice management system that will allow direct capture of online payments into a patient account.

Your merchant services vendor may also have the ability to create recurring charges for patients needing to split payments over time. This can be a much more desirable option than patient financing options where a financial application must be filed.

I’m not a fan of a practice having a separate credit card terminal that will force double-entry of payments. It leaves too much room for error and I’m certain you will agree that patients don’t want errors in their account at your practice.

Accept Payments On Your Patient Portal

If your patient portal (providing you have one) has the option to accept payments make certain it is setup to do so.

This Post Has 3 Comments

  1. Gary Sharp

    Great article and timely as I sit here on a Saturday working on sending patient statements. Just sent email to Kelly at Nextgen to get set up with patient statement processing.

    1. Tim Warren

      Gary, that is great news! Be aware that you will need to estimate the number of monthly statements and pay a postage deposit to NextGen to get everything going. Also, it can take a period of weeks if you want something custom printed on the statements. It has always seemed like it should be a quicker process, but be patient…

  2. Paul Visser

    Great article Tim. You are correct when you mentioned that most practices have employees doing many tasks, A/R phone calls being one of them. Most times these employees do not really want to discuss billing issues with a patient and most times they do not have a good script to follow when talking to the patient. A good solution would use experienced staff that know how to talk to patients in a manner that an amicable result is found to their billing issue.

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