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Patient Statements: A Guide for Billing Success

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 generates an EOB with instructions for adjustments and application of payments then sends it to the practice
  • The practice adjusts the claim based on the EOB and shifts any financial responsibility to the patient when instructed to do so
  • The billing staff generates and mails statements once balances have been calculated
  • Patients receive their statement, review it and pay via check, phone, or credit/debit card payment

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 simultaneously keep your patients happy. 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?

Why monthly?

Billions of consumers pay for goods and services monthly, and are accustomed to it. Billing anything other than monthly will make them wonder why you would do it differently. Consumers do not typically like to be billed more often or less often.

It is important to establish consistency when dealing with financial matters. This will help to avoid uncomfortable misunderstandings with patients. Patients appreciate your adherence to a consistent schedule much more than you imagine.

Who Is Responsible For Your Statements?

A staff member with little experience in patient accounts receivable may suddenly find themselves tasked with the responsibility for patient statements in a smaller private practice office.

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

This is particularly important if a staff member is “wearing many hats” and 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 a visit and a 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 indicating the last time a patient received a billing statement. 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.
If a statement is manually generated before the next batch, the “countdown clock” resets, thus excluding the patient from new statements for another 28 days.

This is why carefully creating rules for statements and protocols for staff is so important and essential to keep in sync. 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.

USPS databases, NCOA and API, identify and correct addresses that are not deliverable. These are tools that screen for proper address formats and correctly presented address locations. Your practice management software will likely have some form of this built in and your statement processor should be utilizing it.

Senders who utilize this technology seldom have significant amounts of returned mailings. 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. 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. 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. 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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