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Successfully Surfing the Self-Pay Wave

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Dealing with the self-pay trend in healthcare is a little like surfing: You can either ride the wave successfully or get engulfed by it.

Patient self-pay as a percentage of total healthcare revenue has nearly tripled in the last five years. According to recent research, it’s now about 30% of an average practice’s overall revenue. That’s a huge change in just a few years that practices need to be able to handle. Here are a few quick tips on how to successfully ride the self-pay trend, as well as shore up your practice against other reimbursement waves:

Rethink your pre-service operations – Since patients may be responsible for nearly one-third of your revenue, you need to consistently request pre-service payment. This may involve a lot of staff training and workflow redesign, but it’s essential in today’s healthcare reimbursement climate.

Collect time-of service payments – When collecting copayments, it’s most effective to ask patients how they would like to take care of their copayment for that visit instead of if they would like to pay. After collecting the copayment, you can follow-up with a discussion about paying any additional balance. For those who do not have insurance, your practice should establish a pre-determined minimum deposit that is consistent with the average level of the copayment that would be due by patients who are commercially insured. Another alternative is to offer quick pay discounts to collect what is due at the time of service.

Prevent and manage denials – Practices today are paying on average about $15 per denied claim. You can avoid that cost by implementing prompt pre-authorization processes and more accurate coding, as well as automating your appeals process. Every dollar saved on denial re-work helps the overall reimbursement picture.

Monitor key metrics – By developing and using dashboards, your practice can keep a close eye on cash flow, receivables over 120 days and other performance indicators. Regularly assessing these metrics can help you proactively identify—and fix—areas of weakness.

Stay ahead of the technology curve – With the increase in revenue generated through self-pay, it is important to make sure you have the technology to support the new workflow processes. There are a number of industry changes, such as the ICD-10 “wave” that are also fast approaching, You need to be ready across the board, from your EHR and practice management system to your claims clearinghouse to make sure your revenue cycle does not suffer.

Self-pay and other reimbursement waves are getting bigger every month. By following these tips, you can stay on top of the trends. For more revenue cycle management tips and recommendations, download our free resource guide, Seven Steps to Improve Your Revenue Cycle Management today.