4 Steps to Improve Self-Pay Collections

on and tagged .

quotation marksThe impact of self-pay is one more burden for hospitals already struggling to reduce costs and increase revenue.quotation marks
Tweet this quoteTweet: The impact of self-pay is one more burden for hospitals already struggling to reduce costs and increase revenue.quotation marks

We all know the risks associated with self-pay patient accounts. The cost to collect is up to three times higher than on commercial insurance accounts, and the longer a self-pay balance goes unpaid, the lower the probability you will ever collect. The reality is, these problems are here to stay because of rising healthcare costs and more high-deductible, consumer-driven healthcare insurance plans. It’s now common for hospitals to see patients with annual deductibles anywhere from $2,000 to $10,0001—quite a burden for many people. You’ve probably heard the statistic that nearly half of Americans couldn’t come up with $400 to pay for an emergency expense without borrowing money or selling something.2 Unfortunately, some people wouldn’t be able to get the money at all.3

In January, the Kaiser Family Foundation released the results of a survey showing one in five working Americans with health insurance have trouble paying their medical bills. As you would expect, the number is even higher for the uninsured, with 53% facing medical bill problems.4

What the self-pay patient means to you financially

When patients can’t pay, your accounts receivables (AR) days go up, cash flow slows down, bad debt mounts and revenue shortfalls are almost inevitable.

The impact of self-pay is one more burden for hospitals already struggling to reduce costs and increase revenue. Stepping up efforts to collect past due medical debts on the backend is certainly necessary, and for hospitals with limited resources, there are excellent outside services that can augment the internal team. Overall, McKesson is seeing more and more hospitals and providers take a proactive approach to self-pay. Addressing it up front not only helps reduce AR days by collecting payment sooner rather than later, it also helps prevent bigger, more serious revenue cycle problems that could threaten the hospital’s long-term growth and success. One very important part of this proactive line of attack is patient-friendly billing practices.

Despite industry improvements made thanks to HFMA’s Patient Friendly Billing® project, “patient-friendly” hasn’t exactly been an accurate way to describe a typical hospital’s billing process. To stem medical debt losses, this must change. Keep in mind that the concept of patients taking on more financial responsibility is new to many people. At the same time, we are all becoming more savvy healthcare consumers and expectations of service in the healthcare environment are changing. Whatever you can do to make the billing process easier and more understandable can help increase collections and improve patient satisfaction.

Steps to improve self-pay collections

  1. Engage patients early in the revenue cycle. Your patient access staff should clearly communicate to patients what their anticipated financial obligations will be and, if possible, collect 50% or more pre-service. Ideally, your staff can assess patients’ ability to pay and, where necessary, develop payment plans that allow them to pay their balances over time. Answering questions and counseling patients on their payment options are good ways to ease patients’ anxiety and increase their likelihood to pay.
  2. Provide easy access to payment processing at every point of service in your facility for patients’ convenience. Improving collections at the point of service includes providing scripts and coaching designed to help your team more easily ask for the payment up front.
  3. Many people are used to paying bills online, and medical bills should be no different. Give them online access to their accounts so they can see what their insurance has covered, verify recurring payments and make payments anytime and anywhere.
  4. Finally, close the loop by setting up an efficient process for follow-up phone calls and managing patient questions and complaints. Audit your own patient payment process by emailing or calling support lines regularly to help ensure they are functioning as planned and that staff is responsive.

A proactive formula: processes, technology and patient advocacy

There’s no question that self-pay will continue to be a key part of the revenue cycle for the foreseeable future, yet many hospitals either don’t know where to begin, or they lack the resources and time to implement a thorough solution themselves. We’ve found that the right combination of processes, technology and patient advocacy helps maximize collections and shorten collection cycles on patient balances.

Partnering with experts allows you to take a proactive approach and improve self-pay collections and patient satisfaction without adding high overhead costs. Acting as your extended business office, these services can help you shorten AR days, increase cash flow, reduce medical debt and optimize financial performance.

Looking to grow revenue and maintain positive cash flow? Learn more about our revenue cycle management services including patient access, coding, charge capture, compliance, medical billing and accounts receivable management.


This post originally published in the July/August 2016 IMPACT Report from Business Performance Services.


2The Secret Shame of Middle-Class Americans,” by Neal Gabler, The Atlantic, May 2016
4New Kaiser/New York Times Survey Finds One in Five Working-Age Americans With Health Insurance Report Problems Paying Medical Bills,” January 5, 2016

About Beth Prince

Beth Prince

Beth Prince is the director of operations for hospital and health system revenue cycle services, McKesson’s Business Performance Services. She has over 20 years experience in all areas of the revenue cycle with expertise in process improvement and optimization.