• A
  • |
  • A
  • Text size

7 Steps to Provide Point-of-Care Pricing

Learn the 7 steps towards providing point-of-care pricing and collecting from patients at the time of service

Avoid the administrative hassle later. Collect payment sooner!

The recent adoption of new electronic health care eligibility standards and operating rules now makes it possible for physicians to price claims and collect deductibles and coinsurance before patients leave the office. In order to provide point-of-care pricing and collect from patients at the time of service, your practice needs information that is necessary to determine patient financial responsibility. Make the most of the information that is now available from electronic eligibility verification, which will allow you to determine what your patients owe and receive payment from patients at the time of service—reducing billing and back-end collection costs for you, while eliminating uncertainty for your patients as well. Timely, face-to-face interactions will increase your collection and patient satisfaction ratings.

By providing point-of-care pricing, how can your practice collect from patients at the time of service?

With electronic eligibility verification, your practice can obtain patient-specific information on the remaining deductible, in addition to current co-pay and coinsurance information. With this information and an understanding of your contract with the patient’s health insurer, you can calculate your patients’ financial responsibility before they leave the office. Educating practice staff on insurance contracts, and the types of services provided by the physicians in your practice, is also integral in ensuring accurate payment is collected from patients. It is important to have information to help you:

  1. understand your insurance contract;
  2. know when to collect from patients;
  3. verify insurance eligibility;
  4. calculate the patient’s financial responsibility;
  5. secure payment from the patient;
  6. document the patient payment and submit the claim; and
  7. track the patient payments you collect.

Access webinars on collecting from patients at the time of service to learn more.

View the seven steps below to help you collect accurate payments from patients at the time of service.

Step one: Understand your managed care contracts

Make sure you adhere to the terms and conditions of your managed care contracts before starting to collect from patients at the time of service, and accept various forms of payment. Review your contracts for specifics to ensure that they allow your practice to provide price determinations at the point of care and collect from patients at the time of service. There are certain questions you will want to ask health insurers before starting to collect patient payments before they leave the office.

Access the Collecting at the time of service fact sheet for tips to help your practice roll out a strategic plan for collecting from patients at the time of service. AMA members can access a sample template letter to health insurers for inquiries concerning the terms and conditions of your insurance contracts regarding your right to provide point-of-care pricing and collect from patients at the time of service.

Step two: Know how and when to collect

Abide by your practice’s payment policy for providing point-of-care pricing and collecting from patients at the time of service. In receiving an electronic eligibility response that shows co-pay, coinsurance, and remaining deductible amounts, you will be able to calculate patient financial responsibility, provide point-of-care price estimates and collect patient payment at the time of service.

Here are some suggestions to follow if you choose to collect patient payment at the time of service:

  1. Adhere to the payment policy of your physician practice. If you do not have such a policy in place, be sure to create one for referencing concerns related to point-of-care pricing and collecting patient payments at the time of service. Reference details of our sample policy to assist you in creating a policy that meets your practice needs. 
  2. Estimate the patient's financial responsibility using the price estimation tools that may be found on payers’ website or online portals. Links to information for the larger health insurers can be found at www.ama-assn.org/go/payerpolicies.
  3. Collect only the amount based upon your patient-centered price estimation presented to the patient at the time of service.

Access an archived webinar, “Helping patients understand financial responsibility at the time of service, part one ” webinar, which outlines steps on how to get started collecting from patients at the point of care.

Step three: Verify insurance eligibility

Be sure to perform electronic eligibility requests the night before or on the day of service in order to determine the most up-to-date copay, coinsurance, and remaining deductible amounts. With these coverage details, you will be able to use the financial information to provide point-of-care pricing so you can collect patient payment at the time of service.

How can electronic eligibility verification improve your practice’s ability to collect from patients at the time of service?

The recent adoption of new electronic health care eligibility standards and operating rules now makes it possible for your practice to price claims and collect patient deductibles and coinsurance before patients leave the office.  Electronic eligibility verification provides your practice with the patient-specific information on the remaining deductible, current co-payment and co-insurance information that will enable your practice to calculate the patient’s financial responsibility at the point of care.

For more information about the Health Insurance Portability and Accountability Act (HIPAA)-mandated standard and operating rules, and the enhanced benefit and financial information that is now available, as well as how it can help your practice, access the AMA’s electronic eligibility verification toolkit.

Acces an archived webinar, “Electronic eligibility request and response: Much more than ‘Yes, the patient is eligible,” which discusses the use and value of the enhanced eligibility request and response transactions.

Step four: Calculate the patient's financial responsibility

In order to secure payment from patients at the time of service, you must determine the price of the medical care. In order to do so:

  1. Provide your patients with a detailed cost determination. You may be able to do this by using your practice management software system (to upload your fee schedule), using a real-time price estimation tool, through real-time claim adjudication (RTA) transactions by the payer, or manual calculation. Access the AMA’s resource, “How to calculate the price of medical care at the point-of-care (POC)” which explains how electronic eligibility verification can be used to provide accurate point-of-care price estimates, especially for patients with high deductible health plans.
  2. As math teachers say, show your work! Explain to the patient how you arrived at the price estimate.

Step five: Secure the payment from the patient

Optimize your ability to collect from patients at the time of service by helping your patients adhere to payment plans. If the patient is unable to pay at the time of service, discuss payment plan options with your patients.  

  • Collect from patients at the time of service. Prepare your staff to request and obtain the payment from the patient while the patient is still in the office. Adequately train your staff on how to collect payments through the use of scripting. Also, consider offering payment plans or financial arrangements such as automatic withdraws from a patient’s bank account, extending the balance over a short-term period, allowing patients to make payments at each visit for those with frequent follow-up appointments, or even contracting with financial institutions where patients may be able to dip into a line of credit or other available options to cover their medical bills. [Caution: If you extend credit options in your practice, you must comply with the laws which govern credit arrangements. Check with your legal counsel before implementing payment options.]

View the archived webinar, “Helping patients understand financial responsibility at the time of service, part two: What to do when you encounter bumps in the road” to learn more.

[Caution: If you extend credit options in your practice, you must comply with the laws which govern credit arrangements. Check with your legal counsel before implementing payment options.]

Step six: Document the payment and submit the claim

Be sure to document the amount the patient owes, the amount that was paid at the time of service and any financial arrangements that were made with the patient. This is a critical step that can reduce hassles with claims processing and future payment collection. The documentation may also serve as a legal record to verify the financial history (what was paid and any payment arrangements that were made).

After the documentation is complete, promptly submit the claim to the health insurer. Access the AMA’s electronic claim submission toolkit for details on how to submit your claims electronically and in a timely fashion.

Step seven: Track the payment you collect

It is important to properly track all payments received from the patient. Monitor, receive and reconcile your payments right away through an electronic remittance advice (ERA) and electronic funds transfer (EFT). Be sure to promptly refund any amount previously collected at the time of service that was in excess of the amount indicated on the ERA.

It is also important to keep track of any payment arrangements that were made to ensure that payments are being received on time and for the agreed upon amount.

Did you know it costs almost ten times less to perform claim status electronically as it does to perform manual claim status inquiries? Electronic claim status inquiries help your practice streamline its claim revenue cycle, as a result of point-of-care pricing and collections at the time of service by learning the status of claims quicker for faster claims reconciliation. Access the AMA’s claim status toolkit for more information about streamlining your claims processing and cash flow.

Visit www.ama-assn.org/go/electronictransactions to learn more about how the use of automation can save your practice money while helping you to collect at the time of service!

LinkedIn Discussion Group
Join discussions in the AMA Administrative Simplification LinkedIn Group.
Additional Resources