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Ted Williams | May 7, 2019

Making Self-Pay Strides in Emergency Medicine

(3 min read) With health insurance premiums already increased for 2017, providers are feeling the pinch of a patient population that can’t afford to pay for care. Emergency physicians suffer the highest rates of uncompensated care for uninsured and under-insured patients, according to the American College of Emergency Physicians. Furthermore, emergency physicians and their billing companies often receive incomplete patient and insurance information, making the submission of clean, accurate claims a struggle for every emergency services provider.


To stem the rising tide of bad debt accounts and the productivity loss physicians face when trying to manage them, providers are exploring new ways to streamline the entire process. One successful approach is to move the collection of demographic, insurance coverage and propensity-to-pay information to the front of the emergency medicine process.

Arming staff with technology and data before the patient is discharged from the emergency department mitigates billing and collection issues. This is especially true for self-pay visits. A proactive approach helps emergency providers secure the funds due to them sooner rather than later, saving time and money for back-end staff.

Assessing Self-Pay Up Front

Several core attributes influence collection performance. Netting as much data as possible on patient financial standing and payment options (Medicaid, commercial insurance, self-pay) is the most effective plan for payment recovery. Third-party patient demographic and insurance data fact-checking resources help emergency practices execute at the point of care.

Real-time Insurance Discovery and Verification
Accurate Health plan verification is one of the biggest determining factors in healthcare reimbursement. Insurance discovery technology identifies possible avenues for coverage by tapping into national insurance databases. Emergency medicine practices can often determine if the patient could qualify for financial assistance, such as Medicaid, that they may not be taking advantage of today.

Real-time verification determines coverage details up front and reinforces clean claim submission. What used to be possible only on the back-end, can now be accomplished immediately.  Real-time verification can mean payment in days instead of waiting weeks or months.  Real-time demographic corrections also save on collection costs.

Onsite Self-Pay Analysis
In the absence of insurance, patients’ accounts are segmented based on propensity-to-pay data, and sorted into different buckets for billing staff. Patients with a high likelihood to pay based on income and credit scores should be set up on payment plans. The same data also pinpoints patients that may qualify for hardship or charity discounts. By segmenting accounts early in the revenue cycle, fewer cases are sent to collections vendors.

Specific focus should be paid to patients above Medicaid qualification but under the poverty level. Emergency practices can individually target these patients with customized discounts and payment programs without advertising to the entire patient population, which might entice others to apply unnecessarily.

Demographic Data Upkeep
Making sure that patient demographic data such as contact information, date of birth and social security number is accurate and up to date also streamlines the billing process. Less returned mail, fewer claim returns and lower billing costs are three benefits of maintaining accurate demographic data. Many resources are available to verify demographic data and help emergency practices stay on top of this information.

Bolstering Collections on the Back End

While a proactive approach to patient data management can be a key driver in avoiding payment roadblocks early on, patient data also bolsters revenue recovery on cases that do inevitably make it to collections. Emergency service providers can use patient insight to:

  • Establish collection service management tiers (likely to pay, slow paying, non-paying, etc.) to send “never likely to pay” cases directly to collections or bad debt write-off.
  • Make outbound calls to debtors to promote patient-tailored collector approach and positioning with predetermined patient targets.

With high-deductible health plans on the rise, implementing a strategy to rein in self-pay issues will be increasingly imperative to revenue capture and recovery in emergency medicine. By establishing best practices to manage patient billing data early on, providers stand a much greater chance of controlling revenue loss and making financial ends meet.

Want to learn more? Contact us or read more about how AR Boost (formerly Payor Logic) technology and services supports your emergency medicine practice billing efforts here.


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More About the Author:

Ted Williams

Ted Williams has been a featured presenter at regional and national EMS conferences, including the state medical associations, ambulance networks, and technology user group conferences. Williams is a founder of Payor Logic, a national provider of healthcare revenue cycle solutions.