Depending on who you talk to regarding the check-out process you will get three different perspectives. One is you must have a check-out process no matter what situation, two you should have a hybrid approach to the check-out process, and three there is no need for a check-out process. In my expert option, one of these may be correct in the right situation. You may ask is there a one-way approach that is right for all practices and hospital systems. I am going to jump out there and say NO! This really shouldn’t be a surprise. The reason why is because practices and hospitals are unique, period! You must understand the positive or negative impacts of the check-out process for each type of specialty practice to make an educated decision to whether you need one of the processes stated above.
The short story regarding the check-out process is to ensure the patients receives all the necessary visit information for that day’s service as well as capture the revenue. However, for revenue cycle purposes the scheduling of return visits, procedures, and testing, as well as, collections of any outstanding balances will affect your overall revenue either positively or negatively depending on your approach. The scheduling of the return visit, procedures, and testing ensure the future revenue for the practice. The collection of balances for either the copay, co-insurance, or deductible or past due balances is allowing the practice to realize revenue at the time of service. Remember if you let the patient leave without paying their balances the odds of receiving the full amount drops by 20%. I have not met anyone in this line of business who believes a 20% reduction in revenue is acceptable. So, the decision to have or not have a check process can make a huge revenue impact over the long run.
So, the question is, do you need the check-out process in your clinic or not? For the revenue cycle leader, you MUST evaluate what type of practice you are working with to make that decision. A PCP practice typically deals with mostly co-pays that are collected at check-in. However, most PCP offices also have ancillary services such as injections, procedures, and another test that may result in a % of the co-insurance or deductibles that should be collected before the patient leaves the office. A surgical or sub-specialty practice may not have a lot of ancillary services. Thus you may not need a check-out process in a sense for collections but for return visits, procedure, or testing you would want some type of check-out service could be done by the nurse. Cardiology, OB/GYN, Orthopedics tend to have high dollar ancillary services, such as Ultrasounds, ECHO’s, Stress Test, X-ray, etc. If you decide to bill the patient for these services and not collect either the co-insurance or deductible at the time of service you are taking a risking to lose revenue.
Another aspect of the check-out process that you should consider is the scheduling of outside tests or procedures which will have a positive revenue impact on the practice. The reason is that these are revenue generating items either through the provider performing the service or conducting the interpretation of the tests. Typically, these types of check-out services are for surgical, surgical type practices, and OB/GYN practices.
Additionally, having a check-out process allows the office to help educate the patient about their bills and insurance benefits. The education is an advantage for the patient but also allows the practice to realize faster payments because the patient understands their bills and responsibility.
Now you may be asking what is the cost if you decide not to have a check-out process in practice. This is where I would say the revenue cycle leader and operations leader needs to understand the opportunity cost. What does this mean, it means what do you lose if you don’t do something over another decision. In my option, these are the opportunity cost for not having a check out process. One (1) Loss of real-time revenue for the collection of deductibles and co-insurance. Two (2) Loss of scheduling productivity in the practice because the patient left the office and the associate is having to spend time calling the patient back to schedule. Third (3) the billing cost, the time and resources you need to bill statements and follow up with patients. Forth (4) the collect service costs when a patient doesn’t pay their bills before 90 or 120 days. Lastly, the cost of patient satisfaction, where the patient could have paid their bill and now they are getting statements. All of these are excellent reasons why your practices or hospital systems should collect as much as possible at the time of service, because when you don’t, you will have a negative revenue impact.
Whether you have a check-out process or not, it always important to make sure that your revenue is not affected in your practice. If you decide your revenue is affected because you do or don’t have a check-out process and you need to make a change! Don’t be afraid to make the change! Push through it and know that your revenue will be positively affected.
Cissy Mangrum, MBA, CMPE, CPC
Revitalize Healthcare Solutions
Email: Cissy.Mangrum@cmhealthconsulting.net
Webiste: www.revitalizehealthcaresolutions.com
Cell: 615-397-5042
Disclaimer – my thoughts are my own and are not associated with any company or system.
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