How to Improve Self-Pay Patient Management

Uninsured or underinsured patient accounts, or self-pay patients, provide unique challenges for hospitals. The cost to collect is three times higher for these accounts than for those covered by commercial insurance providers. And traditionally, the longer an account goes unpaid, the less likely the hospital is to collect at all. 

Whether you’re looking to turn your existing system on its head or simply learn how to improve self-pay patient management, there are several strategies providers can implement for a healthier revenue cycle and better patient experience. 

The Importance of Effective Self-Pay Patient Management

Self-pay accounts are not going away anytime soon. In 2023, the Kaiser Family Foundation reported that 26.5 million people were without health insurance. Forbes reported that 37% of Americans said they would not have the funds to cover an unexpected $400 medical bill. And medical bills remain the number one cause of bankruptcy in the United States. 

Effective self-pay patient account management has far-reaching impacts extending even beyond the revenue cycle and into the patient experience. 

Impact On Revenue Cycle Management

Self-pay patient accounts increase AR days and bad debt while decreasing cash flow. Collecting on these accounts often requires excess labor hours, which further puts a dent in revenue. 

They can be a major burden for hospitals struggling to cut costs and create a healthy revenue cycle. Collecting payment sooner than later can prevent more significant issues down the road and support long-term growth and success.

Patient Satisfaction & Experience

Patients feel assisted and well cared for when their account is covered, setting the foundation for a good relationship with the financial counseling office. They can focus on receiving care and not worry about finances. With some programs, like Medicaid, their family’s expenses can be covered, too. 

Best of all, if they have a good experience, they may return to the hospital for future instances of care rather than opt to treat at home to avoid medical debt. If they return, the hospital will already have their required enrollment information. and coverage may still be active. 

It’s a win-win for the patient and the provider to have accounts covered by financial assistance. For best results, this issue must be handled proactively. 

Six Strategies to Improve Self-Pay Patient Management

It’s always worth examining and auditing your self-pay management processes. These ideas can refresh your strategy to promote revenue integrity and patient satisfaction.

1. Establish Clear Financial Responsibilities & Policies

Prioritize collecting insurance information either in person before the appointment or online ahead of time. Document the insurer's name, policy number, group number, deductible, and copay as early as possible.

Staff should also clearly communicate the patient’s financial obligations ahead of time and ask them to sign an acknowledgment of policy. Train staff to be comfortable directly stating a patient’s balance and asking how they would like to pay at the time of the appointment.

If possible, provide a good faith estimate of what the patient will owe as far in advance as possible. Regulations around good faith estimates, like the No Surprises Act, say providers are legally responsible in certain conditions to provide this estimate to patients. This information makes it easier for patients to manage their finances and prepare to pay. 

2. Efficient & Convenient Payment Processing

Patients differ in payment preferences. Catering to this need by providing payment multiple modes will increase the likelihood of collection. Options include: 

• Online: Offer a patient portal or send emails and texts with a link to an online payment center where patients can pay by credit card or electronic check. Portals can store credit card information for future use. 
• In-person: At an appointment check-in or designated hospital payment center, let patients pay with a card, cash, or check. 
• Over the phone: This process can be automated or one-on-one with hospital personnel. Allow patients to call a hotline and pay over the phone via card.
• By mail: Include a tearaway option at the bottom of paper account statements with instructions for patients to pay via card, cash, or check and mail it back to a specific hospital address. 

Providing these options goes above and beyond, but at the very least, patients should be able to choose whether they pay online or in person. 

3. Pre-Service & Time-of-Service Payment Strategies 

Hospitals can implement non-intrusive collection strategies before patients even attend their appointments. For example, they can confirm and store payment information ahead of time or pre-authorize payment amounts based on a good faith estimate.

Depending on the patient’s ability to pay, providers can also develop and employ discount protocols and rules for charging self-paying patients. Anywhere from a 3% discount to the occasional 100% adjustment is possible.

Providers can also offer prompt-pay discounts for accounts paid in full. This concept might look like a 15% discount if paid in full on the day of service, 10% within two weeks, or 5% within four weeks. 

4. Offer Flexible & Patient-Friendly Payment Solutions

In addition to discounts, hospitals should also develop protocols for payment plans in advance, including the minimum balance needed to qualify and the process for determining monthly payment amounts and timelines. Flexibility is key here as each patient's circumstances differ, but having general guidelines for billing self-pay patients helps staff quickly deliver customized plans to patients.

Optimizing billing communications for user-friendliness can also support collections. Financial counseling offices should ensure billing communications are patient-friendly and do not include acronyms or complex medical jargon. Whether paper or electronic, statements should allow patients to check account balances, show how to set up autopay, and provide answers to commonly asked questions.

5. Proactive Patient Engagement & Support

Talking to people about their finances takes work. It’s a very sensitive job. Patients often think financial counselors are working with the collections department and are immediately distrustful. They don’t often realize financial counselors can help them find coverage - which can sometimes extend to their entire family!

Prioritizing education in patient outreach helps patients understand the counselor is trying to help them, not string them along before asking for money. Be conscious of phrasing, especially in opening statements, and train employees on what elicits a positive response. 

Make it easy for patients to access financial counseling resources via the hospital’s website, patient portal, in-person QR codes, or text and email reminders. Advertise a patient’s ability to send secure messages with questions or concerns via a patient portal. This in-depth level of counseling helps ease anxiety and increases the likelihood of payment. 

6. Follow-Up and Outsourcing Considerations

Finally, close the loop by ensuring patients have had their questions sufficiently answered, have paid their accounts, and/or are satisfied with the level of service they received in response to complaints. Be proactive and vigilant by setting up systems for follow-up and auditing these systems regularly.

Key Features of Self-Pay Patient Management Software

Because self-pay management is a complex process, good self-pay patient management software comes with many different tools, including a patient portal, automated workflows, system integration, and secure messaging and document uploads. Features usually include the following.

Workflows backed by automation

When patient data is entered into the software, it automatically searches all available financial assistance programs. If one is selected, the patient automatically enters a step-by-step workflow. Once the workflow begins, staff only needs to gather the information the software reports as required. 

The software can also store patient data, so there’s no need to start gathering information from scratch if they return for follow-up or a new instance of care. Staff will only need to make sure information is up to date.

AI and machine learning

Self-pay management software uses patient data, algorithms, business rules, and different forms of artificial intelligence (AI) to customize workflows. The same AI can adjust as the account is moved through the process so the patient smoothly goes from self-pay to covered or on a payment plan without unnecessary interruption. 

Electronic application submission

While it is not possible to send data directly to most assistance programs, including Medicaid, software can use data mapping as a workaround. After opening the program application portal in one window and the self-pay management software in another, the software will copy and paste data from one application to another without sharing raw data elements.

This process also works in reverse so that hospital staff can track everything from submission to approval. This ability virtually eliminates the need for manual data input both electronically and on paper, leading to enormous time-saving implications. 

Patient portal technology

While the benefits of using a patient portal are commonly known in healthcare, not all providers have applied them to the financial counseling process. A patient portal allows easy outreach to draw patients into their financials.

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A portal can also help with patient engagement by increasing communication and allowing for an easy exchange of information. Patients can see their workflow status, message to their financial counselor, and submit required documentation. These tools increase the pace and smoothness of the process and decrease days in AR. 

How Can MAPS Help with Self-Pay Patient Management 

MAPS is an all-in-one suite of tools for quickly getting uninsured or underinsured patients into assistance programs by providing complete enrollment support. It helps convert self-paying patient bills into revenue and allows providers to keep the process in-house to save labor hours and eliminate the need for a costly third-party vendor. 

The MAPS solution can be fully configured to meet hospital needs and screen for multiple programs, including Medicaid, Financial Assistance, and health insurance exchanges, all while maintaining full compliance with legislative mandates. Every optimization tool mentioned in this article is included in the MAPS suite. 

If your revenue integrity needs a checkup, MAPS is a practice management solution integration that can help convert your self-pay accounts into revenue-generating, satisfied patients.