Collecting Small Patient Balances – A/R Best Practices

Practice Management

ID-100231194 2014 has certainly had the medical profession dealing with major changes in every facet of healthcare.  From procedure documentation and coding, to billing and coding policy changes, and even the collection of patient balances; just about every aspect of the physician practice has been affected by changes in policy and regulations.  The Affordable Care Act (ACA) has made the already confusing and oft times, costly and time consuming recovery of the patient insurance copay and deductible portion of medical claim even more frustrating.

Many of your patients, especially those with chronic medical concerns, are becoming overwhelmed with higher expenses.  It is vital to your revenue cycle, however, that new practices are put into place, both at the front office and the billing department to ensure that these balances are collected in a timely fashion.  The patient portion of the total payment can now amount to as much as 30% or more, so it needs to be collected. 


The best way to assure timely collection of small patient balances is to not let them get into the A/R bucket in the first place.  Often times the small copays have been overlooked because front office staff felt uncomfortable asking patients for payments.  With patient payments making up a greater portion of the overall payment amount such discomfort has to be met, dealt with and overcome.  If it is a shift that needs to be made within the practice’s culture than so be it.  It is a reality in today’s environment that cannot be ignored.


It is vitally important to educate your front office staff to review, recognize and request payment of any co-pays due and any unpaid balances outstanding at the time the patient presents for the appointment.  If the patient is unprepared to make such payments at that time they should be advised of their responsibility and be asked to commit to a payment plan of some sort.  The same should be true for deductibles involved in their healthcare plan. 

Patient Involvement

It is important that the patient is advised up front what the cost of care will be and what portion of that cost will be their responsibility.  Once an unpaid amount goes into the accounts receivable file it must be billed immediately and often.  In this regard, the sooner the insurance carrier or Medicare/Medicaid is billed and payment is received the better.  The longer a balance remains in A/R the less likely it is to be paid.

Staff Involvement

The billing department must be as intimately involved in the patient registration process as is the attendant at the registration desk.  Ideally, the patient will have pre-registered so both the billing department and the person at the registration desk will already have the insurance information with knowledge of what the copay and deductible amounts are.  If not, then at the time of registration there needs to be immediate communication between the front office and the back office to determine the copay and deductible amount remaining for the patient.  Once the deductible amount is determined the patient should be asked how they would like to handle it.  Would they like to have it put on their credit card or would they prefer to commit to a payment plan.

Often these smaller patient balances are overlooked for a wide variety of reasons.  One of the easiest ways to begin the process of collecting on these small balances is to assign one specific person to begin a vigorous campaign of contacting the patients with these delinquent accounts via telephone, email and regular postal mail.  If personnel is still in short supply, then consider contracting with a temporary medical staffing agency.  The added cash flow from these past due accounts will generally offset the cost of a temporary employee.

Continuing Education

The next step is to implement consistent training for the front office, billing and insurance departments on the constantly changing insurance payment models.  For example, the PPACA Insurance Exchange program now requires larger patient deductibles before allowing the insurer to cover costs.  In some cases, the amount the patient is now responsible for could easily equal 30 percent or more of the total charge.

Seek Assistance

The bottom line on your bottom line is don’t delay in being vigilant on beginning the collection process no matter how small the balance.  Look to outside assistance in your overall revenue cycle management process.  Healthcare Information Services, LLC is prepared to provide that assistance.

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