Top Do’s & Dont’s for Managing Self-Pay Collections

Billing & Reimbursement

ID 10052916 Self-Pay patients present a certain risk for payment that must be taken into account by any practice who will be accepting them. However, following certain guidelines can increase the rate of collection for services rendered.


Recognize the fact that “Self-Pay” is not the same thing as “No Pay”. Patients have their own opinions on the matter of insurance, and unless required by law to have it, they may choose for reasons of their own to forgo having insurance and instead pay their bills directly.  Even patients with a stable income may make this choice. When dealing with a patient who does not have insurance, one of the things you should do is make an assessment of their ability to pay their bills.  Patients may not be willing to disclose their income at first, but many are more likely to be willing to discuss it if they recognize that the concern of your practice is to ensure that they are, in fact, able to pay in the first place.  This discussion can also help the patient realize their responsibilities as a Self-Pay visitor.

In order to help these customers better understand the process, work to provide them with a full disclosure of what their actual costs will be as a Self-Pay patient.  If you have any form of discount program going, highlight this during your discussions with the patient so they can see what they’ll owe.  Depending on your practice’s income, you may also want to offer a variety of payment plans that the Self-Pay patient can choose from; a willingness to work within the patient’s ability to pay over time can be much more successful for collection than rigid and unforgiving payment systems that you want all patients to conform to.

Another tactic that has shown some effectiveness is not waiting for a bill to be due in order to collect it.  As a risky patient, each Self-Pay visitor should be reminded about their payment obligations.  This can begin whenever a Self-Pay patient calls; before getting off the line, inform them of their current balance and the expectation that what they owe will be paid off on their next visit to the office. This can cut down on claims that the patient did not know when to pay by clearly informing them of the expected schedule.  In addition, providing the patient with a statement detailing what they are owed before they leave the office can help to serve as a reminder that payment is expected for services rendered.


Realize that refusing to treat or rescheduling patients who refuse to pay can be a dangerous tactic when used as a form of coercion. In particular, laws that state that patients have a right to care regardless of their ability to pay may be brought into the picture (along with any other laws applicable to your form of practice and location), and a malpractice suit could be an enormous problem for your business.  Prior to using this tactic on any Self-Pay patient, discuss the option with your malpractice carrier and determine in which circumstances, if any, this might be an acceptable option.  

You should also discuss potential alternatives and understand the risks and benefits of each collection tactic before you put them into use.  While it may be a problem to lose the money that you are owed by a patient who does not intend to pay, a lawsuit may not be worth the risk, particularly if other options are available.  Being aware of your options can help reduce the chance of lawsuits; be sure that your personnel are fully aware of which actions are acceptable and which are not.




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