Revenue Cycle Time Line:  Self Pay After Insurance Processing

This article has links to allow easy access time line content from Scheduling to Bad Debt Recovery.  Use this information as a starting point for planning, SWAT Analysis, or to review policies and procedures for gaps.  Create a time line for your facility to assure all participants share the same expectations.

Goals:

· Reduce the risk of uncollected self pay balances (residual balances after insurance)

Activities and Considerations:

The best way to avoid collection delays and bad debt losses from uncollected residual balances after insurance is to increase collection of estimated self pay portions at the time of service.

If significant emphasis placed on collecting estimated balances at the time of service, the transition from insurance to Self Pay After Insurance (SPAI) is a very important phase in processing.  Accounts are reviewed when insurance balances are cleared to affirm the next activity is appropriate based on commitments made at the point of service

· The final amount deemed “patient responsibility is compared to benefit verification information documented on the account to determine whether the payer covered the anticipated amount.  Differences in expected coverage are documented and referred to 3^rd Party Follow Up if appropriate.

· POS estimates/payment instructions are appropriately processed

· POS agreements regarding loan funding of balance after insurance are processed

After determination of a self pay liability, the hospital should follow clearly communicated policies for resolution of self pay balances.  The policy statement should be in clear terms.  While options can be available, the default expectation should be Payment In Full within 90 to 120 days.

The provisions of the policy statement should include:

· Payment in full is expected within 90 days of self pay balance billing

· Partial Payment of 1/3 of the original balance owed is expected each month

· Payments received short of minimum payment will be referred for phone follow up to encourage timely resolution of delinquency or to get the account into an approved payment arrangement

· Accounts that become delinquent are subject to any collection effort that does not violate laws

· Patients with a previous history of unresolved delinquent accounts may have future accounts expedited for collection action.

Requirements

· Up front financial counseling must be effective in communicating financial expectations

· The hospital should have one or more Loan programs that offers payment options that extend beyond the hospital’s internal collection time-line

· Financial Assistance may be offered for patients who are documented as unable to pay based on financial means tests.  However, offering financial assistance to patients who have insurance may lead to low income patients “opting” to purchase high-deductible plans and rely on the financial assistance program to absorb much of their self pay debt.