Collecting co-pays: Providers learn not to give away the store

Money has often been a dirty word in health care, but in an environment where every dollar counts, providers say collecting co-pays and other payments is a must.

"We make sure patients understand completely from the day we deliver the equipment that they have some financial responsibility," said Carolyn Sluiter, president of Freeport Home Medical Equipment, in Freeport, Ill. "Otherwise, they become angry and they don't want to pay, or they didn't think they had to."

Providers are learning that it's OK to get paid, said billing consultant Sylvia Toscano.

"Providers are enforcing payments of co-insurance upfront, where before they used to bill their patient for the 20%," said Toscano, owner of Boca Raton, Fla.-based billing firm Professional Medical Administrators. "Their internal processes have been fine-tuned."

In addition to discussing costs upfront, Freeport Home Medical provides information sheets right along with the equipment that detail how the equipment is billed, whether it's a rental or purchase item, the length of the rental period, etc. Staffers--from therapists to delivery techs--have to understand and be able to explain billing and payment policies to customers.

"It's been an educational process, but I think it empowers us," said Sluiter.

Provider Philip Bane now requires payment upfront on certain services like replacing wheelchair batteries.

"The allowable is only $7 more than my cost," said Bane, president of United Home Healthcare in Roanoke, Va. "If you want us to do it, we'll give you the paperwork (to submit). I can't do repairs with that kind of margin and wait 90 days to be paid."

Often, customers are "ticked," he admits.

"My favorite line is when they tell me, 'Well, I paid into the (Medicare) system,'" Bane said. "I tell them they need to take it up with their congressman."

Of course, providers will probably always come across patients and families who just don't "get it." David Hosemann acquired the assets of another company and soon learned that the previous owner was a little more lax when it came to billing and co-pays.

"The patient passed away in May and her family was going to report me to Medicare because the prior company never charged her (and I tried to)," said Hosemann, owner of Hometown Medical in Vicksburg, Miss. "They thought I was cheating Medicare."