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5 steps to help patients understand medical bills

The business of healthcare is complex and is often not clearly understood by the patient or even by the medical office staff.

"It's important to help avoid confusion, empower your staff to educate patients, decrease the time it takes for medical practices to be paid for their services and to create a better overall patient experience," said Terry Douglas, director of brand marketing at Kareo.com, a web-based medical billing software company.

Douglas outlined five steps that medical practices should take to help patients understand medical bills and be better prepared to handle them.

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1. Front desk insurance knowledge 101.
"The front desk staff is usually the first point of contact for patients," explained Douglas. Too often do practices take for granted that their office staff understands insurance – the differences and complexities between copays, co-insurance, deductibles, etc. It's wise to make sure they know what plans your providers are associated with, both those in-network and out-of-network. Recommend a routine review, especially with new staff, about the definitions of each of these things.

2. Use automated eligibility technology.
Frequently, medical practices miss out on the opportunity to verify that a patient has insurance or they simply don't have the time to go to every insurance company's website to check the status before the patients arrive. Today, technology completely automates this process, taking only seconds and saving a lot of confusion and headaches when the staff are talking with the patients about their bills. With a click of a button, your staff will be able to know if coverage is available for the specified date of service, the general coverage limits for in-network/out-of-network, the standard copay amount, the percentage of co-insurance and how much the deductible is for that plan. Having these details helps inform the staff about the patient's responsibility.

3. Share the insurance verification (eligibility results) with patients.
Other companies and services often explain their statements to new customers. The same should be true in the healthcare industry. With your staff informed about the specifics of a patient's insurance, teach them how to share that with the patient. Have them print out or show the on-screen results of the eligibility verification. Use this conversation to underscore the expectations your practice has for patients, like what part of the payment is expected at the time of visit and what portion will be billed after the procedure/visit occurs.

4. Give patients a sample statement.
Often patients receive many types of medical bills. To help them be familiar with and better understand your statements, give them a sample bill to take home. Describe each area of the statement – the listing of procedures, the amount the insurance should pay and the balance owed by the patients themselves. "This is a great way to acquaint your new patients with your statements and keep existing patients informed when you upgrade your patient statements," said Douglas. It's often helpful to create a one-page handout that explains all of this or post the information on your medical practice's website.

5. Explain insurance basics to patients.
Just like it shouldn't be taken for granted that front desk staff understand the basics of insurance, you can't assume patients do either. Practices need to be more involved in patient engagement, since they are often confused about things like copays, deductibles, whether or not the copay goes against the deductible, co-insurance, etc. Train your staff to be able to clarify these things with your patients. It may be helpful to have a handout or a page on your website that clearly defines – in patient terms – the differences between these things as well as other educational information.