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What's Coming in Medical Collections

  • Written by Joshua Fluegel

Medical Collection Software Roundtable

Medical debt collection has seen much change over the past few years. Many anticipate the changes will continue for at least a few years more. Collection professionals have been working hard to anticipate these changes and adjust their processes and software accordingly. Collection Advisor approached medical collection software providers to see what they anticipate for the future of medical collections and what they recommend professionals do in preparation.

Lex Patterson President of DAKCS Software Systems

patterson lex2What do you see as an upcoming difficulty in medical collections?

Patients’ portions of healthcare cost have increased steadily, and will continue to do so in the foreseeable future. Patient balances after insurance are growing at a rate of 30% per year, and patients are at least two times more difficult to collect from than insurance companies. Because of increased rates and difficulty to collect, healthcare providers are going to need to spend additional time and resources collecting from patients. In addition, patient premiums have increased by 69% between 2004 and 2014. The cumulative effect of all of these trends is that the patient’s financial well-being is negatively impacted by major healthcare reimbursement shifts; but just as important, healthcare providers must now be increasingly savvy when it comes to how they manage and collect from patients.

Most providers do not have the tools, infrastructure, or analytics to more vastly improve their patient collections results. To add, the patient billing and reimbursement process is incredibly complex, which can cause confusion to the patients. This confusion builds additional delays into timely payments of the healthcare receivables as patients often times cannot define whether or not their health insurance has completed paying its portion of the bill, or where the patient portion currently stands.

What do you recommend collection professionals do to be prepared for this eventuality?

In order to be a trusted partner for healthcare providers, collections professionals need to first understand that healthcare organizations have a different perspective on collections than other verticals. The last thing a local healthcare provider wants is a reputation in their community for being hard line collectors. Building out a specific program that has a soft approach while driving effective results is foundational.

Collections professionals need specialized training to understand the federal, state, and local programs that are available for patients including the healthcare provider’s charity programs. Charity programs serve as a natural extension for the healthcare provider in driving the patient to the right program that can best assist both the patient and the provider. Having a local representative from the collection agency to regularly meet with the healthcare provider onsite is important to allow the collector to stay abreast of policy shifts, new regulations, and other challenges in the rapidly changing healthcare environment.

The modern collector needs to offer strong patient-oriented systems to make the payment and account management process easy for patients. Providing a better patient experience that centers on integrating data, technology, content and communication to coordinate payment results through omnichannel tools is becoming increasingly important.

By having the right technology in place, there will be increased opportunities for savvy collection companies. Using the platform that provides the ability to serve various demographics with self-service and omnichannel options making payment setup and tracking easy is a must in today’s world. If collectors can make the complex process of medical reimbursement easier for patients, they will ultimately be much more successful than by employing the standard collections tactics.

Carl A. Briganti President and Founder of CSS, Inc.

briganti carlWhat do you see as an upcoming difficulty in medical collections?

Both the latest and upcoming changes in healthcare policy, such as increasing coverage limitations and increasing deductibles, will generate a higher volume of denied claims. This fact, compounded with an anticipated increase in complexity of compliance regulations, may wreak havoc on those processors that cannot easily and swiftly adapt their CRMs to an increasingly changing regulation environment and have to solely rely on training personnel in order to conform to the volume of claims as well as the myriad of new rules.

What do you recommend collection professionals do to be prepared for this eventuality?

Collection professionals must ensure their CRMs allow them the flexibility to easily define and maintain compliance rules at multiple levels such as federal, state, local and even client governance rules and preemptively anticipate and prevent potential compliance breaches by stopping agents before they can trump policy. Reliance on training would not be enough to avert this.


Chris J. Roberts President and COO of Sentinel Development Solutions, Inc.

roberts chrisWhat do you see as an upcoming difficulty in medical collections?

The trend toward higher deductible health plans. Higher deductibles cause problems for revenue cycle managers because patients with higher debt balances are less likely to pay their medical bills. In addition to higher debt, many patients do not understand their contractual obligations under their high deductible health plans.

What do you recommend collection professionals do to be prepared for this eventuality?

It is important to use simple, easy-to-understand communication methods to inform debtors of their obligations. Providing a clear understanding of what to expect at every stage in the process helps engage people and encourages them to become active participants in resolving outstanding debt. Collectors should assume responsibility for educating consumers early in the account resolution process. Efforts to educate and engage should continue throughout the process. Systems and processes should support this effort at every stage.


Ranjan Dharmaraja CEO of Quantrax

dharmaraja ranjanWhat do you see as an upcoming difficulty in medical collections?

The difficulty in medical and all types of collections is moving from a very physical process to the digital age. The consumer has changed and so must our communication channels and processes.

What do you recommend collection professionals do to be prepared for this eventuality?

Unless you want to end up like Nokia, Blackberry or the taxi industry that may soon be bankrupt because of an app called Uber, think about spending time and money to modernize. This is a technology business and we are in a period of radical change. What worked 15 years ago is not working today!


Chris Campbell CEO of Simplicity Collection Software

campbell chrisWhat do you see as an upcoming difficulty in medical collections?

As with other areas in the collection industry, the biggest challenges and difficulties facing medical collections centers around automation and compliance. Trying to do more with less and still ensuring your business is compliant with current and future standards. In order to be successful, an agency must ensure that they can automate and standardize processes within the bounds of the ever-changing regulations and laws. With regulations ever slanted toward protecting the debtor, it is critical for an agency to ensure that they are able to operate their business and empower their employees to succeed while still maintaining compliance.

What do you recommend collection professionals do to be prepared for this eventuality?

In order to prepare for the compliance challenges ahead, agencies should look to automate processes centered around compliance regulations. Look for opportunities to educate and align yourself with those who understand the compliance regulations and have experience with the challenges that medical collection agencies specifically face. By taking necessary steps today to automate the compliance driven processes in your business, whether within your collection software or your day-to-day business practices, you are ensuring that your business will be well poised for future compliance challenges that are sure to come.