Does it Make Sense to Outsource Self-Pay?

With the Affordable Care Act (ACA), Americans were required to obtain health insurance. This may seem like it is a win/win situation. Patients have coverage for health care and health care organizations may have less bad debt or charity care. However, this may not be true. Many low-income Americans opted for health insurance plan with the lowest premiums they could get. This typically resulted in higher deductibles or out of pocket expenses. This low-income group are the ones who typically struggle to pay their medical expenses.


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With the ACA, a report in June of 2013 by Citigroup ground “patient financial responsibility under their health plans is now approaching the 15% to 20% range, when it was previously in the 6% to 10% range” (Kutscher, 2013). With this large increase in out of pocket medical bills, health care organizations are seeing increasing bad debt and need to have creative ways of collection.


One big way health care organizations can reduce the need for collection of bad debt is require time of service payment. When a patient schedules an appointment the billing and financial options should be addressed. Some health care organizations are now providing financial screening for patients that gives them an estimate of their costs and puts it in a category as to high likely they are able to pay these costs.


Another way to control bad debt is discuss the costs of elective surgery with the patient and what costs will be due at the time of service. If the patient is unable pay, the service should be rescheduled.


There will still be bad debt that health care organizations will need to collect, even with time of service payments implemented. Outsourcing collections can be cost effective to the health care organization. Outsourcing collection has benefits such as staff dedicated to run calling campaigns as well as have longer calling hours than the health organization can provide.


Some of these uncollected bad debt may still fall into the charity write-offs. Some prescreening for finances may find some patients are eligible for Medicaid. Addressing the high deductibles and bad debt up front has shown a decrease in uncollected fees for health care organizations.





Does it Make Sense to Outsource Self-Pay? (cover story). (2015). Health Care Collector: The Monthly Newsletter for Health Care Collectors28(8), 1-10.

Kutscher, B. (2013). Targeting bad debt. Modern Healthcare, 43(33), 32-33.

Self-pay Bad Debt Projected to Worsen. (2016). Health Care Registration: The Newsletter for Health Care Registration Professionals26(1), 3-6.

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