Understanding how much of your revenue comes from patient responsibility versus payers can significantly improve your collection strategy.
Key metrics to focus on
Patient responsibility percentages
Some payers shift a large portion of the claim balance to patients through high deductible plans, and collecting this patient balance can be costly and time-consuming. From 2013 to 2023, patients’ share of healthcare costs increased from 10% to 30%, highlighting a growing revenue risk.
Patient responsibility
Patient responsibility, as a portion of your allowable amounts, should go down over the course of the year as an increasing number of patients meet their deductibles.
Actionable steps
Flag high patient responsibility payers: Identify payers with high patient responsibility percentages to allocate more resources to patient collections.
Use patient payment tools: Implement payment portals, automated payment reminders for patients, and/or patient cost estimates with an option to securely pay upfront to increase your patient receivable collection rate.
Model your patient population: Understanding how your patient population is segmented across insurance payers will help you plan for what your outstanding patient receivables might look like over the course of the year. If you have an aging patient population, you’ll want to model how a growing percentage of Medicare claims might affect your revenue.
Tip: By reducing the effort needed to collect from patients, you free up resources to focus on other areas for improvement like managing and renegotiating payer contracts, tackling denials, and finding where payers might be underpaying you.