3 Ways to Improve Emergency Department Self-Pay Collections

Self-pay collections don’t have to cost your ED lost revenue. Learn how to work around the biggest obstacles to collect more from self-payers now:

Self-Pay Collections

Though the number of self-payers is on the rise, the cost to collect can be up to 3x higher than those paying with insurance.

And just like any balance, the longer these claims go unpaid, the lower your chances of actually collecting on them. That means your emergency medicine (EM) group will suffer from:

  • Longer accounts receivables (AR) days 
  • Less working cash flow 
  • Mounting bad debt
  • Crippling revenue losses

Self-pay collections will always be higher in the emergency department (ED) than other practices. So the key to winning them is learning how to work around the biggest obstacles to timely reimbursement.

Why Self-Pay Collections are Higher In Emergency Medicine

Understand what you’re up against and you can devise a strategy to overcome these issues:


More Patients on High Deductible Health Plans (HDHP)

According to recent stats, patient responsibility has jumped 29% as more consumers enroll in HDHPs[
*]. Now self-payers are becoming the new norm.

The bad news is most Americans can’t afford to pay emergency medical bills as quickly as your practice needs the revenue.

Nearly 50% of Americans cannot afford a $400 emergency expense. And there’s been an almost 30% increase in both deductibles and out-of-pocket maximum costs since 2015. 

Now, the average American has a deductible between $2,000 and $10,000. And the average out-of-pocket EM expenses total around $4,400.

Self-Pay Collections

With one in five working Americans with health insurance admitting they’re struggling to pay off their medical bills, it’s no wonder over 80% of EM practices name the slow payment of patients with high-deductibles their number one challenge.

But dirty claims aren’t too far behind. 

More Dirty Claims

An ED isn’t the calm and structured waiting room of a primary physician’s office. Quick patient care tends to come before intake paperwork. And that’s why over half of patient demographic information is lost during an emergency visit. 

Your intake team will need to rely on your patient’s friends or family for critical information if the patient is too distressed.

But having an incorrect address, phone number, social security number/Medicare Beneficiary Identifier (MBI), and insurance coverage mean dirty or incomplete claims.

And the fewer clean claims you submit, the more time your staff will spend reworking claims for reimbursement.

Unlike routine visits to a primary physician, sometimes an emergency visit won’t even be covered for the patient, causing them financial hardships which may delay your payment.

Underpayment Or Denial for Non-Emergency Visits


Recent controversial decisions to reduce emergency visits for non-emergent conditions by denying coverage mean your EM physicians may not be reimbursed fairly despite performing their high-level services. 

Payers will down-code these claims if the patient’s presenting symptoms or diagnosis don’t qualify as a true emergency. They may even require patient medical records to review claims and approve payment, further delaying your revenue cycle.

A denial in coverage means your patients will be responsible for paying their entire medical bill. 

But just because these situations make it more difficult to collect doesn’t mean you can’t improve your self-pay collections.

How to Improve Your Emergency Department Self-Pay Collections Process

Start by implementing these three tips:

#1. Engage Patients Early and Provide Transparency 

ED staff often struggle with communicating patient payment accountability. So you’ll want to create a workflow with scripted questions and responses to tackle this situation on the front-end of your revenue cycle.

Rather than frame the experience as how the ED will be paid, have your staff approach patients with their best interests at heart. Alleviate their fears of being in the dark and overcharged by providing as much transparency as possible.

Self-Pay Collections

Have your intake staff well-rehearsed on

  • Anticipated financial obligations 
  • Estimates for common tests, care, and treatments 
  • FAQs about payment and financing options

By being upfront and honest, you’ll reduce patient anxiety and make patients more trusting. And when they understand the emergency medicine billing process, they’ll be much more likely to comply.

Aim to collect at least 50% or more before care even begins and you’ll be in excellent shape.

Providing patients with multiple ways to pay their bills is even better.

#2. Use Technology To Give Patients More Payment and Financing Options

Despite research showing healthcare payments made on phones and mobile devices is trending, only 20% of practices are able to accept payments other than cash, checks, or credit/debit cards.

So just like incorporating more telemedicine, try upgrading to:

Easy Online Bill Pay

More people prefer paying their bills online rather than in-person, by mail, or over the phone. 

And stats from the first half of 2017 show[*]:

  • Over 60% of medical bills were paid online
  • 95% of patients would pay their medical bills online if they could
  • 71% of patients say mobile pay and billing alerts have improved their satisfaction

That’s why your ED should fall in line with these customer/patient preferences.

Create an intuitive, easy-to-use online portal where patients can:

  • View charges for services and treatment provided
  • See what their insurance has covered
  • Make payments anytime
  • Set up automatic, recurring payments

This will help patients anticipate their future payments and give them more control so their bills don’t fall through the cracks to collections. 

Guest Pay

This allows spouses, family members, friends, attorneys, and other individuals to pay a patient’s bills without accessing their medical records. This online bill pay option won’t require users to register with a username and password to make a payment.

Payment and Financing Plans

Patients are more likely to clear their debt if they can pay off a bit at a time rather than one lump sum — especially if they can manage their account online.

This is why many EDs have started to implement technology-focused, retail-like payment solutions for their practices.

And it’s also why others are deciding to outsource these new processes to the experts. 

#3. Work With a Billing and Coding Partner

If your team follows the first two steps, you should start collecting more from self-pay patients before they ever receive their bill in the mail.

But they’ll most likely leave with a balance owed.

So to maximize revenue and manpower hours, small and large EDs work with a billing and coding partner who actively pursues self-pay collections and ensures the highest levels of collections.

Your team will no longer spend valuable time and resources leaving voicemails, emails, or letters for patients about paying their balance. And you’ll start collecting more.

Insurance Denials

Should Your Emergency Medicine Group Consider Outsourcing Billing and Collection Services?

Rather than risk thousands or close to a million dollars in unpaid medical bills, your independent ED may want to outsource all your billing and collection services.

You’ll be able to collect more revenue and save your team time without raising your overhead costs. You’ll also reduce your compliance risks, especially since legal, payer, and patient rules keep changing.

DuvaSawko’s revenue cycle management services for emergency medicine include:

Partnering your independent emergency medicine group with DuvaSawko means your team can take a proactive approach to improve self-pay collections and you can concentrate on care and satisfaction scores.

Upgrade Your Revenue Cycle Collections Today

Low self-pay collections can damage your bottom line. Try the three simple tips in this guide to fix this issue before it spirals out of control.

And if your independent ED doesn’t have the time and resources to solve self-pay collections correctly, you should think about outsourcing this task.

DuvaSawko has the right mix of proprietary software and intuitive technology to help your ED shorten collection cycles. Our clients have increased cash flow, collect an average of 30% more, and have fewer headaches.

Click here for your complimentary practice analysis to see how DuvaSawko can help your independent ED group now!

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