In my past life I spent 7 years managing patient accounts for a growing healthcare agency. During that time due to rising healthcare premium costs families started choosing higher and higher deductible plans and plans with higher and higher out-of-pocket expenses.  Also the agency service the pediatric population and they had the state of mind that remaining bills would be covered by our state Medicaid program.  That soon started to be very untrue and patient bill ballooned.  We moved to an online platform to standardize the look or our invoices and allow on-line credit card or direct pay options.  That was a step in the right direction.  However, the on-line process flow still did not account for delinquent accounts.

Medical Billing is different – since there is typically an allowance for charity care and are typically generous with payment plans. That aside, we still needed cash flow to pay our bills too. I developed a process which was professional and we had less than 1% write-offs per year each year in my role. For the sake of this blog I am going to assume your business is doing their own billing and not outsourcing the billing (yet – that will be a later post). I also am going to focus on Healthcare billing both human healthcare and pet health – Veterinary Medicine. I am going to outline below the most important aspects of billing and collecting from patients/families.(Insurance again – that will be a later post).


  • The first encounter with the patient is the most important in terms of collecting as much information as you are able. These are where those annoying forms come in. My only advice with forms – is try not to duplicate the same information on different forms, no need to write their address five times.  Make it so the forms may be shared with whomever needs the information. Critical information to collect:
    • Patient name, Responsible party name, address(es), phone numbers (as many as you can get), at least 2 other non-household member information
    • Insurance information – get copy/scan of card front and back *be sure to ask for ALL insurance* if they only give Medicaid or Medicare card as if there is any other coverage – your sheet for information should also note that the responsible party is responsible for unpaid balances if all payers are not disclosed at time of treatment – otherwise you will be burned due to timely filing guidelines with your payers.
    • Ask for the Driver’s License number for the responsible party(ies) and get a copy of their state issued ID/DL.
    • Employment information is seen on most applications – in billing I honestly never used this information. My ethical code does not feel it is right to hound people at work for money – if it is one of the phone numbers they give fine, but people change jobs, and this information wasn’t kept up to date.
    • Clearly disclose payment terms – if co-pay is known, COLLECT IT UP FRONT! If it is a co-insurance/deductible situation, you should be able to collect some money up front based on their current deductible balance and depending on the procedure.*unless you are subject to EMTALA laws you may decline service based on non-payment*
    • Clearly disclose any interest or late payment penalties
    • Contract with a translation service to review forms with non-english speaking patients


  • Subsequent visits
    • Ask for co-payments due from patients as they come in
    • Ask for balance due from patients as they come in….”Your records states you have a balance of $x.xx, how would you like to take care of that today, credit, check or cash?”  Make note an any or all payment arrangements or if a manager needs to get involved BEFORE treatment is given.
    • ASK every-time if they have new insurance


  • Billing
    • Determine the frequency of patient billing – monthly, as the payments are posted from their insurance, weekly, etc
    • Determine your definition of past due – for example sake after two statements have been sent and no payments, but before the third..
      • Follow up phone call reminding them of their balance and asking how they would like to take care of the balance today – an intern can do this (have them practice first)
      • Consider if you are willing to accept payment plans – document and follow those closely especially if they are still receiving treatment, you want your arrangement to REDUCE the balance not allow it to continue to grow.
      • Follow up with a letter to the patient/family disclosing the agreed upon terms over the phone (and reference original intake form payment terms) also provide your contact information (or that of a decision maker for the business) in case the situation changes
    • If phone call/follow-up letter does not work document all the dates you have been attempting to or actually been in contact with the patient or client.


  • Collections – If payment still is not satisfactory at this point, the approach I take is:
    1. Send invoice with a Delinquency Notice with my contact information and payment terms from intake or from phone conversation asking for a response in 15 days
    2. Send invoice with a Final Notice – again with my contact in and payment terms from intake or from phone conversation asking for a response in 15 days
    3. Contract with a collection agency – you will either receive nothing (if nothing is ever collected) or you can negotiate your rate with the agency, try to get between 60-70% of the original balance
    4. You may also pursue the balance in Small Claims Court make sure you have all your documentation in order.
  • Thanking
    1. By no means do you have to send an invoice saying they are paid in full (unless they ask) – that is a WASTE of your TIME and RESOURCES.
    2. Always make sure your front desk staff thank the patients for their payments – or if on the phone always thank them for their time and payment of services.
    3. Treating your patients with respect will leave an impression – and bring you LOYAL customers.In healthcare you want loyalty and trust…if the patient or the family does not trust you they will find another provider who they will trust.

In subsequent postings I intend to go into depth about cash pay patients – this is affects almost every Veterinarian. I pay cash to my vet for my dog.  How do you as Vets keep those patients/families and more importantly treat the health of the pet if the family has sticker shock? Dentists face this issues as well to a lesser degree.  Dental insurance covers certain procedures but not others – patients might delay treatment due to affordability making things worse…I want to know what some other concerns might be.