No More Patient Aging: Nailing the Checkout to Collect Every Dollar (The First Time)

Patient Checkout and Revenue Cycle Management

You’ve finished the clinical work, the patient is getting ready to leave, and you think the session is done. But the truth is, a critical move for your practice’s financial health is about to happen: checkout. This step is often overlooked in Revenue Cycle Management, leading to the dreaded patient aging report.

We've all heard the stories—or lived them—of medical bills showing up months or even a year later, causing patient frustration and administrative chaos. But patient aging shouldn't exist; there is absolutely no built-in delay to patient collections unless you create the bottleneck.

This isn't just about good customer service; it's about adhering to best practices and fulfilling your contractual obligations as an in-network provider. We'll show you the tactical steps, essential tools, and communication strategies to ensure you close the loop completely, collect every dollar owed, and win the game at the desk.

Why Checkout is a Contractual and Financial Must-Do

The patient's registration is not truly complete until the first checkout has happened. Why is this final step so critical for a practice's revenue cycle?

• The Payment Authorization Form: Your Legal Power Tool This isn't just a piece of paper; it's a legally binding document that gives your practice permission to keep a patient's credit card, debit card, or ACH on file and to charge it for services rendered and outstanding balances. Without that signed form on file, you do not have permission to charge their card.

• The In-Network ObligationWhen you sign a contract with a payer, you agree to certain terms, which often include collecting the patient’s cost-share (copay, deductible, coinsurance) at the time of service. Failing to consistently collect patient responsibility—and letting patient aging grow—can threaten the practice's ability to be a sustainable, profitable practice.

• Closing the Financial Loop: This is the place to put the final punch in for making the patient feel cared for. You're going to make sure their payment method works now, and schedule the next appointment now, before it becomes harder to get a hold of them. The person at the checkout is controlling a lot of your cash flow. Make sure that cash flow remains consistent and healthy!

The Tactical Checklist: 6 Steps to a Flawless Checkout

This process should be clear, consistent, and followed every single time, guided by a simple Checkout Checklist.

1. Guided Transition: Something needs to physically guide your patient to a checkout person. This could be the provider mentioning it (e.g., "Go to the front desk and check out") or physical signage.

2. Collect Current Payment: Once at the counter, a qualified individual is going to collect payment, if they haven't done that before the appointment. This is your final chance to make sure you have the payment authorization form on hand. Attempt to run their card on file according to your payment policies to ensure that it works.

3. Address Patient Aging (Subsequent Checkouts Only): If you are seeing a patient at checkout and pull them up in your EHR to see they have multiple past due balances, now is the time to follow your payment plan process. They do not leave your desk until you have a payment plan on file. Remember, it’s best practice not to allow payment plans for current balances—pay that one in full today, and then deal with the history.

4. Set Future Appointments: Look and say, "Hey, Jane, I see that Dr. Smith wants to see you again in six months. Let's get that on the calendar now". Do not say, "Would you like to schedule that today?". Just assume this is going on the calendar.

5. Provide Necessary Paperwork: This is the time to provide any necessary paperwork, whether they need a referral to a different specialist or are an out-of-network patient needing a superbill.

6. Answer Questions: Offer your help in answering any questions they might have. Ask, "Do you have any questions about your appointment or about scheduling or your bill?".

Avoiding Pitfalls: Training and Transparency

• The Grumpy Person Pitfall: Whoever is in charge of checkout needs to be extremely well-trained and good with people. Stop putting the grumpy person up front! This needs to be a high-quality person who understands how to navigate the EHR and has good customer service skills.

• Communication is King: The checkout process should be a transparent discussion, not a confrontation. If a patient is surprised by a balance, your trained staff person can say, "Let me look at those balances and see what happened". They can pull the ERA and explain, "It looks like this actually processed toward the deductible because your plan renewed on January 1st". Information is so good at diffusing emotion.

• Know Your Policies: Whoever's at the desk has to really know your internal policies—payment plan policies and financial hardship policies—so they aren't stuck saying, "Let me just look it up". The biggest pitfall is failing to communicate balance changes or not having a clear process for outstanding patient balances. We do not want to surprise patients. No surprises!

Conclusion: Control Your Cash Flow

When you master the checkout process using the Payment Authorization Form and a consistent checklist, you not only close the loop on your reputation, but you directly control your cash flow.

Imagine how many Saturdays you could get back if you had a clear process here at checkout. It's time to stop being the bottleneck and start building a plan to collect every dollar before the patient leaves the building.

Follow-Up Actions to Take (CTA):

• Get the Tools: If you're looking for the essential tools we mentioned—the Payment Authorization Form and a customizable Checkout Checklist—we've got them for you. Check out the link to our paid online learning hub, The Hourglass.

• Get Hands-On Help: If you feel like your current checkout process and RCM systems need a complete overhaul and expert guidance, consider a Practice Health Check. Our Practice Wellness Experts will dive into your patient registration processes to establish healthy, sustainable workflows and ensure you’re collecting every dollar.