Why Text-to-Pay is a Key Resource in the Patient Collections Toolbox

October 18, 2022 - The revenue cycle management department at MainStreet Family Care in Alabama has a mission, and that is to give patients every opportunity to pay their financial responsibility.

“We give the patient every opportunity that we can and try to be as communicative with the patient as possible. We do utilize collection software, but that should really be the last step and we really don’t want anyone to get to that point,” explains the multi-state urgent care practice’s director of revenue cycle Drew Smith.

MainStreet Family Care focuses on serving the underserved. The practice is primarily located in rural areas in Alabama, North Carolina, Georgia, and Florida where people don’t have many options for healthcare other than the county hospital, and those facilities aren’t even an option for some communities where MainStreet Family Care is located, according to Drew.

The urgent care centers, which also deliver some primary care services where needed, are filling large access to care gaps. However, operating in small, rural towns is a major challenge for revenue cycle management.

“To this day, we don’t have a whole lot of people navigate out to our website to pay their bill online,” Drew states. “I think part of that is because we’re in rural areas. Unfortunately, there are still parts of the United States that have limited or no access to the internet.”

Patient collection is vital to a growing practice. MainStreet Family Care is looking to provide access to more underserved communities but their business relies on collecting patient financial responsibility as soon as possible and at the lowest possible cost to the practice.

Patient Collection Challenges

Online bill pay has been a key resource in revenue cycle management toolboxes since the rise of deductibles and other cost-sharing arrangements patients are now subject to. The patient collection strategy has been touted as a low-cost, convenient method for both practices and patients that has increased collection rates while decreasing the cost to collect.

However, this has not been the case for MainStreet Family Care, where revenue cycle management has had to rely on paper statements to reach their patients and collect money owed after services.

“Maybe it’s that they don’t trust [paying online],” Drew states.

Not only do manual, paper-based processes slow down the revenue cycle, but they also increase a practice's cost to collect.

“We would send a paper statement, which requires you to rely on the postal service, which we all know over the years is not the most reliable way of getting things to people,” Drew says. “Then, if they don’t pay online, the patient has to mail a check, go to one of our clinics, or call our revenue cycle department to pay their bill.”

Each manual method of patient financial responsibility collection has its downfalls. If a patient mails a check, for example, there is an inherent risk of it getting lost in the mail but, even if gets to the right place, it has to sit in a lockbox for days before a staff member retrieves it and posts it. Calling into the revenue cycle management department also takes time and resources since a staff member must answer the call, explain the balance, and finally collect and post the payment.

Additionally, the nature of the urgent care business works against MainStreet Family Care when it comes to in-person payment.

“Just being in the urgent care business, patients are only coming in when they are sick and you don’t know when they are going to get sick again,” Drew states.

Adding text to pay to the patient collections toolbox

MainStreet Family Care has many resources in its toolbox. The practice already uses paper statements and online bill pay, as well as a credit-card-on-file strategy to improve collection rates and time to collect. However, the revenue cycle management department realized something was missing: text to pay.

The vast majority of Americans—97 percent, according to Pew Research—own some kind of cellphone, with most of those people using a smartphone. The cellphone has become a key resource for people, and a crucial tool for revenue cycle management.

MainStreet Family Care is tapping into widespread cellphone adoption to text patients their statements and communicate with them about financial responsibility long before the bill is on the collections doorstep. The practice recently teamed up with AccessOne to send text messages to all of its patients, not just the ones with a credit card on file.

Now, MainStreet Family Care’s revenue cycle management would ultimately like to have all of its patients put a credit card on file to pay for any remaining balances.

A credit-card-on-file payment strategy can save practices time and resources while implementing a more reliable, consistent method for patient collections. Patients are also very familiar with the payment method seeing as leading companies like Netflix, Apple, and Amazon use it.

MainStreet Family Care leverages its text-to-pay strategy to let its credit-card-on-file population when they are going to run the card, as well as the much larger group of patients without a card attached to their accounts know their patient statements and bills are ready.

“Every text message has our statement and it looks identical on the patient’s phone to the statement the patient would have received in the mail,” Drew explains. “They can see the CPT codes, procedures, what insurance paid, how much they owe, and why they owe it.”

“We also send a very specific message to the group saying we don’t have a card on file,” Drew adds.

Patients with low balances also receive a text despite the practice’s EHR system not generating patient statements for accounts with less than $20 owed.

“We were able to send a ‘small balance’ text out to patients and we were able to collect on those balances that we’re never even had the ability to collect on before,” Drew states.

The text-to-pay collections strategy has been working for MainStreet Family Care. Drew reports a lower time to collect, as well as an overall boost in patient collections since implementing the strategy.

“The vast majority of patients who are going to pay via the text message pay the day that they get the text message,” Drew says. “We also see a good amount of people pay within 10 to 14 days after they received it. Perhaps they are waiting to get paid before they go ahead and pay their balance with us.”

Communication as an opportunity

With a more complete armory for patient collections, MainStreet Family Care has the means to collect patient financial responsibility. In fact, the practice aims to automate as much as possible in patient collections to ensure efficiency. In addition to automatic runs of credit cards on file and text messages, the practice also automatically calls patients when text messages and paper statements elicit no response.

“Once we reach the point where we’re actually close to going to collections, we send two phone calls,” Drew says. “They are automated phone calls, with the first one being a courtesy to patients to let them know there is an outstanding balance and they can press two to talk to someone in the office about it.”

“A week later, we place another phone call that is a little more aggressive, letting the patients know we have tried to contact them about their unpaid balances and they are in danger of going to collections. Again, they can press two to talk to someone in revenue cycle management.”

Automation is key to streamlining the long and arduous process of collecting patient financial responsibility. But perhaps just as importantly, it is opening the door for more communication between patients and the revenue cycle.

One of the main lessons learned from implementing a text-to-pay strategy at MainStreet Family Care was patient education and communication.

“We relied very heavily on our clinical and front desk staff to let patients know when we implemented this,” Drew says. “We spent a lot of time coaching staff on answering questions if patients called about the texts.”

In an age of data breaches and hacks, people are skeptical about texts requesting payment. This was a problem for MainStreet Family Care at first because the practice started by using its official business name instead of what it does business as.

MainStreet Family Care leveraged its call team within revenue cycle management to solicit feedback from patients about the text messages. If patients called to verify the texts weren’t scams, staff asked why they thought it was a scam in the first place. The practice then altered the messaging of its texts to make sure patients trusted and understood.

Patient communication was vital to the success of the text-to-pay strategy. But it also gives practices like MainStreet Family Care, which already faces unique challenges with reaching their patients, an opportunity to discuss patient financial responsibility and the ways to pay it.

When patients call in because they received a text message, an automated phone call, or even a paper statement, then practices can offer financial assistance. MainStreet Family Care, for example, offers payment plans to patients who cannot afford to pay their balances in full.

“We don’t want you to go to collections because if you go to collections, at that point, you cannot be seen in our clinic again until you pay your balance in full,” Drew says. “We understand that not everybody is about to pay their balance in full, so we want to give patients every opportunity to not get to that point.”