How Physician Practices Can Use Text-to-Pay and Card-on-File After Visits Without Disrupting EHR Workflows

In physician practices, collecting patient payments after a visit has historically been viewed as a billing issue. However, it also impacts workflow, patient experience, and staff burnout.

Most practices understand this problem very well. A patient leaves the office and does not pay the full amount owed. Staff have to send paper statements or make follow up calls. Payment, if it comes, is late and only partial. All the while, front-desk staff, billing staff, and management are forced to cobble together a workflow across the EHR, practice management system, payment processor, and telephony support. What should be a simple process becomes manual, fragmented, and costly.

This is why physician groups are beginning to adopt text-to-pay and card-on-file post visit payment collection strategies. For practices, these strategies are designed to reduce the friction of collecting outstanding balances. However, there is a legitimate fear that no practice wants to ease patient payment collection and create more EHR workflow tasks.

The positive news is, they do not need to. Card-on-file and text-to-pay payment solutions can seamlessly integrate into current practice workflows and enhance rather than disrupt current workflows. The solution is to integrate payment technology into the revenue cycle rather than allowing it to be a stand alone process that requires staff to manually intervene.

Why Are Post-Visit Collections Still An Issue For Physician Practices?

Unlike other practices, issues relating to patient balances being left unresolved at check-in or check-out is a big issue that all practices have to deal with. It is a common occurrence for patients to have a bill that is accurate due to the complexities of patient coverage, payment responsibility, and the higher deductibles that are present in today’s society. Patients are involved in the encounter of the practice and are physically present for the services rendered. Once they leave, they will mentally disengage, or “check-out’” from the encounter.

This gap is a huge matter. When a patient receives a bill, they have already moved on from the encounter. When left unresolved, the account will not be settled in the future either. Manual phone calls are labor-intensive, and portal logins associated with bill payment are large annoyances to patients. This affects the patient’s desire to pay a bill with a balance that is lower.

Health care staff are not only impacted by the problem of low collection rates. Collections, system balance tracking, answer billing questions, and account follow-ups are all done without interrupting the daily workflow or causing operational constraints. When payment collection becomes a manual effort, the scalability of the collection system is decreased.

This is the reason why contactless, digital post-visit payment options are appropriate.

What Text-to-Pay Means in a Healthcare Setting

Once a billing/collection contact is set via text, a secure payment link through text is sent to the patient. This text will serve as a replacement for slower methods of billing collection, such as a sent bill and a patient portal, that require a number of steps to complete the payment.

It may look simple from an operational standpoint, but the value comes from the timing and convenience factors. The payment pathway is short, and the customers have become accustomed to everyday mobile transactions. Customers are more likely to respond to payment options that are short and convenient to use.

The text-to-pay solution is beneficial for the following reasons:

• Patient balances are post insurance processing. This is when the final patient payment obligations are unknown during the service day and the outstanding balance is unknown at the time.
• Loose ends on balances. Patients are more likely to describe outstanding balances that are so small that the payment process is too long to pay the balance.
• Patients who are currently busy. This includes working adults, parents and caregivers. They are more likely to respond to mobile communications than to mailed statements.
• Patient practices, which are trying to lower statement costs, reduce outbound calls, and reduce time on payment reminders.

The objective is not to eliminate all other payment options. It is to provide an additional payment option that is easy for the patient, which flows into the patient’s daily behaviors.

The Role of Card-on-File Providers in Supporting Faster, Lower-Friction Collections.

It is possible for the practice to obtain and securely store the patient’s payment information with the patient’s consent. This is known as the Card-on-Files program. This is useful for allowing future balances related to ongoing care to be processed. The practice is able to charge the card in accordance with the patient’s obligations after the claim is processed, and the patient is left with the remaining balance. The practice is then able to charge the patient’s card, depending on their policies and practices.

For practices, this will reduce the time taken between adjudication and payment, and for patients, they will not have to take additional actions after each visit, especially for appointments that may be routine and for follow-up appointments, specialty visits, therapy, and imaging, as well as those with recurring treatment plans.

Consider card-on-file arrangements in situations where:

• Patients are likely to have multiple visits over a period.
• Outstanding balances exist, though the amount may not be known at the time of the appointment.
• Team members would like to minimize the number of times a patient needs to be billed.
• The office would like to have a more systematic process for collecting payment after a patient visit.

Above all else, trust is essential. When payment collection is done in a transparent, consensual manner where the patient understands the process at the time of registration or check in, they are more likely to cooperate. The patient needs to be informed of the charge, the timing of the charge, and the method of the charge as well as how they will be notified about the payment.

Payment Tools Cannot Interfere With EHR Workflows

Physician practices do not need yet another disjointed platform that requires practice staff to switch between different screens or perform manual end-of-day reconciliations.

This is why treating payment technology as a feature rather than as a part of your operational workflow is such a large implementation failure. If staff have to step out of EHR or practice management workflows to initiate a payment request, update a balance, or manually record a payment, the drawbacks may easily exceed the benefits.

The ideal solution is payment processes that integrate seamlessly with existing workflows. Practically, that results in the following:

• Payment requests are automatically triggered as part of revenue cycle management processes
• No additional data entry required for payment visibility
• No manual, end-of-day reconciliation tasks
• Clear roles and responsibilities for front desk, billing, and call center staff without crossing silo boundaries
• The patient experience should be integrated with the practice and feel like a seamless journey, not a detour to a third party.

We are not looking to burden clinical teams with having to think about payments more often. The goal is to minimize the administrative burden related to payments after the visit.

How to Integrate Text to Pay Without Causing Workflow Mayhem

The most seamless and integrated post-visit billing text-to-pay solution allows a practice to trigger a post-visit billing event. The practice should use a billing system designed for Text-to-Pay that allows automatic payment outreach steps when billing clearance is complete – after the claim is paid and patient balance is determined.

This is important because billing becomes less profitable as the administrative burden of billing communication increases.

There are five principles that implementing text-to-pay should consider.

Integrate payment communication with post-visit billing

Text to pay should be aligned with the same explaining logic as the post-visit balance notification. Text-to-Pay should be a part of the workflow.

Simplify the patient journey

Every additional step increases the likelihood of failure. We should eliminate any unneeded steps.

Plan message timing for success

Text payment communication is likely to succeed only if the billing issue is self-evident and the claimant’s certainty is aligned with the claimant’s concern.

Enable Staff Visibility

While the payment flow is automated, it is still important for staff to know if a payment request was delivered, viewed, paid, or left open to assist staff to follow up without guessing.

Integrate Exceptions into the Workflow

Every account may not need the same approach. Payment arrangements, ongoing disputes, financial assistance, and workers’ compensation claim may need to follow a different workflow.

With these in place, the text-to-pay feature is no longer a standalone feature, but an integrated part of an optimized billing workflow.

Guidelines to Implement Card-on-File in a Patient-Friendly Way

The best card-on-file programs are positioned as a solution to the inconvenience of billing not as a surprise billing tactic.

When the process is clearly and confidently explained by the staff, the ambivalence is eliminated. That explanation should ideally cover three points: Why do we need to keep the card, when it is used, and how you will be notified if the payment is made. Ambiguity is where resistance begins.

A patient-friendly card-on-file strategy generally includes:

• Legible consent language upon registration, appointment scheduling, or at the checkout.
• Clearly written post-adjudication charge practices.
• A clear explanation of charge notifications and thresholds for automated small balance transactions and for those defined as “small”
• A patient support mechanism, in case a bill triggers payment.
• A clearly defined process for the secure storage and treatment of payment information.

Staff training is equally as important as the technology gift in focus. If the front desk explains things differently, there is increasing confusion, decreased enrollment. A brief and unified script is worth it.

Best Practices in Respect to EHR Workflow Protection.

Removing EHR from practices is seen as frontline payment modernization, but it is more about practices streamlining workflows.

When looking to protect the EHR workflow, physician groups should first develop a current state process mapping to see where things are before the process is changed. This includes where patient balances are created, who owns the account, who communicates regarding the account, where payment postings occur, and where the process slows down in reconciliation.

With this as a basis, the practice can design for this in a limited manner.

Reduction of duplicated entries.

If staff is expected to input payment information in a system and then make updates in the EHR or practice management system, there is a friction point and more potential for the creation of an error.

Clarify ownership across teams.

Front desk staff, billing staff, finance staff, and practice manager staff should each know who is responsible for recording consent, exception reviewing, payment follow up, refunds, and patient inquiries.

Routine actions, but not exception actions, should be automated.

Standard billing scenarios should be automated. Any billing case that is an exception should have a workflow for manual review. Automation is most effective where it eliminates repetitive actions without losing the need for staff judgment.

Monitor patient communication quality

A payment text message may be an efficient communication tool, but if the wording is unclear, it may generate follow up questions and complaints. The communication needs to sound professional and should be concise.

Assessing Operational Outcomes

When assessing text-to-pay and card-on-file services, do not base evaluations solely on revenue generated. Look at factors such as statement volumes, call volumes, time to payment, staff burden, and patient satisfaction.

What Mistakes Do Physician Practices Often Make?

Some underperforming implementations are not due to ineffectiveness of the tools, but rather a hasty implementation and operational disconnection from the practice.

Some common mistakes are:

• Not having a clear patient consent process, particularly for card-on-file, prior to practice launch.
• Designing parallel processes for digital payments rather than integrating them into the existing billing process.
• Not training staff to address the program, which creates patient apprehension.
• Broad, bland, and neutral communications, which build less trust and lower response rates.
• Lack of attention to Exceptions, which results in staff manually adjusting accounts after automation fails.
• Damaging focus on the speed of collection, and overlooking reconciliation and reporting.

More operational discipline and less technical sophistication are the differences.

Why This is Important for the Patient’s Experience as Much as the Collections

It is natural to think of payments after a visit in purely financial terms. But for patients, it’s a billing process. A payment process that is convoluted or laborious is likely to detract from a positive experience. Conversely, a payment process that is seamless can build trust.

The mental effort for the patient is reduced using text-to-pay and card-on-file. Patients want to know what they owe, settle, and be finished with the service as soon as possible. They are reluctant to receive billing statements through the mail, call to process card payments, or question balance accuracy.

For practices, this entails that the optimal approach for payment is not lightning speed, but rather, simplicity, ease of understanding, and more predictability.

Conclusion

Doctors’ offices do not have to decide between modernizing workflows for collection and safeguarding EHR workflows. Text-to-pay and card-on-file, when designed properly, can ease the burden of paying after visits while lessening the burden of administrative work on staff and billing work on patients.

The operational integration is what makes the difference. These tools become administrative workflow improvements rather than aggravating disruptions when payment outreach aligns with the “billing” process, staff have visibility without duplicate effort, and patients know what to expect.

In a healthcare environment with rising patient expectations and diminishing margins, achieving that balance is crucial. The practices that will thrive are the ones that simplify payments after a visit without increasing the burden of work during the operational hours of the day.

Frequently Asked Questions