Assessing Co-Pay Collection: What’s Your Patient Payment Rate & How to Amplify It

By Blakely Roth | February 1, 2024

How many of your patients pay their co-pay at your practice?  

Practice profitability is a top concern amongst physicians, revenue cycle managers and practice administrators. Shrinking Medicare and payer reimbursement rates, coupled with rising operational costs and inflation, are significantly impacting the bottom line. It’s more crucial than ever for healthcare practices to develop efficient financial strategies to remain sustainable. One key area often overlooked is the collection of patient co-pays.  

What Percentage of Your Patients Pay Their Co-Pay During a Visit?

Determine your co-pay collection rate and set benchmarks for improving it. Taking strategic steps to increase your co-pay collection number will be imperative to fueling practice profitability despite economic challenges. 

Understanding Your Co-Pay Collection Rate

Understanding what percentage of patients pay their co-pay prior to seeing their physician is a vital metric that top-earning practices focus on.  

Surprisingly, many practices don’t have this figure readily available, leaving them without a benchmark for improvement. Without knowing where you stand, enhancing your co-pay collection rate becomes a challenge. Without a benchmark for co-pay collection, it’s difficult to determine if you’re losing money or collecting less than last month or last year. Without consistency and growth around this key revenue stream, keeping up with inflation and reimbursement cuts will become increasingly difficult. 

Put emphasis on benchmarking and increasing your co-pay collection rate to offset revenue challenges and fuel consistency. 

Determining Your Patient Co-Pay Collection Rate

To calculate the percentage of your patients who pay their co-pay before their appointment, divide your total number of visits with co-pays collected by the total number of visits within a specified period. This simple formula gives you a clear picture of your current standing.  

Alternatively, you can measure your overall co-pay collection rate. To determine your overall co-pay collection rate, divide the number of co-pays collected by the number of co-pays due within a specific time period. If you collected $25,000 in co-pays out of $100,000 of co-pays due in January, then your co-pay collection rate for the month would be 25%. 

How to Improve Your Co-Pay Collection Rate

Look back at last year and calculate your monthly and annual co-pay collections rate. Determine which months were lower, which were higher and why. Consider, did that rate increase over the year or fall off?  

These insights will help you set a clear benchmark for your current co-pay collection rate and a reasonable goal of what you’d like it to be next month, next quarter and next year. Consider, do you want to increase your co-pay collection rate by 20%, 50% or 80%? If so, what would that increase mean for your bottom line? 

Once you know your current co-pay collection rate, set a realistic goal for improvement. A month-by-month plan allows for gradual and sustainable increases in co-pay collection, which in turn will help you offset rising costs and dropping reimbursement rates. Monitor changes in your co-pay collection rate closely to identify what strategies are working and when to make further adjustments. 

At Clearwave, we recommend that our clients aim for an average co-pay collection rate of 75% as a healthy goal. Our clearwaveCARE strategic success and support teams work closely with our clients each month to help them get to 75%, and maintain and increase it further. With strategic action and strategies — your practice can also improve your collection rate and fuel profitability 

Key Strategies to Increase Your Co-Pay Collection Rate

There are proven solutions and tactics that high-growth specialty practices use to increase their co-pay collection rate and maintain it. Here are the top solutions and tactics to consider. 

Accurately Determine Patient Responsibility:

The cornerstone of efficient co-pay collection is understanding patient responsibility accurately. An automated multi-factor eligibility™ solution is crucial to correctly verifying health insurance coverage, determining what patients and inputting that amount to patient accounts — all prior to their appointment. First, it’s important to understand that a multi-factor eligibility verification solution doesn’t come standard with your practice management system (PMS) or electronic health record (EHR). See how a multi-factor eligibility verification tool differs and how you can leverage it to improve co-pay determination and automatically match co-pay amounts to patient accounts. 

For example, Clearwave’s Multi-Factor Eligibility™ runs automatically and verifies insurance at every critical patient interaction (up to 7x) to ensure coverage has not lapsed, all without added fees per transaction or staff involvement. Clearwave also automatically maps payers to appointment types, matching and inputting the correct co-pay amount to patient accounts — reducing manual errors and the need for refunds or future co-pay collection efforts. As a result, practices see immediate improvements to co-pay collection and no longer need to register at payer sites or send staff to call on patients or payers. 

Prompt Payment at Every Check-In:

Staff inexperience, forgetfulness or workloads can all impact your administrative teams’ ability to collect co-pays from patients during check-in. High-growth practices don’t leave this high-value task to become second priority, especially when profitability challenges are rampant. Instead, high-earning physicians and practices trust patient self-registration solutions, like self-service kiosks, to prompt patients to make payments at every check-in.  

These practices have seen nearly immediate improvements to co-pay and overall collections by transitioning to self-registration for payment collection, over staff interactions. This switch gives patients the privacy to review what they owe and quickly make payments, which in turn boosts collections. Practices can also use patient self-check-in kiosks to prompt collection for not just co-pays, but also past-due balances and estimations! 

For instance, Southview Medical Group witnessed an immediate improvement in co-pay and past-due balance collections after launching self-registration kiosks. Daniel Chattom, previous Clinical Systems Manager at Southview Medical Group, shares the impact here: 

Similarly, Mann Eye Institute reported a staggering 112% increase in co-pay collections after adopting self-registration methods. These are two examples of the hundreds of practices who’ve seen how self-registration boosts their bottom line. If you need to put profits back into your practice, you may find value in taking a similar approach. 

Fuel Profitability Despite Payment Challenges and Collect More Than Ever Before

In an era where healthcare practices are squeezed by external economic pressures, strategically increasing co-pay collection is not just a financial strategy but a necessity. By adopting these steps, your practice can improve its co-pay collection rate and fortify its financial health against the tides of inflation and decreasing Medicare reimbursement rates. With the right approach and tools, you can ensure that your practice not only survives but thrives in these challenging times. See how Clearwave can put profits back into your practice.