Best Practices for Maximizing Time of Service Collections in Private Medical Offices

For private medical offices, effective Time of Service (TOS) collections are essential for maintaining healthy cash flow and minimizing accounts receivable. Collecting patient payments at the time services are rendered not only improves your financial performance but also reduces administrative burden and helps foster transparency with patients.

Drawing on years of consulting experience and firsthand knowledge of medical practice operations, here are proven best practices—each supported by industry research and practical background—to maximize your TOS collections.  All of these ideas can enhance Time of Service collections and ultimately profitability, but we always recommend taking time on a regular cadence (i.e., monthly) to evaluate the business and work “on” the business, including logistics and operations. The physician owners who skip this crucial component of evaluation and improvement tend to have to “put out fires” when the patient’s past due becomes too high or the cash flow is reduced due to poor collections at the time of service.    

As a physician owner or practice administrator, take a few minutes each month and pick 1 or two items from this list to review and improve: 

1️⃣ Educate and Train Your Front Desk Staff

Background/Research:  
Industry studies consistently show that well-trained front desk staff are more successful at collecting payments at the time of service. According to the Medical Group Management Association (MGMA), practices with regular staff training report higher collection rates and fewer billing disputes. Staff who are confident in financial conversations help set expectations and reduce patient discomfort.[¹]

Recommended Steps:
➤ Provide regular training on payment policies and patient communication.
➤ Role-play common collection scenarios to build confidence and consistency.
➤ Empower staff with clear scripts and answers to frequently asked questions. 

2️⃣ Set Clear Payment Expectations

Background/Research:  
A 2023 survey by the Healthcare Financial Management Association (HFMA) found that practices with transparent billing policies experience fewer payment delays and higher patient satisfaction. Patients are more likely to pay promptly when they understand their financial responsibility upfront.[²]

Recommended Steps:
➤ Communicate payment expectations during appointment scheduling and reminders.
➤ Display payment policies at check-in and on your website.
➤ Remind patients of outstanding balances prior to their visit. 

3️⃣ Verify Insurance and Estimate Patient Responsibility in Advance

Background/Research:  
Insurance verification errors are a leading cause of payment delays and claim denials. The American Medical Association (AMA) recommends verifying coverage and estimating patient responsibility before each visit to avoid surprises and ensure accurate collections. Many payers now offer online tools to help practices estimate co-pays and deductibles in real time.[³]   

As a best practice, we often see the best performing practices verify insurance 3-5 days prior to the visit and often again when they check in.  This helps ensure that the patient’s insurance is accurate and up-to-date without any recent changes. Some Medicaid plans are updated monthly, so always ask the patient if there are any changes to the benefits in addition to verifying benefits.  

Utilizing visit types can be a quick way to get a good estimate of the patient’s copay and their co-insurance.  For specialty practices that have frequent procedures, planning ahead and understanding the ordering style of the providers can improve the estimation process.  

Recommended Steps:
➤ Verify insurance eligibility before each visit at least once within 3-5 days of the visit.
➤ Use software or payer tools to estimate co-pays, deductibles, and coinsurance.  
➤ Inform patients of their estimated responsibility before their appointment. 

4️⃣ Offer Multiple Payment Options

Background/Research:  
According to a 2022 Experian Health study, practices that offer flexible payment options—including credit/debit cards, mobile payments, and online portals—see higher collection rates and improved patient satisfaction. Payment plans are especially effective for larger balances, making it easier for patients to fulfill their obligations without financial strain.[⁴] 

There are always occasions where a well established patient starts to grow a balance and they are running into their own financial challenges.  As a provider, you want to ensure you have continuity of care, but you also need to balance your responsibility to collect the co-pays and co-insurances required by the payers.   If you have a clear protocol that the front desk team is aware of, then there is an opportunity to create a path for the patient to pay down their balance through a payment plan.   Example guidelines rules: 

Example 1:  If a patient has a balance under $500, then at least 50% needs to be paid prior to the next visit and then the remainder can be paid over 3-4 months 

Example 2: If a patient has a balance over $500, then at least $200 needs to be paid prior to the next visit and then the remainder can be divided between weekly or monthly payments.   

Payment plans can be customized, but empower the front desk by giving them guidelines to work from. Anything outside the guidelines should have Physician Owner approval.

Recommended Steps:
➤ Accept a variety of payment methods (credit/debit cards, checks, mobile payments).
➤ Offer payment plans for larger balances, with clear terms and written agreements.
➤ Consider implementing online payment portals for pre- or post-visit payments. 

5️⃣ Monitor and Track Collection Performance

Background/Research:  
Regular performance monitoring enables practices to identify bottlenecks and measure the effectiveness of their collection strategies. MGMA benchmarks suggest that practices should aim to collect at least 90% of patient balances at the time of service. Tracking by staff member or location can highlight training needs or workflow improvements.[⁵]  Patients who are confused about payments often end up delaying payment even if they were prepared to pay at the time of service.   

When it comes to performance management of your front desk staff, the general rule is this: “What is measured, improves.”  With little work and typically without much more than a few minutes a week, you can see improvements.  For example, if you provide a report to the staff about their TOS collections performance, they will naturally start improving, but with guided help and training, they will exceed your expectations.

Recommended Steps:
➤ Track TOS collection metrics by provider, location, and staff member.
➤ Set realistic collection goals and review progress in staff meetings.
➤ Address barriers or workflow issues promptly. 

6️⃣ Foster a Culture of Accountability

Background/Research:  
Successful TOS collections require buy-in from the entire practice, not just the front desk. Leadership engagement and provider support are crucial for reinforcing payment policies. Recognizing high-performing staff and providing ongoing feedback helps maintain motivation and accountability.[⁶] 

As a private business, collecting the money that is owed is the lifeline for paying payroll, bills, and rent, etc.  Everyone in the practice should be working towards the same goals of providing excellent medical care for patients AND ensuring they are paid for the services rendered.  If a physician owner shys away from this conversation, then the employees will shy away from improving the process.

Recommended Steps:
➤ Engage providers in supporting collection policies and reinforcing expectations with patients.
➤ Recognize staff members who excel in collections.
 Provide constructive feedback and ongoing education.

Conclusion

Maximizing Time of Service collections requires a proactive, team-based approach and a commitment to clear communication with patients. By implementing these best practices—each grounded in industry research and practical experience—private medical offices can reduce outstanding balances, improve cash flow, and enhance the overall patient experience.

If your practice needs help optimizing collections or training staff, DoctorsManagement, LLC offers tailored consulting and operational solutions designed for today’s healthcare environment. Learn more at www.doctorsmanagement.com.

Footnotes

1. Medical Group Management Association (MGMA). “Front Desk Collections: Keys to Success.” MGMA Insights, 2023.  
2. Healthcare Financial Management Association (HFMA). “Transparency in Patient Financial Communications.” HFMA Research, 2023.  
3. American Medical Association (AMA). “Best Practices for Insurance Verification and Patient Collections.” AMA Guidance, 2023.  
4. Experian Health. “Patient Payment Preferences and Trends.” Experian Health Survey, 2022.  
5. MGMA. “Benchmarking Data: Patient Collections at Time of Service.” MGMA DataDive, 2023.  
6. HFMA. “Building a Culture of Accountability in Medical Practices.” HFMA Leadership Series, 2023.  

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