Checklist: Collect Surgical Deductibles Up Front to Improve A/R
Posted on 17. Jan, 2010 by Editor in Toolkit
This 3-step checklist will boost your bottom line.
With fewer patients following through on procedures because of economic and financial struggles, and an increasing number of patients not paying their bills, your practice needs to find ways to improve your A/R and bring in deserved money. Adapting an up-front deductible collection policy is one proven way to do both — and setting up a policy can be as easy as 1-2-3.
1. Confirm the Deductible With the Payer
Insurance verification services now make it possible for practices to find out if a patient has met his deductible yet. Some services can tell you how much of the deductible remains unpaid. Because this information is available online, your practice can get this information last-minute, the day of, the day before, or several days before the patient is scheduled to come in for a service or procedure.
“I have started to look up insurance deductibles and copays on Web sites,” says Joy Bloodworth, CPC, CCS-P, office manager and coder for Surgical Associates in Cordele, Ga.
Pointer: Check with your benefits verification services, as some offer real-time information on how much of a patient’s benefits have been used to date, the deductible to date remaining, number of hospital days remaining, skilled nursing facility (SNF) days remaining, and if the patient has Medigap coverage that will cover a portion of the payment.
2. Contact the Patient Before the Procedure
Once you have the information from the payer about what the patient’s responsibility will be, you should contact the patient. Most practices are more successful when they contact the patient several days before the procedure, rather than the day of the procedure, experts say.
“We are calling patients about one to two weeks in advance if possible requesting the deductible or their percentage of the allowable...
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Julie Carpenter
18. Jan, 2010
While in theory, the practice of collecting deductibles up front may sound good, it’s best to check your carrier contracts to be sure you are allowed to do this before requesting the deductible amount from the patient up front. There are plans which strictly prohibit this type of up front billing, and you can cause quite a headache for your practice if you are not well informed. The reasoning is, and this holds true for many surgeries, your charges may not end up being the ones that are processed and applied to the patient’s deductible. For surgeries, there are most likely multiple parties who will submit claims, for example, the surgeon, the facility, the anesthesiologist, etc. If you don’t want your surgeon’s bill to go to the patient’s deductible, some providers will simply hang onto the charges for a few weeks in order to let the other providers submit their charges first, thus lessening the chance of being the provider whose charges end up out to deductible.
Leesa A. Israel, CPC, CUC, CMBS
18. Jan, 2010
You are correct, Julie. It is always best to check your payer contract before implementing any billing or collections practice. Every payer, and every contract, can be different. In fact, I just covered this very topic in the latest issue of Medical Office Billing & Collections Alert. Here’s a snippet of that piece:
Whether you can collect a deposit from the patient before performing a surgery is a function of your payer contract that your physician has signed. If the contract does not exclude collecting copays and deductibles up front, you are perfectly legal in collecting the patient portion of the surgery before providing the service.
Exception: If your physician signed a contract that forbids this type of up-front collection, you would be violating the contract by collecting a pre-surgery deposit.
Lesson learned: This is why it is so important to read your contracts before signing them and why it is so important to have a copy of all of your signed contracts. That way, you can quickly and easily determine if there are any limitations or any privileges that you have as stated in the contract that affect your billing and collections procedures.
Thanks for the comment Julie.
Best,
Leesa