# collecting deductibles up front



## kellyobenour@yahoo.com

I work for an Urgent Care.  With these new ACA policies emerging, and these incredibly high deductible amounts, we need to start charging patients their deductibles up front.  What is going to start happening, is patients are going to stop seeing PCPS and start Urgent Care hoping.  As to avoid paying their terribly high deductibles.  

In order to help prevent this, we are looking at starting to collect deductibles up front, at time of service.  

I have a meeting Monday morning with the owners, to discuss why we need to start doing this and HOW to implement this new office policy.  

Any thoughts/suggestions/articles that any of you might want to shed light on, I would love to hear.  

Thank you in advance.


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## penny571@hotmail.com

I work for pain management and we collect on high deductible plans. We require the patient to pay 1/2 of what the procedure is going to cost them (estimate). Some patients are resistant to the upfront charge, some cancel, but most are ok with it.


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## FriasA2014

*collecting deductibe upfront*



kellyobenour@yahoo.com said:


> I work for an Urgent Care.  With these new ACA policies emerging, and these incredibly high deductible amounts, we need to start charging patients their deductibles up front.  What is going to start happening, is patients are going to stop seeing PCPS and start Urgent Care hoping.  As to avoid paying their terribly high deductibles.
> 
> In order to help prevent this, we are looking at starting to collect deductibles up front, at time of service.
> 
> I have a meeting Monday morning with the owners, to discuss why we need to start doing this and HOW to implement this new office policy.
> 
> Any thoughts/suggestions/articles that any of you might want to shed light on, I would love to hear.
> 
> Thank you in advance.



I am a Billing supervisor in a Neurology group, collecting deductible upfront it is not a good practice especially if it is a Medicare patient.  Before asking for the deductible go to the patient's insurance website and find out if the patient indeed has a deductible,  the website will tell you how much of the deductible have been met already.  You can ask for a small part of the deductible and make sure the patient signs the financial agreement.  Also making sure that the patient is an established patient and in good financial status with the practice should be taken into consideration.  You don't want to make a good patients/clients upset when they always pay their balances.  Always remember that yes we need to collect money but also practicing good relations with patients is better, after all our salaries are paid due to those patients.  For Medicare patient, if the patient already went to a few doctors, the one that submit the claim first is the one who gets the deductible applied.  I had situations where deductibles are collected and then we need to refund it because it was applied to another physician's visit.  These patient are elderly and understanding the Medicare reimbursement process can be confusing.  In this case the patient would need to call your office and ask for the refund in order to pay it to the correct provider.  My advise is collect a copay, check the website for deductible information and make sure you have demographic updated correctly in case it goes to collection and of course the financial agreement.  Hope this help. Annette


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## Herbie Lorona

I would say it all depends on the situation. For most part I think if its a high deductible and they are not close to meeting it yet I would try to collect it up front. For Medicare patients if you aren't the primary care I probably wouldn't. Most times when they are going to a specialist that means they probably just recently seen the PCP and once his claim gets sent and processed the deductible might not apply to the patients visit to the specialist at that time. If they have a $5000.00 deductible and only met say around $1000.00 I would definitely try to get something from the patient.


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## dclark7

I agree that for high deductible plans it's a good idea to collect up front. Most insurance companies will let you know how much is left on the deductible when you verify coverage. Medicare is different since the Medicare deductible is a lot less, but if someone has a 3 or 5 thousand dollar deductible, chances are they haven't met it. 

I know personally my family has only met our $3,000 deductible once in the last five years and that was when my husband had a sleep study done. I also have no problem with paying the provider up front when I haven't met my deductible.


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## drakena74

I agree with collecting on high deductibles. I work at an ASC and it's our policy to collect partial deductibles on high deductible plans.  Just remember,  it's easier to refund the patient then it is to collect from the patient after the procedure has been preformed.


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## annawade13

This is a question for anyone who works in an office setting that collects coinsurance/deductibles up front. If the coding isn't completed before the patient leaves,  how do you know what to collect? Or do you just collect a standard "deposit" on office visits?


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## drakena74

If your office does Elig.  & benefits ck prior to appointment,  you know what to collect & if office visits are applied to ded. or not. When the patient makes an appointment,  you have a general idea of what the patient is seeing the Dr. for.


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## MarcusM

At the very least, collect at least 80% of the anticipated amount with an agreement to bill the patient for the balance.  Medical bills are one of the hardest to collect on once the service has been performed. Many patients think doctors are overpaid, and can "just write it off."


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## Herbie Lorona

Anna, I work in a small office so when the charges haven't been entered we usually go ask the provider to enter the charges so we can charge the patient. If they were just there for an office visit you can always go with one of the visits and base it off that and worse case the pt will have a credit if you choose a higher visit then is actually done. Better to get something now then trying to get it all later.


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## annawade13

Thanks everyone. I work for a billing and coding company and have recently started coding for an optometry practice. The practice checks eligibility and deductible up front, and is used to getting the codes from the doctor before check out but this doesn't happen anymore, obviously. The doctor had been seriously undercoding, and so these patients are going to pay coinsurance/deductible on a 99212 but the coding will turn out to be a 92012, for example. In my experience, offices that collect coinsurance/deductible amounts up front seem to generate a much higher number of phone calls along the lines of "I paid everything they told me to when I checked out, I'm not paying any more." They sign the form that states all unpaid balances are the responsibility of the patient, but we all know that doesn't solve the problem. I guess it's a trade off of getting the exact right amount from the people who pay their bills when they come, or getting at least some from everyone who walks in the door. (Oftentimes the amount left over is too small to generate a statement, anyway.)

I think I'll just recommend they collect based on a 99213 unless the doc says differently, and try to be very clear that this is not balance in full. Thanks everyone.


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## Herbie Lorona

Yes I know what you mean Anna. It will happen from time to time where the patient pays one amount but ends up owing more. This happens to me when they add the office visit and the front desk charges him but later after the Dr. has gone through he may add a procedure code like an injection or something that may have been given. You just have to explain to the patient when they ask why and as you said make sure they are not being told that is balance in full. I would suggest telling them there estimated total is. The more you guys do it the easier and better it will get. Maybe try talking to the providers and let them know the importance of putting the right codes.


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## suemt

I came across this again yesterday with a new client.  When I asked them what are they doing at the front end to educate patients (they have a high volume of ACA and lower income patients to whom this whole concept of coins, deductible and copay is foreign), they threw up their hands and said (1) they have a notice about patient responsibility but the patients never read it and (2) the front desk is too busy already to start having conversations with patients.  

I asked them if they wanted to try to fix the problem at the front end (before they provide these 'free' services) or at the back end when they've not only delivered the free service but spent a lot of time, energy and money pursuing cash they will never collect?  

Hopefully will help them put some protocols in place (after I help train the docs on proper E/M coding - they lament they weren't taught this in med school and it is now biting them in the butt when the insurance companies are auditing them and wanting money back).


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## teresabug

hospital reg depts collect patient coinsurances before they will schedule someone for an elective procedure. It's been done for years. I do not recommend collecting from a Medicare patient. But if that pt does not have any other coverage, definitely get the 20% coinsurance before services are done. I have worked in many offices and have sent many patients to collections and never saw a dime! To be profitable you have to be proactive.


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## JesseL

some insurance restricts you from collecting up front. Bluecross Blueshield is one of them.  It's total BS how they have this restriction but not give a rats rectum when patient's don't pay their deductibles.

Another example is FIDELIS CARE:  http://www.fideliscare.org/Portals/...l/NY State of Health Provider Manual/PM12.pdf

Their bloody policy manual states this:

"Providers should only collect a member's copayment at the time of service. Providers
may bill members for applicable coinsurance and deductible amounts *only* after claims
have been adjudicated by Fidelis Care. The provider's remittance advice will indicate the
member's financial responsibility."

And this is for their bloody Obama Care Plan that has been nothing but useless.

It's really such B.S.  Do they not know that patients are very likely to not pay after they leave the building!?!?


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