Gastroenterology Coding Alert

Question: Thank you for your Q&A last month about how front desk staff should be trained on how to collect past-due balances. Should we have them do this when the patient walks in, or as the patient is leaving? We’ve been told not to collect until the service is rendered.

Wisconsin subscriber

Answer: You can collect past-due patient balances at any time, since those services have already been rendered. However, you may have been told not to collect deductibles and Medicare coinsurance amounts upfront, and this is an area that can be trickier, although it’s still not necessarily a hard and fast rule. Here’s the scoop on what you can collect and when:

• Coinsurance: If you properly verify the patient’s coverage upfront, you can typically collect Medicare coinsurance payments before patients leave your office. For Medicare Advantage patients, you can collect this when the patient checks in, since the figures don’t depend on which services you render. For Part B, you can usually charge the patient after the service but before they leave your practice. At checkout, read the chart to determine which services were rendered, and then you can collect the appropriate coinsurance amount.
• Deductibles: The rules for deductibles may be slightly different, depending on the insurer. From a compliance standpoint, if the practice knew without a doubt that the patient’s deductible had not been met, there is nothing that prohibits the practice from collecting it at the time of service prior to sending the claim to Medicare. However, keep in mind that if a patient has a secondary policy, that insurer will typically pay the deductible, and in some cases, the patient may have other claims processing that will impact the deductible amounts they still owe. Therefore, many practices choose to bill the patients after the fact for deductible amounts.

You should create an office policy that addresses these types of situations and train your front desk staff accordingly so that each patient is treated the same in terms of when they’re expected to pay any balances due.