Ophthalmology and Optometry Coding Alert

Question: We often have patients who don't pay their deductible after surgery. Is there a recommended way to collect these payments up front?

South Dakota Subscriber

Answer:  Yes, you may collect a deductible upfront. The first step is to confirm the deductible amount with the payer. Insurance verification services now make it possible for practices to determine if a patient has met his deductible, or how much deductible remains unpaid. Others provide just information on what the total annual deductible is. This information may also be found online. You usually can access updated information before the patient's scheduled procedure. In the event of an overpayment from the patient, be sure to promptly refund the overpaid amount as necessary to the patient.

Pointer: Before settling on the deductible due, check to see if the patient has Medigap coverage or other secondary insurance that will cover a portion of the payment. Then contact the patient to communicate what his responsibility may be. Try to speak with the patient about collecting the deductible several days, or even weeks, before the procedure, rather than on the day of the procedure.

Make sure you tell the patient where you obtained the information about his deductible, and let him know that the amount is an estimate based on the services your physician expects to perform. Otherwise, you may receive calls from patients after procedures saying they don't owe any additional fees because they have already paid up front.

Always emphasize that the amount you are collecting is just an estimate, and after their insurance pays, you will adjust the payment amount, which may result in a partial refund or additional monies owed. Some practices use a written surgical fee estimate, which they provide to the patient.

If you cannot collect up front from a patient, you're left with two options: reschedule the procedure or perform the procedure and hope the patient pays you afterwards when you send a bill. Many practices are opting for rescheduling, especially if the case is elective.

The last option to consider would be setting up a payment plan to allow the patient to pay off the amount due over time -- an option, granted, which may leave you with a balance to write off.