Pediatric Coding Alert

When asked if they are collecting co-pays before the patient is seen, most pediatric office managers respond with a sheepish, Oh, I know we should, but were not doing it. They know that they should for a number of reasons: it streamlines patient flow, facilitates processing, and virtually guarantees that you will collect the co-pay that day. They dont because, well, they havent figured out how to break such news to parents. Also, they are worried about how to adapt their front desk to handling of money.

There are ways to solve problems of collecting co-pays up front, to the benefit of your practice. Here are some tips on how to do it.

1. Contractual obligations. You may have a contractual obligation to collect co-pays, says Gerrie Kugler, managed care consulting director for Pediatric Healthcare Alliance, a 28-pediatrician, 11-location practice based in Tampa, FL. And if you do, its best to collect them up front, at the same time that you verify the insurance, opines Kugler. The co-pay is usually listed on the claim form or the patient's insurance card, she notes. So, if its not recorded as being collected, the managed care company may reduce the pediatricians fee by that amount. Therefore, its absolutely essential to collect the co-pay. And why not do it at the very beginning of the visit -- while the patient is checking in? That way, the claim form can at least have the co-pay part -- a very important part -- filled in before anything else is done.

2. Get it over with. In many instances Kugler has found that parents actually like getting the payment over with before they take the child in to see the pediatrician. The last thing they want to do on the way out is pay a bill. Especially when their child may be upset, she says. Also, it means theres no long line of people holding crying babies waiting to pay up. And anything you can do to eliminate that part of the pediatric experience will be appreciated by parents.

3. Let the parents know. Reminding parents of the new policy is key -- starting with scheduling. When parents call for an appointment, they should be asked what insurance they have and what their co-pay is, says Kugler. This should be verified before the patient comes in; if it isnt, the front desk should do it as soon as they walk through the door.

Tip: When you explain why youre instituting the payment-before-examination policy you can tell parents that it will make leaving the office a lot easier.

4 . Verify co-pay. We have a matrix that states what the co-pays have to be, by managed care companies, says Kugler. We have it listed by employer too, she adds, noting that different employers have different agreements with managed care companies about what their employees co-pays and deductibles will be. But with plans merging every other day you still should verify this with the parent each time they come in.