Hint: Collecting early is often the key. As payer contracts get more and more complicated and payment continues to dwindle, many practices are choosing to not participate, or become "non-par," with some or all payers. But non-par collections can be a losing proposition that is complicated and time consuming, if you don't implement a solid, consistent plan of action. Let our experts help you start off on the right track to ensure you bring in every non-par dollar your practice earns, without having to do a lot of extra work. 1. Get the Patient to Sign a Statement When you don't participate with an insurance plan the patient is responsible for payment. You should clearly inform your patients of this, along with your financial and collections policies. Be proactive: "Most practices already have the patients sign some kind of document telling the patient that claims are being sent to the payer as a courtesy, that ultimately the patient is responsible for making sure payment is received by the provider," says Leslie Johnson, CPC, manager of coding, compliance, and education at Somnia, Inc. in New Rochelle, NY. Reminder: Keep in mind, however, that if you are non-par getting the insurance information is not the key to your collections success, but rather is a patient courtesy. "Getting the insurance information prior to performing the service is a courtesy for the patient, so that you can submit to their insurance and get them reimbursed after paying the physician for the service," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPCH, CPCP, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. "The collection of insurance information and submission of the claim is for the patient's benefit!" 2. Collect While the Patient Is In Your Office In some, but not all, cases if your practice does not participate with the patient's insurance company, the payer will send the check directly to the patient. Your challenge is to then collect your fee. If you collect while the patient is in your office -- after the provider sees the patient so you know what the services performed and the level of service he provides for things such as E/M visits, or before the service for surgical procedures -- you won't have to spend time chasing the money after the payer sends a check to the patient. "Collecting payment from the patient upfront before the service is rendered is most important," Cobuzzi says. "The best possible practice is to get the money upfront before the patient walks out the door," Johnson agrees. "Non-par payers actually believe this is what should happen, that the money is received upfront, so they will reimburse the patient." Tip: Solution: Alternative: 3. Know What Fees You Should Charge Determining what amount to charge a patient when you don't participate with his insurance is challenging for many billers. You may think you need to know the payer's allowable or that you need to bill the payer on behalf of the patient and wait for the explanation of benefits (EOB) before you can determine what to charge the patient. Not true. Your fee is your fee. The insurance company's allowance should not matter. "The payer's fees are irrelevant; you should charge your fees," Cobuzzi explains. "But if you are doing a surgery, when you balance bill the patient, it is reasonable to take multiple surgery discounts (50 percent) and only charge 150 percent for bilateral surgeries, etc. You do not have to charge out the surgery to the payer with these discounts, but once it is billed to the patient, these standards of billing would be considered reasonable." "It would be good if the payers' fees were known, but most of them are 'proprietary' ... because it's not generally known what a non-par payer will pay for a procedure, a physician can generally charge whatever they want -- and can reasonably expect to receive some sort of percentage, if not all, the charged amount," Johnson explains. How it works: Why you can bill the patient: 4. When All Else Fails, Turn to Collections If you opt not to collect at the time of service and the patient won't pay, your next option is to send the patient's account to a collection agency, to small claims court, or even to the Internal Revenue Service (IRS). Do not be afraid to use a collection agency whenever a patient owes you money and refuses to pay you. It is important that you do this in a timely manner. Do not hand the collections agency old debt to chase. Give them fresh debt, once you know that the patient has decided to not pay for the medical services rendered. The same applies to going to small claims court. "You have a better chance of collecting the monies due if the debt is not extremely old," Cobuzzi says. Exhaust other options first: Additionally: