Practice Management Alert

If your surgical practice is in a market that has high insurance deductibles or coinsurance amounts, offering patients a surgical cost quote before the procedure may help you avoid being stuck with the bill later.
 
Providing patients a cost estimate of the professional component of their surgery can help them better understand their financial responsibilities, and help the practice identify potential collection issues before they become problems, says Sarah Wiskerchen, MBA, an associate with Karen Zupko and Associates, a consulting firm based in Chicago.
 
The cost quotation process begins after the patient is seen and the decision is made for surgery. The practice's surgical specialist or surgical coordinator calls the patient's insurer to precertify the procedure and verify the patient's eligibility and benefits. "If I came into your practice and was going to have surgery," Wiskerchen says, "the practice would confirm with the insurer that I have this plan, my identification numbers and benefit level. You would find out whether I have a deductible and what the amount is. You would also ask how much of my deductible has been met, and what the coinsurance is."
How to Draft the Quote
Use the information to prepare a cost quote for the patient. The surgical cost quote is a worksheet that a practice can develop and fill out which states the proposed procedure, fee and patient's insurance information. For example, the form would list the practice's charge, the plan's allowable for the service, what the noncovered services are and their charges, the deductible and its amount, the coinsurance and its amount. The sheet contains a calculation of the patient's estimated financial responsibility.
 
The written cost quote is discussed with the patient, often during the visit when the procedure is discussed in detail, preoperative and postoperative instructions are supplied, and a surgery date is scheduled. In some practices, the surgical coordinator calls the plan to gather the cost quote information while the patient is in the office so the patient can discuss coverage and benefits directly with the insurer. Practices need to point out to patients that the cost quote is just that an estimate based on a normal surgical procedure performed by the physician. The physician's actual charge may be more or less than the quote, depending on what occurs during the surgery, such as the doctor discovering new or different medical circumstances during the surgery, or complications.
 
After the surgical cost quote is presented to the patient, practices should ask for a deposit. How much the deposit should be depends on the practice. "This is where the practice can be flexible on what its policy is. There is no hard and fast rule about how much of a deposit should be [...]