Practice Management Alert

When you put a claim through a patient's insurance company and the payer doesn't pay, you need to know what the next step is to ensure your physician gets reimbursed for his services. But can you make the bill the patient's responsibility? Here's what our experts have to say.

Make sure you-re not writing off entire claims that payers deny. If the insurance company is not paying, most likely the bill becomes the patient's responsibility, and you should send the bill directly to the patient.

If a claim does not get paid -the charges go to patient responsibility, and then the patient will usually call and we get them involved to help get the claim paid,- explains Ann Blake, CPC, assistant office manager at Dubuque ENT Head & Neck Surgery P.C. in Dubuque, Iowa.

First step: Review every denial that comes in before automatically passing the bill on to the patient. You need to make sure the denial is not because of a billing or coding issue on your part. If the payer is denying the claim for another reason, such as when the payer requires a referral before covering services by a specialist and the patient did not get a referral before seeing a specialist in your practice, you should bill the patient directly.

One of the most important things to remember if you-re going to bill patients for this or any other reason, is that you need to clearly outline your billing practices and financial policies to your patients.

-I have put in a clause in our patient intake forms that states -by affixing your signature to this document, you understand that if your insurance carrier does not pay within 60 days or if you have failed to obtain a valid referral, you are responsible for payment of services,--says Connie Treonze, practice administrator for Associated Orthopaedics in Union, N.J.

-In the financial policy that our patients sign, it states that the bill is ultimately the patient's responsibility; that we file insurance as a courtesy,- says Linda H. Huckaby,CMA (AAMA), billing manager with Carolina Medical Rehabilitation in Greenville, S.C. -After a reasonable effort, we will transfer the balance to the patient and let them deal with it from there. I have had to send collection letters in some cases, and that usually gets some results.- Note that filing insurance as a courtesy is fine if a practice does not participate, but if you participate with a payer you-re required to file the claim.

Essential: You need to check your contracts to see if your payer allows these sorts of practices. Even though it seems fair to bill the patient, this practice may actually violate your third-party payer contracts, experts caution. If your contract does not mention billing patients after a denial as a prohibition -- in other words, if the topic is not addressed in the contract -- go ahead and bill the patient.