Practice Management Alert

Question: I've done everything I can possibly do to get paid from the insurance company, with no success. At what point is it acceptable for me to turn the balance over to the patient and make him responsible for payment? How should I go about doing this?

 New York Subscriber
 
Answer: This is a call each practice should make individually, and you should address this in your financial policies and procedures.
 
"Our office takes many measures to avoid billing the patient," says Lucia Yang with Windsong Radiology Group in Williamsville, NY. For example, if there's a denial because the insurer is awaiting documentation from a referring physician, Windsong's billing department will contact that doctor, she explains. However, in some cases you simply must bill the patient, Yang notes. "Denials for things such as non-coverage will automatically have to be billed to the patient."
 
Patients at Windsong are introduced into the billing equation once 35 days have passed since the practice first billed the insurance company, Yang relates. "We don't expect payment, but it serves as a notice to patients that they need to contact their insurance company and follow up," she continues.
 
If the patient doesn't call, and the practice still hasn't heard anything from the payer, Windsong sends a second bill to the patient. If there's still no response, out goes a third notice and then a collection notice. In the collection notice letter "we advise the patient that payment or resolution is expected within five business days, at which time the account will be turned over to collections and the patient will be liable for all collection fees associated with his/her account," Yang says. Again, this process is explained in the practice's financial policies, which patients sign before their first visit.
 
A word of warning about billing patients: If you're dealing with an insurance company that you contract with, "you cannot bill the patient if they deny for timely filing" or you'll be in breach of contract, points out Jean Chasin, CPC, owner of MD Solutions in Arlington, Vir. "The only way you can get past that timely filing is if you can prove that the patient did not provide you with the correct insurance information in order to bill timely," she offers. Another strategy is to show proof of timely filing, "such as an electronic receipt from the carrier stating they got the claim and put it into processing."