Primary Care Coding Alert

Follow these steps to collect money your doctors earned.

As insurance companies threaten to pay physicians less for services, your practice may decide it just isn't worth participating with some payers. But if you continue to see patients with insurance you no longer participate with, you may have to revise your collection practices to get the money you're owed.

Here's why: When you are a non-participating provider with a payer, the patient directly receives the check from the insurance company. But some patients do not, then, use those funds to pay the bill your practice sends. Employ one -- or more -- of these strategies to ensure you're not letting dollars slip out the door.

Collect Before the Patient Leaves Your Office

If you know in advance that a patient has an insurance that your practice doesn't participate with, then you know the payer will send the check right to the patient. Therefore, you should collect your fee directly from the patient at the time of service.

"Obtaining patient insurance [information] before the appointment is critical," says Lori Wechsler, CPAR, billing manager for Savannah Vascular and Cardiac Institute in Georgia. "For a non-par plan, we would find out if the patient had out of network benefits and collect any balance due."

First step: Make sure that your patients know they are responsible for paying for non-covered services. "Patients should be advised that you are not participating with their insurance when they call to make the first appointment," says Marge McQuade, CMSCS, CMM, a consultant and director of education for PAHCS in Florida.

Outline your expectations in the financial policy you give all patients, and post a sign in the waiting area stating that payments are due at the time of service. "All practices should have a financial policy they give their patients on the first visit," McQuade says.

Another good practice is to remind patients when they make their appointments that they will owe any non-covered fees for the visit, as well as the payment methods your practice accepts. "We tell our patients when we schedule their appointment that they will be responsible for making payment when they come in," Wechsler says. "If we know what they are being seen for, we go ahead and estimate their portion and collect it when they check in. If we don't know what's being done, we collect at checkout."

Don't Rule Out Sending the Patient to Collections

If you opt not to collect at the time of service, you can send the patient's delinquent 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.

In her practice, Wechsler says, "If the patient is paid and then in turn doesn't reimburse our office, that qualifies as immediate collections."

Good practice: Write a letter that states the patient will receive payment from the payer and therefore the patient will be responsible for paying the bill.

The letter should state that the insurance company will be sending the patient the payment, therefore, making him responsible for the services provided. The patient will then need to pay services in full at the time of the visit or arrange to make payments.

You can also create a form letter you send to non-par patients reminding them that they owe you the money. "Currently, we have a letter we send after we get an EOB (explanation of benefits) from the insurance saying they paid the patient," Wechsler says.

Pointer: "Send the patient a statement first and try to collect before taking further measures," McQuade recommends.

Accept Assignment With Payers, Even If You're Non-Par

If you're unable to implement an upfront collections process for some reason, you're not necessarily out of luck when it comes to easily collecting for your services. You can still submit claims to the payer and accept assignment if the patient agreed to allow you to accept assignment, even though you do not participate with that payer, Wechsler says.

Practices should accept assignment on all claims whether you are par or non-par, McQuade recommends.

How it works: Have the patient sign a form allowing you to accept assignment. Consider making that form part of your standard initial patient packet that every patient signs.

The catch: If you're dealing with Medicare as a nonparticipating physician, you will be paid less than a participating physician, even if you accept assignment. You will, however, be guaranteed payment without having to chase down the patient. Some other payers will pay you the same as they would have paid the patient, and you will only have to bill the patient and perhaps have to send them to collections or small claims court for the deductible or co-pays.

Still other insurers will not pay a non-participating physician, even if the claim has an assignment of benefits to the physician. In those cases, you will not be able to accept assignment and will need to look at one of the other collection options.

Updates: Your practice should regularly evaluate the payers with which you do (and do not) contract as well as your patient base. You may find in some cases that participating with a particular insurance company will save the practice time, money, and headaches in the end.