Pulmonology Coding Alert

Question: We ended the final quarter of 2018 furiously trying to submit charges to patients for copays and coinsurance amounts, and we are vowing to do better this year. What should we remember to do to avoid this problem in the future?

Codify Subscriber

Answer:  Good for you vowing to streamline your billing processes for the new year. There are several ways you can accomplish this, but the first is to ensure that you collect any co-pay and coinsurance amounts at the time of the visit, and then educate the patient on his out-of-pocket expenses that may follow. This step is essential to ensuring that if the patient gets a bill down the line, he won’t be surprised since you already explained the potential payments to him.

Furthermore, once you get the insurance payment and remittance advice for a service, send the patient a bill for any applicable balance right away. A delayed response might confuse the patient, who may not remember the exact nature of the charges.

Note:  If patients are having a procedure done, it is always best to identify any financial responsibility for the patients prior to scheduling the procedure. Patients often do not understand that they may have to pay the entire procedure amount when they have a high deductible insurance plan. They become overwhelmed when they get the bill, and often state that although they knew they have a high deductible, but they weren’t prepared to pay that deductible all at once. Scheduling procedures in different locations (when possible) can minimize the patient responsibility as well. Outpatient hospitals typically yield a higher cost than physician offices, for instance.