Wiki Advice regarding deductibles

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jhendrix08

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Hello...

I'm a new biller and the physician I work for (Primary Care) is throwing around the idea of collecting deductible amounts up front, at the end of the visit when the patient is checking out. This seems like a daunting task. Not only do we not know the amount that would be applied to patient's deductible beforehand, we would also have to identify the patient's that actually have deductibles. He's thinking about this now because of the deductibles starting over in January and wanting to save time and effort (and money) chasing deductible amounts.

I would love some feedback from other offices that have a good workflow for this situation....how do you all handle deductibles?

Thanks so much for taking the time to offer your advice. It's much appreciated!!
 
Deductible

The insurances websites typically have a cost estimator and you can more or less have an estimate of the visit beforehand.

What we did that worked for us, is we would run it through the cost estimator and inform the patient this is approx cost - that way no surprise bills.
 
Basically what heartyoga said.

Do you have someone who does verification of insurance in your office? Long story short:
* Verify coverage
* Run Cost Estimate
* At 'check out' have someone speak with patient about any 'osb' or outstanding balances.
 
I agree with the response from the other members.

Another option is to create a financial agreement between the providers and patient to place their credit or debit card on file. This alleviates the headache of having to run full eligibility checks/ deductible cost estimators when patients are in the office which could slow down or back up the providers schedule. In my experience, patients are more inclinded to leave a card on file so they are not hit with the deductible cost up front. This prevents you from having to initiate a whole bunch of patients refunds on the back end in the event the cost estimator overstates the cost! Finally, this allows a steady revenue stream for your provider! This would be a great time to inplement this policy as it’s a new year!

More than happy to provider additional assistance if you’d like to connect!

Robert Meza
http://linkedin.com/in/dermbillingexpert
 
advice regarding deductibles

Be careful.... make sure payment upfront is allowed by your contracts.

Example...Medicare patients - you shouldn't collect their deductible upfront. They may see multiple providers and you don't know which claim will be processed first or how much will be applied to the deductible.

Also - keep in mind contractual amounts. Primary care visit - patient hasn't met their deductible. Staff says that will be $125 for todays visit since you haven't met your annual deductible yet. Patient says okay, I'd rather pay it now, than wait and get a bill. (Right! :rolleyes:) Pays with their FLEX card (flexible spending account). Office files the claim to insurance. Insurance in fact does apply the claim to the deductible, but.... not the $125 - they only apply the "approved" amount to the deductible. If contracted with the insurance, the office adjusts off the non-allowed amount. This results in a credit balance, since the patient paid $125. It also - results in a red flag, as patient used their FLEX card to pay for an amount over and above the contracted amount. IRS doesn't look to kindly upon that. :mad:
 
Thanks for taking the time to respond to my question...I agree with both of you. Unfortunately, it's not an easy thing to deal with up front because of all of the things mentioned above. I certainly don't want to create more work for myself or the front office.

Thanks again, you've all been very helpful and have provided some good points to discuss with my provider.

Have a great week!
 
We collect upfront

This is an achievable and not-so-daunting task. To simplify, you'll need all of your fee schedules from the insurances with which you are contracted - which you should always review every year, as they change. Front staff gets superbill after visit, then they match the charges to the fee schedule and charge patients only the allowable, fee schedule pricing. Voila! Deductibles collected up front. :D In my opinion, you should always collect day of visit because the times have changed and patients are responsible for more OOP. The patients used to only be responsible for 5-10% of allowable charges and now that percentage is 30-33%. Better start collecting or you'll never see it. (Or you'll only see 50% of that revenue after statements). It's just the nature of the beast.
 
I worked for a practice that took "down payments" on visits - especially procedures. It was roughly 20% of Medicare rates, unless the patient had a straight copay or something like a 90/10 plan, then they took half the normal down payment. They just had to make it crystal clear to the patient that it was only a down payment and their actual cost may be more or less than what was collected. If it's more, they'd get a bill, if it was less, they'd have a credit to be applied to any existing or future balance or refunded if the patient chose.
 
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