Wiki Billing Deductibles

[JillMedicalBiller]

Hello all!
I have a question or rather two questions, about billing deductibles.
#1. I've been going over some older patient accounts and billing out the copays, coinsurances and deductibles, and it recently came to my attention, that I may not be able to charge the deductible that is listed on the remittance advice, if the patient saw other providers or met their deductible in the last several months or even weeks. What is the best way to determine if I can still charge a patient for a deductible for a date of service in 2023? Ask the insurance company if their 2023 deductible was met and go from there? What about in 2024?

#2. If a patient's primary insurance paid for a given date of service, then the secondary insurance adjusts their payment for same date of service and says that there is a patient deductible, can I charge the patient for the deductible amount stated in the secondary insurance remittance advice?

Thank you! I appreciate any tips or advice!

 

[sls314]

#1. I've been going over some older patient accounts and billing out the copays, coinsurances and deductibles, and it recently came to my attention, that I may not be able to charge the deductible that is listed on the remittance advice, if the patient saw other providers or met their deductible in the last several months or even weeks. What is the best way to determine if I can still charge a patient for a deductible for a date of service in 2023? Ask the insurance company if their 2023 deductible was met and go from there? What about in 2024?

I think you may have misinterpreted or been confused about something you read.

The insurer processes claims in the order they are received. If your remittance advice states that it was processed to the patient's deductible, then it was processed to the patient's deductible. Claims that other providers submitted after yours are irrelevant to your claim.

If the patient's deductible was met for 2023, your claim was included in that deductible calculation.

Additionally, you must make a good faith effort to collect that balance from the patient, or you'll likely be in violation of your payer contract.

 

[JillMedicalBiller]

#1. I've been going over some older patient accounts and billing out the copays, coinsurances and deductibles, and it recently came to my attention, that I may not be able to charge the deductible that is listed on the remittance advice, if the patient saw other providers or met their deductible in the last several months or even weeks. What is the best way to determine if I can still charge a patient for a deductible for a date of service in 2023? Ask the insurance company if their 2023 deductible was met and go from there? What about in 2024?

I think you may have misinterpreted or been confused about something you read.

The insurer processes claims in the order they are received. If your remittance advice states that it was processed to the patient's deductible, then it was processed to the patient's deductible. Claims that other providers submitted after yours are irrelevant to your claim.

If the patient's deductible was met for 2023, your claim was included in that deductible calculation.

Additionally, you must make a good faith effort to collect that balance from the patient, or you'll likely be in violation of your payer contract.

I appreciate your input on this! I know now where I was wrong in my thinking! Thank you!