Wiki Billing question

[Cdawso2]

I am taking over our previous billets job and I have a question. I am sure we are doing something wrong.
When a new patient comes in we verify insurance. Say they have a 1500$ deductible.
The doctor lets them do a self pay discount and collects 50$ and then bills the insurance for whatever the visit total was (varies from $150,250,350) we get eob back claiming no pay due to the deductible. We then apply the 50$ payment the patient made and adjust the balance to zero. Essentially writing it off. So basically we bill insurance, we keep the 50$. Is the visit total paying down the deductible even though we never collect it? I'm so confused I feel like this isn't correct. Shouldn't I be putting the visit total to patient portion if deductible has not been met or make a rule that we don't bill insurance until the deductible is met.

 

[mitchellde]

The patient has a legal obligation to pay their deductible. They agreed to this when they became a beneficiary for that payer. Also you have a contractual obligation to make the attempt to collect the patient owed amount. That means you must submit a minimum of three bills to the patient before a decision to write it off can occur. Also check your contracts, some payers require that you inform them if a patient does not pay their required amounts. Remember the patient owed amounts are their contract with their payer, you cannot amend the terms of that contract.

 

[annawade13]

I agree with Debra. Our providers were notorious for this for a long time before we finally broke them of the habit. It really is unfair because the patient is getting credit for paying a deductible they are not paying. I don't think it's an option make a policy of not billing insurance for deductible reasons if you are contracted with that payer, but this is what our compliance officer advised: If a patient cannot afford their portion and you know this before the visit, give the patient the option to come in as a private pay patient (it's ok as long as it's their choice and not company policy). Charge them full price in your system, but then have them sign a hardship form that states that they are unable to pay (templates are available online). Then the provider can discount the service down to some agreed upon lower price. This avoids having two fee schedules, one for insurance and one for private pay patients, and also avoids you having to send multiple statements before writing off. I don't advise doing this for every patient that walks in the door, though, because your revenue will suffer and remember, those patients will come across their deductible at the next doctor they visit, so chances are they're going to have to pay it sooner or later. Might as well be to you!
Hope this helps, good luck!

 

[Cdawso2]

Thanks yall. I guess I wasn't sure that when it "was applied to deductiable" that it was infact applied and that we had to collect the full amount. I work for a chiropractor so they of course bill crazy sometimes. Not having the knowledge needed. I worked in cardiology before so of course we always took the deductible. So from now on if we only accept 50$ from the patient should we only bill the insurance 50$?

 

[crystalW712]

This method is actually considered illegal and all involved could get into trouble. The patient is legally responsible for all deduct, co-ins, out-of-pockets and copays. Doctors are responsible to collect this money as it does take money off the deduct. And the doctors actually end up losing money in the end!