Wiki Patient payments

[pchamp25]

Hello all!

I work in an ASC and per our policy, we provide patient's w/an estimated cost for the upcoming procedure and then ask for payment of their responsibility in full prior to their surgery.
We are being advised by HPHC, that we are not allowed to collect member responsibility prior to their procedure, and have to wait until after the claim processes. Has anyone else noticed this w/HPHC? What are some of your policies when it comes to collecting patient responsibility for a surgery @ an ASC.
FYI - we are located in the Northeast

TIA

 

[csperoni]

Don't work for an ASC, but....
Is this restriction part of your contract with HPHC? If yes, you may not have a choice.
That aside, I would imagine you frequently have the issue where a patient paid your estimated responsibility but when processed by insurance, the amount was less. How responsive are you in contacting and refunding those patients?
Many, many, many years ago, I did work in billing for a primary care office that was an urgent care before urgent care centers existed. For Medicare patients (both deductible and co-insurance), the front desk would collect as the patient was leaving based on the superbill by the clinician. I can't tell you how many patients I had to explain there was an additional balance or a refund due because the clinician forgot to circle something, or circled the wrong item, or the front desk made a math error, or an additional claim processed in the interim changing the deductible. Honestly, it seemed like a lot of additional work from my perspective.
If it's not prohibited by your contract, it is your business decision. You would need to estimate how much time/effort goes into doing it this way vs billing afterward and unpaid bills. At an ASC I would imagine your patients tend to have larger responsibilities, so collecting up front the way you do now may be the best option (provided you PROMPTLY refund any overpayments.)
Hopefully some others with ASC experience can give their workflows.