Wiki Patients benefits verification

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Kimonae

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Hello,
I am a new practice manager at an Ophthalmology/Optometry office. Our Billing software can run the eligibility for us however I am not sure if I should involve the staff in verifying patients deductible balances in order to collect at the check in.
What is your best practice for benefits verification?

Carine
 
I've worked at practices (none eye related) that have done it both ways. I personally prefer NOT to collect deductibles at time of check in. Here's why:
1) Perhaps pt saw another clinician last week and that claim will be processed before yours.
2) You need to know to the penny what the insurance allowable is for each of the codes (for services you haven't even provided yet at check in).
3) You need to know (again to the penny) how much deductible is left.
4) If your fee schedule is not up to date, patients may still have balances, or may also owe for co-insurance.
5) You wind up having to write an awful lot of refund checks which to me is a pain you know where and causes angry phone calls.
Unless you have a patient population that is non-compliant with paying bills, I prefer to inform the patient at check in about the possibility of a deductible, and let the insurance decide exact patient responsibility. Another option is to collect a "deposit" of a set amount if you know there is definitely a deductible of at least a certain amount, again making sure patient understands they will be billed the remainder as determined by their insurance plan.
Side note - most billing software can tell you not only eligibility, but also the deductible and amount left. If you go the route of collecting deductible or a deposit, check with your vendor about that feature.
 
I personally think it's important to verify benefits online prior to the visit. Every carrier has their own website nowadays...

I never collected upfront payments for deductibles or coinsurance that was a percentage. That was too much trouble and also usually ran into way too many issues. But if you verify benefits and it gives you a flat copay amount, I would absolutely collect it when you check them in. If they balk, fine... but it takes 30 seconds to ask for it, but it could take you WEEKS and lots more legwork to collect it on the back end (if at all).
 
csperoni said:
I've worked at practices (none eye related) that have done it both ways. I personally prefer NOT to collect deductibles at time of check in. Here's why:
1) Perhaps pt saw another clinician last week and that claim will be processed before yours.
2) You need to know to the penny what the insurance allowable is for each of the codes (for services you haven't even provided yet at check in).
3) You need to know (again to the penny) how much deductible is left.
4) If your fee schedule is not up to date, patients may still have balances, or may also owe for co-insurance.
5) You wind up having to write an awful lot of refund checks which to me is a pain you know where and causes angry phone calls.
Unless you have a patient population that is non-compliant with paying bills, I prefer to inform the patient at check in about the possibility of a deductible, and let the insurance decide exact patient responsibility. Another option is to collect a "deposit" of a set amount if you know there is definitely a deductible of at least a certain amount, again making sure patient understands they will be billed the remainder as determined by their insurance plan.
Side note - most billing software can tell you not only eligibility, but also the deductible and amount left. If you go the route of collecting deductible or a deposit, check with your vendor about that feature.
Click to expand...
Thank you!
 
MeanderingMichigander said:
I personally think it's important to verify benefits online prior to the visit. Every carrier has their own website nowadays...

I never collected upfront payments for deductibles or coinsurance that was a percentage. That was too much trouble and also usually ran into way too many issues. But if you verify benefits and it gives you a flat copay amount, I would absolutely collect it when you check them in. If they balk, fine... but it takes 30 seconds to ask for it, but it could take you WEEKS and lots more legwork to collect it on the back end (if at all).
Click to expand...
Thank you!
 
Kimonae said:
Hello,
I am a new practice manager at an Ophthalmology/Optometry office. Our Billing software can run the eligibility for us however I am not sure if I should involve the staff in verifying patients deductible balances in order to collect at the check in.
What is your best practice for benefits verification?

Carine
Click to expand...
Our office absolutely collects deductibles and coinsurance at time of service. We verify benefits and contact the patient prior to services, It is based on our contract amounts with the many insurance companies and yes we have a few refunds here and there but the benefit of collecting up front way out weighs that and patient's appreciate the up front communication to avoid surprise bills at a later date. The staff member pays for herself with the job she does with verifying and contacted the patients in advance. Plus this keeps our accounts receivable staff from trying to collect on balances once patient is out of sight and doesn't necessarily want to pay at that point.
 
Billing and collecting from patients after they've left the office, many of which will claim they never had a copay or deductible because they don't understand how their insurance works, is extremely costly and time consuming. The patient's responsibilities are in the "contract" the patient signs when they sign ups for an insurance plan. You didn't force them to get that plan and it isn't really your problem if they have a copay or deductible because you have absolutely no control over that other than, in your contract as a provider for the plan, you have agreed to collect certain copays and deductibles.

Tom Cheezum, OD, CPC, COPC
 
Different specialty here. We have patients in ongoing treatment and have a team who does insurance verification, provides treatment estimates and collects deductibles and estimated coinsurance amounts. There is always a chance of other provider claims processing and changing the way our claims adjudicate. Because these are recurring patients, they can carry the credit forward to another date of service or get a refund of the overpayment.
 
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