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Patient Deductibles Can Strangle Your Cash Flow

5 Tips to Normalize your Cash Flow

At the beginning of each year, many physician practices face shortfalls in cash flow due to health plan deductibles.  Medical deductibles can play havoc with physician practices.  Health plans have consistently increased deductibles and, of course, the Affordable Care Act (ACA) plans are now in the mix.  Thus, a greater financial burden is placed on the patients for medical services and, in turn, physician practices are left to deal with the cash flow slow down.

Not so very long ago, a large portion of the medical bill was traditionally paid by commercial insurers, Medicare and other third-party payers.  But now, the landscape has changed.  Physician practices are forced to walk a fine line between providing good clinical care and limiting the burden associated with increased costs.  There are no other professions where consumers expect to receive services or goods and pay later.  But that is exactly what happens with health care.

At the beginning of each year, patients must first meet their deductibles before reimbursements will be sent to the provider.  So when you submit your bill the majority, if not all, of the allowable (what the insurance carrier would usually pay directly to you) is applied to the patient’s deductible.  Therefore, you get $0 from the insurance carrier and you must then bill the patient and wait for payment.  This can result in a delay of payment for 45-90 days.  Without excellent collection efforts from your billing team it can even result in bad debt.

What does this mean for your practice?

Let’s say Dr. Brown’s monthly collections average $100,000.00 and the total patient deductible amount for the month is $25,000.  If Dr. Brown did not collect any money from the patients at the time of service, then the projected collections for the month would be his average of $100,000 – $25,000 in patient deductibles = $75,000.  Rather than his average of $100,000 he would have only $75,000  to pay his expenses.

Ultimately, patient balances should be collected.  But how long can your practice wait for this money?  How long can you provide these interest free loans to your patients?  Below, are five practice tips to keep patient deductibles from strangling your practice.

  1. Staff members need to know what a plan covers;
  2. Verify eligibility and deductible status before every visit;
  3. Have honest conversations with patients and explain patient responsibility up-front;
  4. Collect whole or partial payments from the patient while they are in the office;
  5. Develop payment plans.

The best way to minimize the impact of deductibles is to be proactive with patients by detailing costs and  requiring a payment of the patients’ deductible.  At first, this may seem awkward or you may feel uncomfortable asking for a payment upfront, but in today’s health care environment more assertive tactics are needed to protect your bottom line.


Flu Shots Given – Charges Denied

Flu ShotsNew codes for flu shots in 2017!

By:  Claire Ariyoshi, MBA, CPC

The flu season is underway and the Center for Disease Control (CDC) is recommending that people get their flu shots.  According to the CDC, only injectable flu shots are recommended this season.

Health care providers have been providing flu shots to their patients in record numbers.  However, some providers are now left wondering why their charges are being denied by various insurance carriers.  If this is happening to you, it may be because you are using the wrong codes.  Following is a summary of how providers must code in order to be paid.

Effective January 1, 2017, many influenza codes were revised to remove the age indicator and a dosage is now required. The table below illustrates these changes.

REVISED Influenza codes

2016 (age of patient) January 1, 2017 (Dosage)

90655, 90657, 9085,90687

6 – 35 months

0.25 mL dosage

90656, 90658, 90686, 90688 Older than 3 years

0.5 mL dosage

Providers who have followed these coding guidelines are being reimbursed in accordance with the carriers policies.Additionally, a new CPT 90674 has been added for a quadrivalent cell cultured influenza vaccine that is indicated for use in those 4 years of age or older.

Claire Ariyoshi is the Vice President of Finance for Onpoint Medical Solutions.  She has over 30 years experience managing medical billing and patient registration departments for private practices.  In addition to her MBA, she is a certified professional coder and is ICD-10 certified. 

Physical Therapy Coding Changes

Physical Therapy Coding Changes

2017 Coding Changes

Every specialty is impacted by the 2017 coding changes but physical therapy coding changes are drastic.  Over the next few weeks, Onpoint Medical Solutions will highlight some of the changes by specialty.  This week we’ve summarized the coding changes for physical therapy.

There are major changes for the Physical Therapy evaluation and re-evaluation codes for 2017.  The current codes 97001, 97002, 97003, 97004 have been deleted and replaced with 3 new evaluation codes, CPT 97161, 97162, 97163.

You are likely aware that Medicare and most commercial carriers required the switch as of January 1st.   But did you know that workers compensation and auto insurance carriers are not mandated by HIPAA to use the new CPT codes?  This means that you will still have to use the old codes for these carriers while remembering to use the new codes for all other carriers.  For your reference, we have included an easy to read summary of the new physical therapy CPT codes.

For physical therapy, the new evaluation codes will include different components of complexity and severity.  For instance:

  1. Patient history, medical and functional, including relevant comorbidities and personal factors;
  2. Examination AND the use of standardized tests and measures;
  3. Clinical presentation of the patient; and
  4. Clinical decision making including standardized patient assessment instrument and or measurable assessment of functional outcome.


Changing what you’ve done and how to do it is always challenging.  Don’t let your practice suffer.  Make sure you capture all services, all codes and enter the correct number of units.  Now is the time to work with your biller to implement edits to catch and correct the coding errors before the claims go out.  This will ensure that your cash flow won’t be negatively impacted.  The physical therapy coding changes don’t have to jeopardize your practice.

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