Whew the holidays and 2020 are behind us! But now providers are faced with collecting patient deductibles. Every January, patients with health insurance have new deductibles to meet and many of those patients have high deductible plans which make collecting payments upfront even more important. Some providers do a good job of collecting the annual deductibles at the time of service. Those practices who make a concentrated effort to collect deductibles have a much more consistent cash flow over the first two quarters of the year.
This is a team effort. It takes effort and consistency from both the clinic and the billing company in order to maximize cash flow. Billing patients for any amount owed that wasn’t collected at the time of service is a big part of the service that Onpoint and presumably most medical billing services provide to clients. But collecting the deductible upfront eliminates waiting for the insurance company to adjudicate the claim and then billing the patient. Patients don’t always pay on their first statement and some may wait 60 or 90 days before they pay. This means the practice doesn’t get their money for at least 120 days or worse the patient doesn’t pay at all but continues to receive care during this process.
The question we get a lot is how much should be collected at time of service. Some commercial insurance carriers offer on-line tools to estimate the patient’s portion. We suggest using those when they are available. When those tools aren’t available estimate the patient’s responsibility. You could base this amount on your average reimbursement per visit. You may collect too much and eventually have to issue a refund, but it is better to collect too much and have to issue a refund than to collect nothing at all. Be sure to explain to your patients that the money you are collecting is an ESTIMATE and that the total owed after insurance processes may vary. This helps tremendously if a statement is sent with a remaining balance.
As a friendly reminder, don’t forget to verify eligibility on every patient before every visit. Onpoint clients have an online tool to do this automatically before the appointment. Many of the carriers will also show the remaining deductible amounts with this tool, as well! This is so very important not just at the first of the year but before every visit. A patient’s insurance can change for many reasons and if the insurance is the same the benefits may have changed so this step is vital. If there are problems with the coverage it is best to contact the patient before they present at the clinic for their appointment. The patient will appreciate it much more than being confronted at the front desk or receiving a statement with a large amount due.
Last but not least is to make sure you have pre-authorizations in place, when required. Insurance carriers are not as lenient with allowing retro-authorizations as they once were. Pre-authorizations must match the date of service and the type of service exactly. Missing or inaccurate authorizations mean you provided the care for free.
As the saying goes – there is no I in TEAM. The front desk, scheduling, pre-authorizations, patient registration and billing all go hand-in-hand. Onpoint isn’t just a billing company, we want to be part of your team, and we work very hard to collect every penny owed to you. For more information, feel free to contact us.