Verify co-pay early to save time, money
Question: A patient came to our office for a routine exam with the same insurance card she’s had for years. We charged her the standard copay of record. Then I found out her employer changed the terms of the insurance, so the copay she paid was short by $20. What went wrong?
Answer: You might easily assume that when a patient has the same insurance company, the copay is the same as it has always been. But unless you check first, you won’t know the patient’s coverage has changed until after the fact.
Best practice …Set up a process to verify each patient’s insurance information before every visit. The ideal time to verify with a patient or her insurance company is either before the appointment or when she arrives at your office. Devise a plan for how you will obtain patient information early on. Your options include connecting with the patient, a software program, or through the payer directly.
Finally, copy every patient’s insurance card every time. This simple step will put you in the clear for those times when a patient’s terms, copays, or precertification contact numbers have changed.
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Find out if you’re legal in collecting patient portion before providing the surgical service.
Don’t be too hasty in collecting a patient’s copay and deductible up front.
“While in theory, the practice of collecting deductibles up front may sound good, you should check your carrier contracts to be sure you are allowed to do this before requesting the deductible amount from the patient up front. There are plans which strictly prohibit this type of up front billing, and you can cause quite a headache for your practice if you are not well informed,” warns a subscriber who commented on “Checklist: Collect Surgical Deductibles Up Front to Improve A/R.”
True, says Medical Office Billing & Collections Alert editor Leesa Israel. It is always best to check your payer contract before implementing any billing or collections practice. Every payer, and every contract, can be different.
Whether you can collect a deposit from the patient before performing a surgery is a function of your payer contract that your physician has signed. If the contract does not exclude collecting copays and deductibles up front, you are perfectly legal in collecting the patient portion of the surgery before providing the service.
Exception: If your physician signed a contract that forbids this type of up-front collection, you would be violating the contract by collecting a pre-surgery deposit.
Lesson learned: This is why it is so important to read your contracts before signing them and why it is so important to have a copy of all of your signed contracts. That way, you can quickly and easily determine if there are any limitations or any privileges that you have as stated in the contract that affect your billing and collections procedures.
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- 10 Carrier Contract Negotiation Tips Carrier contract negotiation is often a long, difficult process....
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Verify co-pay early to save time, money
