Billing/Collections

[IAmTheOne1]

Want to gain some insight from those in PP.

Currently in a private practice, our billing company isn't very good (that's another issue). But I wanted to see what others are doing in this scenario:

We've had some new consults come in who are insured but have high deductible plans. Currently how things are being managed, these patients are seen and then billed for services rendered. But the billing is always a month or two delayed. So what has been happening is patients will be seen for a consult, then 1-2 procedures are done, a follow-up or two is done. By this point the patient owes several hundred dollars and sometimes over a grand. The patient feels better, we don't really see them again. Billing company sends patient a bill or two, they ignore it (or maybe even never get it). Several months go by, still haven't collected anything.

If this happens once or twice, okay no big deal. But more and more patients are on these high deductible plans.

Is there a way to prevent doing unpaid work like this? Is it permissible to treat these patients as cash-pay (applying the amounts paid to their deductible) and requiring payment upfront?

Would prefer not even dealing with collection agencies. Seems like a lose-lose scenario: we are unlikely to see any of that money, even if we do the collection agency will take a massive cut, the patients credit gets destroyed (likely already is if they have a habit of not paying bills).

Any suggestions...

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[nvrsumr]

Estimate patient $ responsibility upfront and collect before seeing.

 

[smarterchild]

Estimate patient $ responsibility upfront and collect before seeing.

This isn’t always possible. You have to check your insurance contracts. Many insurance companies and some states prohibit upfront collection of money from patients before the claim is processed by the payer

one suggestion would be to have a credit card on file prior to any services being rendered and explaining to the patient that you will only charge them once their insurance company determines the patient’s financial responsibility.

 

[nvrsumr]

This is correct. There is a particular way to phrase to avoid getting in trouble. My staff was trained what to say. I’m sure there are some state specific rules.

anyway have been doing for more than 10 years.

Better to beg for forgiveness than permission

 

[PinchandBurn]

Question

Are you just missing out on the patient responsibility? What above the insurance company. Are they paying their portion?

 

[IAmTheOne1]

Question

Are you just missing out on the patient responsibility? What above the insurance company. Are they paying their portion?

I’m referring to patients with very high deductibles who haven’t met their deductible - on an insurance plan which pays nothing prior to deductible being met. So in other words, there is no insurance portion.

 

[promethius]

Estimate patient $ responsibility upfront and collect before seeing.

Your office should have an idea approximately how much these insurance companies are reimbursing. Collect the allowed amount plus some change upfront and tell the patient that you are taking a deposit; once the claim comes back with the allowed amount, your office will either send them a bill for the difference if you undercharged or refund the difference if you overcharged; the latter is preferable than the former.

This isn’t always possible. You have to check your insurance contracts. Many insurance companies and some states prohibit upfront collection of money from patients before the claim is processed by the payer

one suggestion would be to have a credit card on file prior to any services being rendered and explaining to the patient that you will only charge them once their insurance company determines the patient’s financial responsibility.

A wise man once said, money that is mine is better in my pocket than in yours. You already know that the patient owes the full allowed amount if they have a high deductible plan, and he/she is no where close to exceeding the deductible yet. Unless you want to spend your time chasing after money that you may never get back, take the deposit and make sure the deposit at least covers the allowed amount of the claim; you can refund the difference later.

 

[Ducttape]

can you just collect posted ASIPP fees for that procedure as the deductible, and reimburse if over?

 

[Pain Applicant1]

Want to gain some insight from those in PP.

Currently in a private practice, our billing company isn't very good (that's another issue). But I wanted to see what others are doing in this scenario:

We've had some new consults come in who are insured but have high deductible plans. Currently how things are being managed, these patients are seen and then billed for services rendered. But the billing is always a month or two delayed. So what has been happening is patients will be seen for a consult, then 1-2 procedures are done, a follow-up or two is done. By this point the patient owes several hundred dollars and sometimes over a grand. The patient feels better, we don't really see them again. Billing company sends patient a bill or two, they ignore it (or maybe even never get it). Several months go by, still haven't collected anything.

If this happens once or twice, okay no big deal. But more and more patients are on these high deductible plans.

Is there a way to prevent doing unpaid work like this? Is it permissible to treat these patients as cash-pay (applying the amounts paid to their deductible) and requiring payment upfront?

Would prefer not even dealing with collection agencies. Seems like a lose-lose scenario: we are unlikely to see any of that money, even if we do the collection agency will take a massive cut, the patients credit gets destroyed (likely already is if they have a habit of not paying bills).

Any suggestions...

I have my own practice and have been doing my own billing for several years through Athena.

#1. All billing companies are terrible. How hard do you think they're going to work for a $100 claim? If they're making 5% they collect only $5 if you get paid. They would go out of business if they were able to spend any reasonable amount of time working on this claim. Multiply this by 10 and you have about $1000 for you but only $50 for them. Billing companies work for several practices so the bulk of their time will be spent on bigger claims. They know that most doctors are clueless when it comes to billing and don't know enough to audit them. This leads to #1a. which is to never allow anyone you pay to know more than you. It's a recipe for disaster.
#2. I don't believe the pt's credit will be affected. I believe you would have to first get a judgment against them for this and you can't do that without taking them to court. I don't believe civil judgments from small businesses are being reported to credit agencies anymore.
#3. Have a collection agency send them a somewhat threatening but legal letter. You don't have to pursue it but sometimes that does the trick. The collection agency should only charge you maybe $10 a letter or so.
#4. Claims should always be submitted the same day the pt is seen. Make that your office policy. This way you'll receive the EOB asap and can see the pt's balance. If past due balances are important to you create an office policy where no pt is seen with a balance over $10. If the pt doesn't pay you, not only did you not receive your payment but you're actually paying the pt's deductible off for them.
#5. You can check your pt's deductible electronically when checking them in. Create a policy where the pt will first have to pay off the balance first if you see a high deductible remaining. Therefore, no f/u visits are scheduled until the first claim's EOB is received.
#6. When all of the above fails, accept that this is part of medicine and you can't collect on everything. Be happy with the money you're making as you're rich and are well into the 1%. Try not to get angry from this as anger can impact your health.

 

[Orin]

What's an acceptable collections/billing percentage?
How much can you write off?

 

[NJPAIN]

As stated, all billing companies suck. I’ve had many and they are good for 6 months and then all turn bad. We found that our current billing company stops sending bills for remaining balances once the patient stops treating. So , if treatment continues they get a monthly statement. If they don’t come for a month or two, statements cease. They claim that this is “ the industry standard” because of the price of postage.