Cash practice and superbills

[liquidshadow22]

Have been taking direct cash payment and provide superbill for pt to submit after visit currently.

However is there a significant advantage to submitting the superbill to the insurances on the patient's behalf? Also what about only charging post-reimbursement amount: only charge pt for the remaning balance after the pt gets reimbursed from their insurance plan, so they don'tneed to pay the session fee upfront..?

Is it worth making these changes to the payment process for out of network coverage, would it make pts more likely to engage in care with an out of network psychiatrist?

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[sighchiatry]

Also what about only charging post-reimbursement amount: only charge pt for the remaning balance after the pt gets reimbursed from their insurance plan, so they don'tneed to pay the session fee upfront..?

This will give you a lot of headaches

 

[romanticscience]

I submit on the patient’s behalf and wait until I receive the EOB before invoicing them. Unless, we both know for sure we’re working down a deductible. Then, I’ll bill them after the appointment.

However, this applies to established patients, often who changed insurance. It has strengthened the alliance.

I’d be hesitant to do this for the first visit/new patients, given risk of them not following up. Thought, taking a credit card on file would hedge this risk.

I would doubt it would be a major selling point. Your reputation, location, fees, and specialty would matter more.

 

[liquidshadow22]

I submit on the patient’s behalf and wait until I receive the EOB before invoicing them. Unless, we both know for sure we’re working down a deductible. Then, I’ll bill them after the appointment.

However, this applies to established patients, often who changed insurance. It has strengthened the alliance.

I’d be hesitant to do this for the first visit/new patients, given risk of them not following up. Thought, taking a credit card on file would hedge this risk.

I would doubt it would be a major selling point. Your reputation, location, fees, and specialty would matter more.

How do you submit on their behalf? Is it built into your emr or do you have a billing company?

 

[romanticscience]

It’s built into my EMR so it’s very easy.

 

[Bartelby]

Which EMR is that? Have you found that process to be time consuming or stressful? I see an out of network dentist who files for reimbursement for me, and can say that from the patient perspective it is very nice. It also brings the cost down so that there is not a very significant difference financially between seeing that dentist and seeing an in network one for me.

 

[TexasPhysician]

Holding balances for patients is a good way to never get paid.

 

[Username2015]

Let patients submit their superbill to insurance for them. If you want to make it easier, you could try a service like reimbursify which helps them.

I would avoid getting involved in insurance admin headaches unless you have to

 

[splik]

Yes you can do this it is called balance billing. I wouldn’t recommend it but you could do this. More often then not the pts OON benefits only cover a part of the costs. This depends on how much you charge how they calculate the maximum allowable charge and what percentage they reimburse. Say your charge is $450 for example and the maximum allowable is $200 and they reimburse 50% of that then you are first collecting $100 from Insurance (which could take a month or longer - on rare occasions I’ve waited 6 months before getting anything from insurance) before collecting the majority from the patient. As mentioned elsewhere OON benefits should be seen as icing on the cake for patients to get a bit of their money back, it is not a reliable way in the most part for patients to pay for their care as they will usually only recoup a fraction of the costs. If you put that onus on to you it could be very risky.

the whole point of a cash practice is NOT to deal with this. It would be better to have a single case agreement rather than do this IMHO. Or if you have a pt who can’t afford your fee you could offer sliding scale. But submitting these bills for pts and waiting to collect does not make sense for a cash practice. It may be more reasonable for an insurance based one but depends on other factors too.

 

[romanticscience]

Which EMR is that? Have you found that process to be time consuming or stressful? I see an out of network dentist who files for reimbursement for me, and can say that from the patient perspective it is very nice. It also brings the cost down so that there is not a very significant difference financially between seeing that dentist and seeing an in network one for me.

Simple Practice. Not stressful at all. Though, consider that I have a mostly insurance-based micro-practice (~170 total patients) and I'm only doing this for about 5 people.

 

[Jules A]

I'm sure patients would appreciate it but essentially defeats the beauty of a cash practice. Only about 10% of mine request a superbill.

 

[medium rare]

I do not take insurance but for patients who request this, my office manager will submit a CMS-1500 directly to the patient’s insurance but they must have their balance paid in full prior to doing so. I inform them I do not accept assignment and, once submitted, it’s between them and their insurance carrier.

I’ve found it’s quicker to do this than have my office manager on the phone answering patient questions about how to complete a CMS-1500 from a superbill. Yes, it’s a courtesy to the patient and not something I have to do but I feel it’s a small effort to help patients paying out-of-pocket get some reimbursement. Takes my office manager about 2 minutes to complete.

A bit of advice, if you do this and the insurance happens to send you the reimbursement instead of the patient (even when you’ve selected ‘do not accept assignment’), send the check back to the insurance along with a letter stating you do not accept assignment. Best to stay separate of any insurance dealings if you don’t take insurance.