e-MDs Billing Tip: Maximize Patient Collections- Part 3 Deductibles

e-MDs Billing Tips: Maximizing Patient Collections In Primary Care- Part 3 Deductibles

Copays, Coinsurance, and Deductibles are all part of the patient collections process. These are the three basic means of front end revenue that practices should be collecting before a patient is seen by a provider.  We’re going to define those terms, let you know what your front desk team should be doing to collect those on a daily basis and why they are crucial to your bottom line. This week’s e-MDs billing tip will focus on Deductibles.  To see the first part of the series click here.

Deductible: Wikipedia does a good job in giving a layman’s definition- In an insurance policy, the deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. In general usage, the term deductible may be used to describe one of several types of clauses that are used by insurance companies as a threshold for policy payments.

99.9% of insurance policies today have some sort of deductible: in network, out of network, individual, family, etc.  For our purposes, we’re going to assume that the patient has an individual deductible of $2500.00.  Let’s use the example from the previous 2 blog entries on Maximizing collections:

Total Billed $85.00
Contractual Adjustment -$18.00
Allowed $57.00
No Copay or Coinsurance $0.00
Pmnt from Ins. Co $0.00
TOTAL PAID $0.00

 

In this scenario, the patient doesn’t have a copy or coinsurance.  Therefore, they owe the entire allowed amount of $57.00.  Again, just like with our talk on coinsurance, front desk staffers are not likely to know what level of service will be performed before the patient is seen.  But SOMETHING can be collected at the time of service.  We’ve seen practices collect a standard $30.00.  We’ve seen practices charge 50% of the average allowed amount billed in most cases.  Your practice will need to decide how much to collect based upon your patient population and workflow.  Here’s an interesting discussion on the topic at the AAPC forum.

If the front desk person has a cheat sheet (we call them “job aides”) at their desk of the allowed amounts for the 5-7 biggest insurers, they can feel very confident in collecting SOMETHING before the patient is seen.  Once the patient leaves the room, the provider can communicate via sticky note, taskman, etc. what the level was to the front desk person.  They can collect anything additional that is required at check out before the patient leaves.

The key to copays, coinsurance, and deductibles is based in three key concepts:

  1. Check eligibility so that you KNOW what each patient has in all three categories
  2. Make sure that the e-MDs billing system actually reflects that information (You would be absolutely SHOCKED at how many practices don’t have updated demographic information on the billing side).
  3. Instruct your front desk staff to be proactive in checking eligibility and then collecting all monies from the patients that your practice is entitled to BEFORE they see a provider.

If you have questions about this blog or have other questions about billing workflow, let us know if we can be of assistance to your practice by filling out the form below.

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