e-MDs Billing Tip: Maximize Patient Collections- Pt 1 Copays

e-MDs Biilling

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e-MDs Billing Tip: Maximizing Patient Collections In Primary Care- Part 1 Copays

Copays, Coinsurance, and Deductibles.  These are the three basic means of front end revenue that practices should be collecting before a patient is seen by a provider.  In this third party e-MDs billing series, we’re going to define those terms.   We’ll let you know what your front desk team should be doing to collect those on a daily basis.  Finally, we’ll determine why they are crucial to your bottom line. Today’s topic will be copays.

Copay:  A copay is the portion of the allowed amount for a service that the insurance makes the patient (insured) pay for that service.  For example, if a patient is seen for a cold and the provider bills a 99213 at $85.00.  The insurance might allow only $57.00 for that 99213 (It depends on what your contracted fee schedule dictates). A contractual adjustment of $28.00 reduces the allowed amount to $57.00.  Consequently, that is all the provider is entitled to if they are contracted with that insurance company (think “in network”).  Now, the patient has to bear some of this burden as their policy states that they have a $30.00 copay for primary care visits.  Let’s take a look at the math:

Total Billed $85.00
Contractual Adjustment -$28.00
Allowed $57.00
Patient Copay $30.00
Payment from Ins. Co $27.00


So as you can see the patient is responsible for over 52% of the total amount that the practice would collect from this claim.  As the old saying goes, “You only collect 100% of what you ask for upfront.”  If the front desk person just says, “We’ll bill you for it” or doesn’t even ask, this is a huge percentage of your collections that are delayed in reaching the bank.  Unfortunately, the practice would now send a statement (that costs the practice employee time, postage, and payment lag) when it never needed to be. 

Primary care copay amounts are generally easy to find, most often on the front of the patient’s insurance card.  If front desk staffers can’t find the copay amount, they can always go to most insurance websites or your clearinghouse and check the patient’s eligibility to find out exactly what it is.

As a rule, copays do not go toward a patient’s deductible but do count toward their out of pocket max.  They are also fixed no matter the level of E&M code selected by the provider.

We’ll talk more about how to collect copays in e-MDs in an upcoming video.  More importantly, we’ll discuss how to put in correct insurance information into e-MDs which is CRITICAL to proper e-MDs billing.

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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Solor is a specialized third party medical billing company for e-MDs® Practices.  e-MDs® is a registered trademark of e-MDs Inc.  e-MDs Inc. is not affiliated with Solor, Inc., our products, services, or website.  Additional legal disclaimer here:  http://wp.me/P7cvJE-kI

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