Co-pay and deductible amounts vary from policy to policy so it’s important to know your patients’ co-pay and deductible responsibilities. As part of patients’ contracts with their insurance companies, it is their responsibility to pay their portion. However, physician practices are also obligated by their contracts to collect co-pays and deductibles and failure to do so is a violation of contract terms.
Here are some helpful tips to help you maximize your collections:
- If possible, it is best to understand your individual contracts with third party payers
- Delegate a staff member to be responsible for maintaining current patient insurance information
- Verifying insurance is extremely important. Enter all available information (i.e. insurance numbers, DOB) into your software system. You should also check the eligibility status prior to each patient’s visit to make sure the insurance information you have on file is current. If it is not, contact your patient before the visit to get the current insurance and enter it into the system so you can do a real-time eligibility check.
- It is best to review the eligibility checks to confirm if the deductible is met or not. Some plans will not provide detailed information, making this task difficult at times. Keep in mind that patients could be seeing multiple providers for the first few months of the year.
- Always advise your patients to bring current insurance cards and any applicable copay the day of their visit. Keep in mind that some services, such as preventative services and surgical global periods, may not be subject to co-pays, co-insurance or deductibles. Also, it is important to remember you cannot collect a deductible from Medicare patients (you can only collect applicable co-pays).
- It is important to have a financial policy in place that is reviewed every year (at least). Display your policy to ensure patients understand their obligation upfront. Your policy should outline the expectation that: 1. Co-pays are expected at the time of service. 2. Patients with deductible plans are expected to pay a set amount (to be determined by practice, for example: $50) at the time of service. Also, note that once the claim is submitted and reconciled, the practice will refund any amounts overpaid (if applicable) within a specific time frame (this will help to ensure you get some upfront payments for the visit until the claims are reconciled).
- Staff should understand the importance of your financial policy and be consistent about enforcing it. Develop talking points on what should be disclosed to patients. Most importantly, staff needs to know how to respond to objection easily and respectfully when attempting to collect money.
- Make sure patients are aware there are multiple ways to pay, including cash, check, credit card, or debit card.
If you need help putting together a financial policy, please contact Sherrie Fairchild at (203) 294-6659.