Collecting Deductibles, Co-Pays and Co-Insurance in Your custom

Insurance Card - Collecting Deductibles, Co-Pays and Co-Insurance in Your custom

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It's a fact that many of our patient's have unmet deductibles. Deductibles are the amount of money that your inpatient has to pay out of pocket before their guarnatee enterprise will begin to pay their claims.

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To clarify, it's also foremost to understand how this is distinct from co-pays and co-insurance. Co-pays are the amount of money that an individual's guarnatee states they must pay upfront for each and every visit. Co-insurance is regularly the 20% that an individual (or secondary plan) must pay after figuring in the allowed amount, minus the co-pay. And of course, the deductible is the amount of money your patients must pay out of pocket, prior to the guarnatee enterprise paying any of their claims.

Deductible amounts will vary from course to policy. The Medicare 2011 deductible rate is 2.00. Assorted commercial policies will have deductibles fluctuating from a few hundred dollars to more likely ,000 or ,000 or even ,000. Knowing the amount of deductible and collecting it is imperative for the financial condition of your practice.

Another point...it's likely written into your guarnatee contracts and failure for you to gather co-pays, co-insurance or deductibles leaves you potentially open to accusations of fraud. There is something called the "False Claim Act", which would leave you field to prosecution for fraudulent billing under federal law. Know your contracts and thus your requirements. Adequate said.

So what can you do to maximize your collections?

First and foremost, understand your individual contracts with third party payers. You'll need to be aware of when you can gather deductibles (some prohibit you from collecting prior to providing services). Additionally, some services, regularly inhibitive services may not be field to co-pays, co-insurance or deductibles.
Review your financial policies on a quarterly basis. Make sure patients understand their enforcement upfront. Remind them every year about deductibles, and surely every visit if necessary. I still have habitancy who tell me they were unaware of this being an yearly enforcement on their part, and some Medicare patients who tell me I'm the only one who has ever collected a deductible.
When verifying insurance, do what you can to confirm if the deductible is met or not. This is not all the time easy, especially if patients are looking multiple providers the first few months of the year.
Work with your staff to teach them how to gather money, what should be said and not be said to patients and how to reply to objection surely and respectfully.
Most patients will want to pay their bills, make it easy for them by providing multiple ways to pay such as cash, check, credit or debit card.

Good financial policies, fair collection practices and perfect schooling of your staff and patients will go a long way in avoiding any problems when it comes to proper collection of co-pays, co-insurance and deductibles.

Steps You Must Take

Review your guarnatee contracts Review your financial policies. Tweak them if necessary Spend some time with your staff to report their practices and make sure it's consistent with your policies and that of your contracts. If you need a merchant account, check out Carolyn Zaumeyer's service for clinicians, fdispink. You can find her site on the web.

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