Deductible and copay question

[ruthie72]

Hello
I posted this question in another forum, I am hoping somone can help me..I am a new biller billing for a LCSW...My question is..she has been collecting copays and deductibles before any claims have been sent out..How do I handle this? If someone pays some of their deductible..when I send in the claim will the provider still get paid or does she just keep the deductible as payment? Copayment, same question..Thanks so much..I am really confused.

[rdmoore2003]

do you have a contract with the carrier?  if so, you would collect the deductible and/or copay at time of service.   you still file the claim but the ded/copay that patient paid is the payment.  for example,  pt. A has $500.00 deductible.   your contract with pt A's insurance has an allowed amount of $65.00 for cpt used.   pt A will pay $65.00 and office still files claim to be processed under deductible.  eob will come to you showing that the $65.00 was applied to deductible.   same thing with copay,  pt. A pays copay amount but still file the claim.    Hope this helps!

[ruthie72]

I think this does help..now does the patient have to pay the $65 first or after the EOB comes back? I know copays are made at time of service It is for a LCSW..thanks again.

[RichardP]

Generally, we look to the EOB to see what amount was applied to deductible and then bill the patient for that amount.  But there is nothing stopping the patient from paying toward his deductible at the time of service - assuming the patient knows how much he has left to pay on his deductible.

[PMRNC]

I'm going to recommend two good books you should get.  Please don't think I'm picking on you as I think you will really get a lot from one or both of these books.

http://www.amazon.com/Understanding-Health-Insurance-Reimbursement-EncoderPro-com/dp/113328373X/ref=sr_1_1?ie=UTF8&qid=1361919373&sr=8-1&keywords=understanding+health+insurance

http://www.amazon.com/Insurance-Handbook-Medical-Office-12e/dp/1437722563/ref=sr_1_1?ie=UTF8&qid=1361919456&sr=8-1&keywords=Insurance+Handbook+for+the+Medical+office

Both are geared towards learning the basics of understanding health insurance and has a LOT of information every medical biller should know even before taking any medical billing course.. IMHO

[ruthie72]

No I am so happy to have any kind of resource. Thanks so much

[ruthie72]

I actually have the first book, I have been referring to it daily..but the other one I do not have will look into  it..Maybe I should get Medical billing for Dummies..lol

[Billergirlnyc]

You'll be fine, Ruthie. Those two books are excellent resources. You're no dummy. It just takes time to absorb the vast amount of information we must store, on top of remembering our names, our own insurance, and daily life issues. 

[PMRNC]

The reason I recommended those two was because of ALL the medical billing classes I've seen NONE really explain the inner workings of health insurance. They just teach you what to do and when all is said and done if you don't know why you can't effectively answer questions your patients might have about their bills.  When I worked in the claims department I can't tell you how many times a physicians office would call me and say "Hey you guys told me the patient had a $500 deductible so we collected it and now we have a credit!"  the response I wanted to give was of course completely different from the standard canned response of "Deductibles are taken from the first ____$ of covered charges based on the time claims were submitted".  Another one I won't go into was that many office managers didn't even know or understand R&C / U&C  all they wanted to know was "Can I bill the patient"?   Even having worked on the "other side" I have EVERY edition of both of those books in my home office. I refer to them quite a bit. I love that they cover things you won't see covered in any medical billing class.  For example, I still have a hard time explaining to patients what a Medicare Carve out Plan is so I have that page bookmarked There are also things in there like Workers Comp, Personal Injury, PIP/Auto  and how to understand how they work in general.   NO you are no dummies, like I said, I have every edition of both books and refer to them all the time    

[ruthie72]

Thank you so much..I know I was just kidding around..I will keep referring to my book of course..and reading all the helpful posts on here. Have a good day.