Author Topic: collecting payments  (Read 2698 times)

ruthie72

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collecting payments
« on: March 08, 2013, 10:24:36 AM »
I have a question..my provider wants to collect a fee from patients even if they do not have a copay and then submit the claim. She says we will reimburse the patient if they pay over the allowed amount..is it okay to do this? thank you

DMK

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Re: collecting payments
« Reply #1 on: March 08, 2013, 11:51:58 AM »
If it's insurance, and you're contracted with the insurance company, you can ONLY collect co-pays and deductibles per their policy.  You can't take money just to be taking money.  I understand wanting to create cash flow, but it's not the legal way to do it.  When the patient comes in, check their insurance while they're there, or if possible, check it when they make their appointment so the patient knows right up front what they are expected to pay (if anything) at the time of service.

ruthie72

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Re: collecting payments
« Reply #2 on: March 08, 2013, 12:12:27 PM »
That is what I have been trying to tell her, but she does not seem to understand. She keeps saying well what if they do not pay their bills??? I do not know what to do...I told her to please look over her contracts with each insurance company..How would you handle this?

DMK

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Re: collecting payments
« Reply #3 on: March 08, 2013, 01:08:33 PM »
I COMPLETELY understand the doctor's point.  Some people aren't good at paying their bills, and they think the "rich doctor" can just write it off.  That's why you verify their benefits, and if you already have patient's on the same plan you will know EXACTLY the correct amount to collect so there's no surprises on either side.   And it is a good habit for people to pay something, if they're going to owe something.

For example, our office bills for only a few types of services and I have a fee schedule from the insurance companies we deal with regularly so I know exactly what each service pays.  I can quickly add up what the days services will be, calculate their deductible or co-insurance or just collect their co-pay. 

If you collect correctly at time of service after verifying benefits, you won't have any issues down the road and no huge outstanding balances.  Nowadays, MOST patients will have to pay something at the time of service since MOST policies have deductibles and co-pay or co-insurance.  The better the front desk is at educating the patient as to what their portion will be (and doing it correctly) the better the better patient relationship is.

Billergirlnyc

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Re: collecting payments
« Reply #4 on: March 08, 2013, 04:06:20 PM »
I couldn't agree more with DMK. It's imperative that verifications are done before hand. It's imperative that your doctor looks over her contract as he/she doesn't want to run into issues w/any plans he/she is contracted with. And it's imperative that the front desk is educated on how to educate the patient on what their responsibilities are before they're seen. I can't tell you how many headaches this will eliminate if everyone does their part in informing the patient beforehand.
Don't worry. Be happy.
~Dalia, CPC, CPC-H, RHIT.

ruthie72

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Re: collecting payments
« Reply #5 on: March 10, 2013, 08:07:44 PM »
well I am doing the best I can on educating my provider..but she says she is going to charge them whatever the other establisment used to charge them and for me to wait to bill until she is In network...I just hope this works..the only problem is..she does not understand that she is seeing these patients now and she is NOT IN network..when I bill the dates the insurance companies are going to know that she is not in network correct??? Then she will either owe the patient or lose out on money she could have had? Am I right? or am I crazy? I am so confused right now.

RichardP

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Re: collecting payments
« Reply #6 on: March 10, 2013, 08:56:57 PM »
I know that when you apply to be a Medicare provider, there is a certain point in the process where you become eligible to bill Medicare, even tho you are not set up completely in their system at that point.  Medicare's counsel is to hold off on billing at that point until they are ready to accept the bills.  When they give the signal, you can submit bills for service back to your eligiblity date.  I don't know if such a situation exists with any of the private carriers in your state.  You could check.

Bottom line is, your doctor won't get paid from Insurance Carriers for services she provides before she becomes a provider unless the Carrier gives her permission.

ruthie72

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Re: collecting payments
« Reply #7 on: March 11, 2013, 08:44:21 AM »
Thank you Richard..so basically I am right? If she saw a patient on 02/28 and does not become IN network until 03/15..when I submit the claim and the DOS is 02/28, will she still get paid as an OON provider? I just want to be able to explain this to her when it happens without getting things in an uproar...she is a little stubborn..lol ;D

PMRNC

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Re: collecting payments
« Reply #8 on: March 11, 2013, 09:12:09 AM »

Quote
Thank you Richard..so basically I am right? If she saw a patient on 02/28 and does not become IN network until 03/15..when I submit the claim and the DOS is 02/28, will she still get paid as an OON provider? I just want to be able to explain this to her when it happens without getting things in an uproar...she is a little stubborn..lol ;D


That's correct. She will get the OON rate.  With OON it's not "allowable" but rather Usual & Customary meaning if the carrier cuts the charge $50 for example, that $50 is patient responsibility. When the provider has officially become IN Network (Contract will have start date) then there is an "allowable" fee schedule to which you adjust off the difference between the allowable and the billed charge. For example if the charge is $75 and you are now in network, carrier ALLOWS $70, that $5 is your participating adjustment but you can bill the patient the diff between the Paid and the allowable, that is their OOP Coinsurance/copay/deductible
Linda Walker
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www.billerswebsite.com

RichardP

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Re: collecting payments
« Reply #9 on: March 11, 2013, 11:04:56 AM »
What Linda said.

Billergirlnyc

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Re: collecting payments
« Reply #10 on: March 11, 2013, 08:56:44 PM »
Yes, what Linda said. Also tell your doctor that very few commercial carriers will back date effective dates when it comes to credentialing (I honestly can only think of maybe 3 out of 30 carriers that I know of that offer some flexibility on effective dates). Most give approval dates AFTER it hits the boards for approval.
Don't worry. Be happy.
~Dalia, CPC, CPC-H, RHIT.

ruthie72

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Re: collecting payments
« Reply #11 on: March 12, 2013, 11:00:32 AM »
Thank you Linda and Richard..I will just bill the claim and deal with it when the  time comes I guess. I tried to do my best to explain it to her..She is very confusing lol..anyway..Thanks so much for your help..If the charge is 75 and the insurance company pays her 70 then the patient is getting a $5 dollar bill...and that is just the way it has to be. Correct?? thanks again. Have a great day. ;D

PMRNC

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Re: collecting payments
« Reply #12 on: March 12, 2013, 11:23:16 AM »
What you can do in this case with an overzealous provider is put a report together in a few months (2-3) with the credit returns so she can get a feel as to what this does to her overall A/R.   She is thinking.. better to collect more now.. which isn't an entirely BAD thing.. but it can lead to some problems down the road, she should NOT have to routinely issue credit refunds. Also a patient or two could make a headache for her if they get ticked off enough. I know I would NOT be happy to pay my doctor up front with an assignment of benefits and they collected more than I paid.. I had a dentist that did that and eventually I switched.. didn't feel it necessary to pay $700 when my insurance company paid them $700 10 days later.  That's another thing.. The doctor really shouldn't be doing an assignment of benefits with the patients if they are OON .. I'm surprised she hasn't had patients complain.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ruthie72

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Re: collecting payments
« Reply #13 on: March 13, 2013, 10:31:01 AM »
Me either..I will keep you posted on how it all goes..thanks again for all of your help. :)