Payments > Patient Billing

Patient responsibility



One of my client want us to provide the benefits prior to service with $ amount that patient will be responsible for xyz cpt code. Is anyone aware of any software that can help us to predetermine the patient's share prior to service?


Depending upon the insurance, you can do a patient cost estimator prior to the claim being billed. Many insurance websites, as well as sites such as Navinet and Availity offer this service for free. You would need to know the CPT code(s), and what the patient's benefits are exactly, to figure out what the patient would be responsible for, as well as figuring in any multiple procedure discounts, etc. Then, of course, for patients with Medicare or Medicaid, you can always reference their published fee schedules and take it from there.

Let me just add is one thing to figure out ahead of time what the patient will be responsible for after the claim processes, and another thing to try to collect what they will "owe" at time of service, before claim is submitted. Some insurances are very strict about not collecting at time of service. If that is part of why your client wants this done, be careful...make sure they are contractually allowed to collect ahead of time.

Thanks. I appreciate.

My pleasure, hope it helps!


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