Author Topic: Provider or Patient responsibility  (Read 332 times)

Beatriz

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Provider or Patient responsibility
« on: August 29, 2017, 08:19:50 PM »
I do billing for mental health therapists and psychiatrist. I have two questions. New patient, you call or look in the website and find the patients copay's and deductibles. 6 months later the patients insurance copy changes without your knowledge 1. Is that the patients responsibility to let the provider know that her/his insurance changed? 2. Can this provider put in place an office policy advising the patients that the provider will not be held accountable for any changes that occurred in their insurance regarding copay's and deductible if they are not informed in a timely manner?

Example Patient is an established patient paying 25.00 copay. After a year of medical treatment she states to the provider that her copay changed 6 months ago and that she was only suppose to pay 20.00, and states to the provider that she is owed the difference but did not tell the provider until 6 months later. Is the provider responsible to pay her back the difference?
« Last Edit: August 29, 2017, 08:35:51 PM by Beatriz »

PMRNC

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Re: Provider or Patient responsibility
« Reply #1 on: August 30, 2017, 05:43:52 AM »
Quote
Example Patient is an established patient paying 25.00 copay. After a year of medical treatment she states to the provider that her copay changed 6 months ago and that she was only suppose to pay 20.00, and states to the provider that she is owed the difference but did not tell the provider until 6 months later. Is the provider responsible to pay her back the difference?

A patient's cost-sharing is their responsibility, but it is up to the office to collect the correct co-pay's up front, so it is a better idea to do regular benefit verification's.  MOST non-govt plans will change deductibles if they change twice per year (Jan and July)
Using your example, yes the provider is responsible for giving back any account credit. The copay decreased, the patient should receive the difference back.
Linda Walker
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Michele

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Re: Provider or Patient responsibility
« Reply #2 on: August 30, 2017, 08:07:27 AM »
To add to what Linda said, you should have noticed the difference in the copay sooner than that.  If a patient is paying a $25 copay but when the EOB/ERA comes in showing a $20 copay it should have shown a $5 credit when posting that payment. 

When your question started I thought you were going to state that the patient owed the provider more money, not the reverse.  :)

I know it is frustrating when patients don't notify you of changes in their insurance.  Like Linda states, regular benefit checks can help with that.  But I do know that sometimes the patient truly isn't aware either.  Most likely they did receive something in the mail but we all know that some of those correspondences are not always clear!
« Last Edit: August 30, 2017, 08:10:29 AM by Michele »
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Jmojica

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Re: Provider or Patient responsibility
« Reply #3 on: October 04, 2017, 08:14:30 AM »
I'm happy you asked this question because it's a situation that consistently arrises with my LMHC provider. Thing is she doesn't know how to check the benefits regularly and relies on me for that information which isn't part of our arrangement yet somehow she finds a way to put it on me.  :-[

PMRNC

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Re: Provider or Patient responsibility
« Reply #4 on: October 05, 2017, 12:39:25 PM »
This is JUST my opinion, but verification of benefits and eligibility are a part of the revenue cycle management, so if you are a billing company that offers full practice management, it really SHOULD be a part of your services. If you leave it to the provider or office, trust me it's not pretty and makes you look bad. I use the old saying "If you want something done right, do it yourself" It's just better in the big picture. I charge a flat fee, but my flat fee is based on my time so I get paid for everything I do and that includes verifying benefits, eligibility, patient responsibility and any initial authorizations that need to be done.
Linda Walker
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