Family Practice

[TXBiller]

For those of you working in a family practice, do you collect co-insurance and deductibles upfront...aside from co-pays?  What are your thoughts on this process?  Our new employee is doing this and I'm having to refund money. 

TIA

[Michele]

It is hard to collect deductibles and/or coinsurance up front because you really cannot be 100% sure of the amounts until the claim is processed.  For instance, a patient may have a deductible but another provider's claim may get processed before yours causing the deductible to be met, and creating an overpayment.  With co-insurance, the allowed amounts vary so much from plan to plan, and also change periodically, so again, hard to know for sure ahead of time.  However if you have a specialty such as mental health where the patient is coming in regularly with the same insurance for the same code/services, you can be pretty sure of the coinsurance and charge up front.  I don't like to have situations where there are overpayments since that creates another mess!

[TXBiller]

Yes I agree with you completely.  I don't like playing the guessing game and having to refund.  Thank you for your opinion.   

[PMRNC]

I do mental health and pediatrics, we will collect deductibles and coinsurance up front but we have a procedure in our P&P's we use. This must be addressed in your practices P&P and office financial policy the patient sees. For some of my clients we will have Deductible payment plans for those with high deductibles over a certain amount (each practice creates their own policy) We verify benefits including deductible and coinsurance / out of pocket max. If patient has, for example 20% coinsurance but has a $5000 out of pocket max that wasn't met, we will collect. In all of our policies we tell patients if they can show us an EOB where deductible and/or coinsurance has been met for the cal year we won't require it. We don't do many refunds on this at all because of the time spent in making sure the policy was adhered to exactly. All of my ped practices do appt reminders so when they do that they will tell the patient their expected out of pocket so they can bring it or address any issue before coming in. For my clients that never did this in past before I took them on, they were losing so much money on patient statements and trying to collect these after the fact that it's much easier to issue one or two refunds here and there rather than lose 35% of quick revenue.  If you are doing too many refunds then it's possible you want to look at your verification process.  Nearly all the carriers now even apps patients can show their ded/coinsurance as met from their mobile phone. So if you are verifying benefits long before a visit and a patient has claims to be processed it makes sense to just ask them if they know if they met their deductible and can they show you.