Billing > Billing
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
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