Billing > Billing

Benefits/Deductible

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TammyL:
Just curious on how do some of my fellow billers keep up with the verification of benefits and how do you know when they have met there deductible to keep the patient from have a  credit on there account like for example we check benefits in Sept and deductible was 750.00 then in Oct they met there deductible but we had no ideal it was met because it was only checked 1 time

Michele:
We don't do benefits verification for our providers.  Too difficult for us on the billing end.  We know the deductible has been met when the eob comes in.  We don't call to check.  Sorry, I know that's not much help.

kristin:
If you are going to collect money from a patient at time of service, you have to do three things to avoid collecting too much, and then having a refund due back to the patient:

1. Check their benefits the day they are seen, so you know how much deductible is left, and if they have co-insurance amounts they pay
2. Know what the allowed amounts are for each charge, so that you charge them the right amount up front
3. Submit their claim that same day

Even with doing those things, there will still be times you will have to refund the patient, because you may check benefits in the morning when the patient is seen, and by that afternoon, another claim for another doctor has processed through, and changed everything.

PMRNC:
I do verification of benefits as a billing company, I think it's the best and first step in the reimbursement process so someone NEEDS to do it. My pediatric practices have financial policies in place for pay-down deductible payments for the larger deductible plans on the exchange market or individual plans. We verify benefits. If a carrier tells us that a deductible has NOT been met, we ask the patient to either bring us a check for the full amount up to their deductible or bring in an EOB to show that their deductible for that calander year has been satisfied. Insurance carriers won't (not supposed to) tell you how much a patient has to go to satisfy the deductible, they can only tell you the deductible amount and yes or no it's been satisfied. That's to prevent fraudulant billing (for example if a carrier says a patient has $125 left to meet their deductible, they might increase the fee of a service to $250 or any other amount higher than the patient needs to satisfy the deductible and increase reimbursement.)

The practice should have a clear office P&P that outlines who is responsible for benefit verifications and the process in which to do them. Make sure your office's financial policy is also up-to-date and outlines a patient's responsibility upon check-out of each visit which really helps collect up-front.  The office financial policy should also outline a patient's responsibility plus offer any additional payment plans or options.

kristin:

--- Quote ---Insurance carriers won't (not supposed to) tell you how much a patient has to go to satisfy the deductible, they can only tell you the deductible amount and yes or no it's been satisfied.
--- End quote ---

I never knew this, because whether I verify insurance through a website, or by speaking to a person at the insurance company, they always tell me(even when I don't ask) how much of the deductible has been met for the year, down to the penny.

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