Collecting Deductibles, Co-Pays and Co-Insurance in Your convention

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It's a fact that many of our patient's have unmet deductibles. Deductibles are the estimate of money that your sick person has to pay out of pocket before their assurance business will begin to pay their claims.

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To clarify, it's also prominent to understand how this is different from co-pays and co-insurance. Co-pays are the estimate of money that an individual's assurance states they must pay upfront for each and every visit. Co-insurance is ordinarily the 20% that an individual (or secondary plan) must pay after figuring in the allowed amount, minus the co-pay. And of course, the deductible is the estimate of money your patients must pay out of pocket, prior to the assurance business paying any of their claims.

Deductible amounts will vary from procedure to policy. The Medicare 2011 deductible rate is 2.00. Assorted commercial policies will have deductibles fluctuating from a few hundred dollars to more likely ,000 or ,000 or even ,000. Knowing the estimate of deductible and collecting it is imperative for the financial condition of your practice.

Another point...it's likely written into your assurance contracts and failure for you to regain co-pays, co-insurance or deductibles leaves you potentially open to accusations of fraud. There is something called the "False Claim Act", which would leave you field to prosecution for fraudulent billing under federal law. Know your contracts and thus your requirements. Sufficient said.

So what can you do to maximize your collections?

First and foremost, understand your individual contracts with third party payers. You'll need to be aware of when you can regain deductibles (some prohibit you from collecting prior to providing services). Additionally, some services, ordinarily deterrent services may not be field to co-pays, co-insurance or deductibles.
Review your financial policies on a regular basis. Make sure patients understand their compulsion upfront. Remind them every year about deductibles, and literally every visit if necessary. I still have people who tell me they were unaware of this being an each year compulsion on their part, and some Medicare patients who tell me I'm the only one who has ever collected a deductible.
When verifying insurance, do what you can to confirm if the deductible is met or not. This is not all the time easy, especially if patients are finding multiple providers the first few months of the year.
Work with your staff to teach them how to regain money, what should be said and not be said to patients and how to rejoinder to objection literally and respectfully.
Most patients will want to pay their bills, make it easy for them by providing multiple ways to pay such as cash, check, prestige or debit card.

Good financial policies, fair range practices and excellent instruction of your staff and patients will go a long way in avoiding any problems when it comes to permissible range of co-pays, co-insurance and deductibles.

Steps You Must Take

Review your assurance contracts Review your financial policies. Tweak them if necessary Spend some time with your staff to relate their practices and make sure it's consistent with your policies and that of your contracts. If you need a merchant account, check out Carolyn Zaumeyer's assistance for clinicians, fdispink. You can find her site on the web.

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