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BUSINESS ADVISOR
insurance benefits and their financial responsibility. Research the
patient's deductible and find out how much he's met. What's his copay? What about his co-insurance amount? You can find these things
out by calling the patient and by reviewing the insurer's website.
To give patients a sense of what they'll owe, send them a letter in
advance of their surgery that spells out their obligations in as much
detail as you're able to provide. Some numbers, like deductibles, are
moving targets, but a co-pay is a fixed dollar amount that's printed on
the patient's insurance card. Head off potential problems early on.
"You know, it looks like you're going to have a really big balance after
surgery," you might say. "We don't want to send you to collections
after 90 days. Let's work out a reasonable payment plan."
Collect time-of-service fees
As soon as patients enter your facility, ask them to settle up. If
they try the "I-left-my-pocketbook-in-the-car" excuse, counter with this.
"That's OK. Your husband can bring it in when he comes to get you."
Staff might feel uncomfortable asking patients for money, but this is a
business. It's best to collect money with tact and diplomacy, but you're
not running a charity. Track how much you collect from patients on the
day of surgery. Our benchmark is 95%.
It's likely that a growing number of patients will have high
deductibles, some as much as $5,000. Hold patients responsible for
that — maybe not within 3 months, but certainly within the calendar
year. It's not sufficient to just collect co-pays at time of service. We
tried for a while to collect deductibles at the time of service, but found
that oftentimes we were refunding money to the patient. If an insurer
processed another provider's claim before ours, the patient didn't have
a high deductible anymore. So we recommend only collecting the
deductible if it far exceeds the total cost of surgery. In that case, ask
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J U N E 2013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E
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