Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/736989
Affordable Care Act is not so affordable. Thanks to Obamacare, more Americans have health insurance, but fewer can actually afford to use it. As insurers shift more of the burden for health costs to patients, healthcare providers used to getting paid on the back end from govern- ment and commercial insurers must now collect hundreds and some- times thousands of dollars up front from patients. But cost-sharing health plans are also a burden for patients, some of whom must pay $10,000 or more in deductibles before their insurance kicks in, and hundreds more in co-pays. Even the relatively modest co-pay for cataract surgery — $193 in an ambulatory surgical center and about $361 in a hospital outpatient department — can be a financial hard- ship for some. • Calculate what patients owe. Not only can the patient's out-of- pocket cost be the size of a monthly mortgage payment, but it can also be confusing to figure out. While most patients who don't pay their portion on the day of surgery can't afford to, others simply aren't aware of what they owe — or even that they owe — because they're confused about how their insurance works. Don't assume patients will know how much they owe on their deductible or even what their co-pay is. Assign one of your business office staff to compute what each patient's responsible for and then communicate that amount days in advance of surgery. Sometimes you won't know the exact amount patients owe until after the procedure is completed, but you can at least come up with a pretty good estimate. This requires some math and some digging. First, contact the patient's insurer to find out 4 things: his deductible amount, how much has been met, the co-insurance and the out-of- pocket limits. Next, refer to your fee schedule to get the insurance- allowed amount for the CPT code. To make this process more effi- cient, I've requested a fee schedule from each of our 18 payers and Business Advisor BA 3 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 6