entered each into an
Excel file. The spread-
sheet includes a list of
payers, CPT codes and
their descriptions, and
the contracted rate
that we've negotiated
with each insurer.
Here's an example of
how to calculate the
patient portion. Let's
say your contracted rate with Aetna for CPT code 42826 (tonsillecto-
my) is $1,700. The patient has a $1,500 deductible (that he's met none
of) and an 80/20 co-insurance, meaning he pays 20% up to an out-of-
pocket limit of $3,000. The patient portion would be $1,540, a figure
you get by subtracting the $1,500 deductible from your $1,700 con-
tracted rate, and then applying the 20% co-pay to the remaining $200
($40).
Mention to patients that you've made every effort to be as accurate
as possible when calculating their portion, but that they're responsible
for any amount if their insurance plan doesn't cover as much as
you've estimated.
• Put patients on a payment plan (but only if you must). Whatever
the reason, sometimes you'll have to put patients on a buy-now, pay-
later payment plan or let them finance their out-of-pocket responsibili-
ty — but only after you've made every effort to get them to settle up
with cash, check or credit card on the day of service. My suggestion:
Don't even mention the possibility of monthly installments unless a
patient asks about a payment or a finance plan. If you give patients
the option to pay now or to pay later, most will put it off.
O C T O B E R 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 3 3
Don't ask patients if they can pay at
check-in. Ask how they intend to pay.
Pamela
Bevelhymer,
RN,
BSN
