they assumed that their health plan fully covered their surgery. That's
where your business office team comes in, taking the time to educate
patients about their insurance plan, verifying their benefits and eligi-
bility, and then explaining those benefits so patients understand how
much they owe before they show up for surgery. Here's what you'll
need to do.
Translate their insurance plan. Don't assume that patients
understand the terms and conditions of their health plans, espe-
cially complicated cost-sharing ones that have, let's say, a $1,000
deductible, 20% coinsurance and a $50 set copay. It's confusing. Your
collection rates will benefit when you help patients sort it all out.
Estimate what they'll owe. Send patients a letter with an esti-
mate, based on your contracted fees, of what they'll owe, and a
reminder that payment is due at the time of service. It's important to
emphasize that the dollar amount you quote is an estimate. For one
thing, the patient could receive additional services on the day of sur-
gery. For another, estimates are based on the patient's remaining out-
of-pocket accumulators for their cost shares about 10 to 14 days
before surgery. When verifying the benefits, let's say the patient has a
$2,000 deductible on his plan, $1,000 of which has not been met. Your
claim could have $1,000 applied to the deductible (if the allowed
amount is higher than $1,000), then the remaining amount will have
whatever co-insurance percentage the plan has (typically 10%, 20% or
30%) applied to it. That remaining $1,000 deductible is going to hit
some provider's claim, but it might not hit yours if claims for other
services go through the plan before surgery.
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