Deductibles

By editor
January 26, 2016

It's January and that means deductibles have reset and more and more of your patients have very large deductibles and they might not even know it. While the 2016 Medicare Part B deductible is set for $166, commercial plans are reaching up to $3,000 or even $5,000 per year. All this means is that more and more of your practice revenue will be coming from your patient's pocket.

So what should you be doing to ensure that you are collecting everything that you should be? First off you need to realize that not only is your practice dependant on the revenue received from patients deductibles, you are contractually obligated with the insurance plans to make every effort to collect that deductible. Failure to do this could result in penalties from the insurance plan.

Patient statements need to be going out on a regular basis of at least once a month. Keeping a tight statement cycle will ensure that your patients are constantly reminded of their financial responsibilities. It is also important to give them the ability to pay by credit card and if possible have online payments available through your website.
Have a phone number on the statement so that the patients can call and pay you but also ask any questions they may have on their bill. Unfortunately you will always have patients that just have no intentions of paying but the other major reason they don't pay is that they are just uneducated to the whole process. Believe it or not some patients believe that if they have insurance then they don't need to pay anything. They have no understanding of their plan and their financial responsibilities. Setting up a communication center will be very advantages in collecting patients outstanding bills.

Educating your patients on their responsibilities is something that you and your staff need to be doing. 100% of your scheduled patients should have eligibility done prior to the day of the appointment. This will tell you what their coverage is, how much their co pay or deductible is and how much of it is left. You will then be able to kindly remind them of their deductible and that they can probably expect to see a bill for it. Also remind them to be on the lookout for the explanation of benefits that they will receive from their insurance that will explain their responsibilities. This way when the bill comes in the mail they can remember the conversation that you had with them and the bill will hopefully not get put aside.

You should also run a report on all your scheduled patient balances prior to them coming to their appointment. This way when you confirm the appointment with them you can remind them of their balance and that they will need to make arrangements for payment when they come in and prior to seeing the doctor. You can even check patient balances when they make the actually appointment. Allowing patients to set up payment plans is something that you should consider as well but the payment should be every month and the plan should not last longer than 4-6 months. By offering payment plans to patients with large balances early in the process you increase your chances of receiving money from them.

You should avoid seeing patients with balances unless some discussion has been had with them and arrangements have been set up. If you are not checking patient's balances you will continue to see patients who owe you money time and time again and not even realize it. If a patient has a $3,000 deductible they could conceivably come to your office more than ten times during the year, have their insurance apply their whole allowed amount to their deductible each visit and if they do not pay you anything you will have received no money from the insurance company or the patient for seeing that patient all year.

The other fear that physicians have is that if they ask the patient to pay their deductible they will start going to another practice and then the practice will lose the patient. You should rather lose the patient than see them for free. Plus, as we discussed earlier you are legally obligated to collect that deductible due to your contract with the insurance company. A quick search on the internet will show you multiple examples of practices getting audited for not collecting patient deductibles and then getting penalized with thousands of dollar fines. And if that doesn't scare you enough, 20-30% of your current and future practice revenue may come from patients, how can your practice survive with that revenue missing?

So with regular patient statements, starting the education process with the patient and keeping the communication open with the patient regarding their responsibilities, your practice will be in good shape financially as the industry continues to see more and more money coming directly from the patients.

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