The two things providers hate when it comes to healthcare? High deductibles and patient refunds.
Coincidentally, the two can play off each other. Deductibles are higher than ever and providers are trying to collect as much money up front as possible. So it’s not a bad problem to have.
What is important in knowing when to refund the patient, and when to hold on to their overpayment (temporarily)?
Without knowing the exact benefits of a patients insurance this can result in over collecting, which leads to patient refunds. If you want to solve both problems at once, start by using a patient insurance eligibility verification tool. The technology to verify insurance eligibility is only getting better. You can now verify a patient’s insurance benefits in real time and get responses on deductible information, out of pocket stop loss, co-pays, co-insurance and more.
This is why it is so important to have that main contact with your billing department. They should be able to review the insurance EOBs and know if the patient has met his responsibility. Oddly enough, this also seems to be the only time the patients review the EOBs they receive.
By determining the patient’s eligibility and benefits (in real time) you ensure that you are getting the most accurate, up-to-date information on their policy and will know the exact deducible amount they still owe and can collect money up front accordingly. If you no longer have to guess, you should be collecting the right amount and ultimately reduce the amount of refunds you issue.
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If the patient already met their deductible, you have two main options.
- Do not collect anything up front and wait for the insurance EOB to collect the remaining patient balance. This would be best practised if a patient is coming in for an office visit or lower cost procedure.
- Use the patient’s co-insurance amount and your payment history with the insurance to estimate a good amount to collect up front.
I would only recommend doing this if the patient is having a high cost procedure done. I would not recommend trying to get the entire amount up front, but estimating a portion of it (to avoid future refunds).
The most important thing to remember is to communicate with your patient when there is an overpayment. Investigate it thoroughly, and explain to the patient that if they can make a few phone calls to the insurance company, it will help move the insurance payment along. This will allow you to release any overpayment that there might be. The patient is the insurance company’s customer. They really want to keep them happy, so asking the patient to step in and help get you paid, is a great tool to utilize in situations like this.
Even though my patient has a high deductible, I am still worried about collecting the balance up front
This is a valid concern many providers have about collecting patient balances.
- Just because someone has a high deductible, it does not mean they will be paying the amount you bill out. That will never happen unless the patient is self-pay.
- Even when the claim is applied to the patient’s deductible, the insurance will first adjust the amount based on their contract with the provider.
- I recommend creating a list of your top CPT codes and setting a price amount for each to collect up front. You can use past payment history from your insurances to determine the average allowed amount and set a base price to collect.
- Even if the patient ends up still receiving a balance on their EOB, it will be minimal. This will also help with collecting patient balances. If you never see the patient again or they never pay their portion of the bill, you would have still collected something.