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October 2006

Savvy Coder: Coding & Reimbursement

Copayments and Deductibles: 10 Tips for Tackling Nonpayment
By Anne M. Menke, RN, PhD, OMIC Risk Manager

Why do some patients fail to pay their bills? This can occur for a number of reasons—many unrelated to the patient’s financial situation. Indeed, nonpayment is often an early warning sign that a patient is unsatisfied with his or her outcome.

Determine why the patient is unwilling to pay. These conversations can be difficult, so this responsibility should only be assigned to a staff member with excellent communication skills.

  1. Ask open-ended questions such as, “I noticed you have not sent in your payment. Is there a problem we need to know about?”
  2. Patients with financial hardship appreciate being given the opportunity to make arrangements to honor their financial obligation.
  3. Those who are unhappy with their outcome need to be referred to the physician, who should seek risk management assistance from his or her professional liability carrier.

Educate patients about their financial responsibilities. Patients often are confused or angry about copayments and deductibles, and some of them mistakenly feel that physicians can waive these at will.

  1. Notify new patients that it is their responsibility to pay for care.
  2. Explain that if they have insurance of any kind, including from the federal or state government, you are obligated by law and contracts to collect any deductible or copayment at the time of service.
  3. When patients need assistance in coordinating payment from an insurance company, ask them to speak to your billing manager. Similarly, if they have problems making their copayment, deductible or—for those without insurance—the full bill, inform them that your billing manager can help them set up a payment plan.

Review your billing practices. Incorporate the following recommendations into your billing practices.

  1. The bill should include information on whom patients should contact if they have questions or problems paying the amount by the due date.
  2. Give the patient a reasonable amount of time to pay the bill. Consider offering to make a payment plan.
  3. Instruct your billing manager to notify the physician if the full billing cycle has ended without payment or a payment arrangement. The physician can then make the decision on how to proceed.
  4. The ophthalmologist’s approval should be required before sending a patient to collections. Next, the biller should notify the patient that he or she will be turned over to collections by a given date unless the patient contacts the office and agrees to pay the bill or make a payment plan.

Meet the Experts

Got risk management or insurance questions?If you are attending this year’s Joint Meeting (Nov. 11 to 14), Ms. Menke and OMIC’s other experts will be on hand to answer your questions, as well as provide the latest rate and coverage information on professional liability, business, life and health insurance programs. Set aside time to visit them at the Academy/OMIC Insurance Center (Booth #2231).

This year’s OMIC Forum addresses After-Hours and Emergency Room Calls. It takes place on Sunday, Nov. 12, from 10 a.m. to noon in Vendome B, Paris Hotel. This seminar is free and no preregistration is required.

Got a reimbursement query? Bring your conundrum to the AAOE’s coding experts at the Coding Questions desk in the Academy Resource Center (Booth #1431).