1) In your initial visit paperwork packet that you have your patients sign, you should clearly state your office payment policies and that the patient is ultimately responsible for all fees. Tell them that you will assist the patient sending out claim forms and supplying needed documentation but ultimately it's the patient's financial responsibility if the insurance company does not pay. The patient should also be encouraged to contact their insurance company to make sure they understand THEIR plan’s policies regarding pre-authorization of services, deductibles, coverage limitation of services/facilities etc. When payment is denied the patient should become involved with the appeals process as well. You should make sure the claim was properly submitted and correct any specific errors. But beyond that, the patient should initiate any appeals (after all it is their insurance company). Obviously offer to copy any records what would be of help in the appeals process.
2) Clearly post signs that state that payment is expected at the time of service. This may not always apply to HMOs and other insurance entities such as Medicare were you accept assignment. But still post your office policy. Medicare and other insurance carriers will allow you to collect the deductible at the time of service. This can be confusing to some patients as they may not remember services rendered by other providers. Furthermore the deductible more than likely will be applied to the first few claims received not specifically to any date of service.
3) Collect co-pays at the time of service. This is a must. I would suggest collecting the co-pay when the patient is checking in rather than at the end of the office visit. The patient may late for another appointment or confused/upset by what was done (i.e. a minor surgery or hearing a difficult diagnosis ) and collecting a co-pay at that time can be more stressful. Having to send a statement at the end of the month is costly when considering you are spending office time and money to try to collect a $5-10 co-pay amount. Patient should be made well aware of the co-pay responsibilities. Some offices will charge administrative fee for mailing statements to collect the co-pay. If you have such a policy that should also be clearly posted.
4) You should also post your policy regarding returned checks and associated fees assessed for returned checks.
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5) Consider accepting credit cards. Patients can often forget their checkbook at home or may not have enough cash with them. Generally they will have their wallets with credit cards. Although there are merchant fees charged to you when accepting credit cards this will be more than offset by prompt collection of payments and not having to bill patients. If a patient does not pay their co-pay or other small amounts it is very impractical to take them to collections for relatively few dollars. Yet these few dollars do add up over the course of weeks and months. Having a credit card option may also make it easier for patients to pay other outstanding balances as this allows them to pay this and other debts off over time. This may be more feasible/affordable for the patient. I found this especially helpful with payment of orthotics. You can set a payment plans which can be very helpful for the patient but if the patient does not pay the agreed upon amount at the agreed upon time, collecting can be difficult. Credit card sales avoid this because once you have credit card sale completed it is strictly the patient's responsibility to deal with their credit card company/balances.
6) It is not appropriate to withhold delivery of services simply because of patient does not have ready cash available for co-pays or if they have an outstanding balance. There could be issues of failing to provide care especially in an emergency situation. You may consider calling delinquent patients or those patients who seem to always “forgot my checkbook” the patient prior to their appointment as part of a reminder call for the office visit and mention any outstanding balances which you would like them to take care of at their next visit.
There is an important caveat you should be aware of. You cannot balance bill patients when you are a contracted provider with their insurance company. The provider contract prevents doctors from billing for anything other than co-pays, deductibles and any coinsurance (i.e., patient is responsible for 20% of allowed charges) beyond the allowed amounts of the services that are approved by the insurance company. The only exception to this rule is if you provide services outside the patient's policy and therefore not subject to control by the insurance company. For example, if the insurance company does not include orthotic services, routine foot care, etc as part of the policy, you are free to charge your usual and customary fees at the time of service. However in those circumstances you should inform the patient in writing that those fees are PRIOR to the service being provided and have them sign an acknowledgment form that they are directly responsible for those fees and services.
All financial polices should be included in your office manual so that all staff members are aware of the office policy and to avoid any confusion as to what is told to the patient.
Finally read all insurance contracts carefully to make sure that you are not violating any provisions of your contract with the insurance carrier when it comes to collecting co-pays, deductibles, balance billing etc. If you have any questions it is advisable to consult with an attorney knowledgeable in collection
