Improve Your Surgical Care Cashflow in One Easy Step

by: Kristi Martucci, CPC ENTAA Care Billing Manager Glen Burnie, MD

Collecting patient balances after surgery can be tricky. Many patients are out of work for several weeks after surgery and find it hard to keep up with their bills. These delays in patient payments can severely hinder your collections on high paying services. To improve our collections, our practice developed an approach to collect patient balances prior to surgery.

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For scheduled surgeries, we verify insurance benefits on all of our cases. We ask that our patients that have co-insurance, copays, or even deductibles pay their portion prior to their surgery.

In order to calculate what the patient may owe for their surgery, we review the allowed rates for the scheduled surgery and total what our anticipated collection will be. We then apply any patient benefits to the allowed rates. For example: If a patient is having a tonsillectomy, primary or secondary; age 12 or older (CPT 42826) in which the insurance allowed rate in Maryland is $283.00, and the patient has a 20% co-insurance, we collect $56.60 from the patient as a deposit prior to surgery to cover their portion of the cost.

To know the allowed rate for surgeries will require you to frequently update your contracted rates on all plans in your software. This is good business practice anyway. To simplify, you may elect to use one fee schedule, such as the Medicare rate, on all patients to calculate a deposit. The amount will not be exact, but it will be close enough to collect most of the balance up front. Don’t forget to apply reductions or increases, such as a 50% reduction for secondary procedures or a 50% increase for bilateral procedures using modifier 50.

Applying this policy has significantly reduced the amount of surgical patients that are sent to collections and keeps our patient receivables down.

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