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Explore All Coverage Options to Recoup Out-of-pocket Costs

Gain deserved reimbursement when insurance and patients come up short.

By Alexandra Archibald, MBA, CMPE
In recent years, practices have seen significantly higher patient out-of-pocket costs for covered services. Combine that with the number of uninsured (15.6 percent, according to an April 2014 Gallup poll) and undocumented workers, and it’s no wonder collecting payments from patients is increasingly difficult. Don’t write off those unpaid bills to the cost of doing business just yet, however. You may be able to reduce patient costs and cover your services by employing one or more of these reimbursement options.

Ask Where the Injury Took Place

If your practice treats a lot of sports injuries, find out where the injuries occurred. Practically every facility or organization carries liability insurance. If a patient is injured during an event held on public grounds, the town or county usually requires the organizer to carry liability insurance. In New Jersey, these supplemental insurance plans are primary over Medicaid plans.
To ensure this important question gets asked, rewrite triage questions to include, “Where did the injury take place?” (I stopped using age as criteria to ask this question when an 80-year-old local physician was injured while playing in an ice hockey league.)

Check for Other Insurance Options

Aflac now offers policies to cover the (high) deductible for ACA plans. Consider adding a question to your intake form, such as, “Are you covered by supplemental insurance? Example: Aflac or sports/school/scouts/travel insurance, etc.”
Some insurance companies are still able to offer short-term benefits to patients between coverage. They are: Golden Rule, Humana, Mutual of Omaha, and eHealth (portal for searching short-term plans). The downside to these limited benefit plans is that they can still apply a pre-existing exclusion to any treatment or diagnosis occurring up to 12 months prior to purchasing coverage.

Research Workers’ Compensation Coverage

You may have noticed an increase in injured workers who are not covered by workers’ compensation insurance, as well. Some of these patients are undocumented workers, some patients’ employers dropped their coverage, and still others have employers who refuse to acknowledge and/or report claims to their carrier.
Almost every state requires workers’ compensation coverage if more than three people are employed at an organization. Go here for a summary by state.
Many states also have a website allowing you to search for an employer’s current workers’ comp coverage, so your office can notify the carrier directly if the employer refuses to disclose the information. In New Jersey, that link is http://pcov.njcrib.com/.
If you suspect a patient’s employer does not carry workers’ compensation coverage, notify the proper government authority in your state. Most states have a form for reporting non-compliance. An employer refusing to carry workers’ comp could be fined. You might remind the employer of this to encourage an agreement for claims payment. If that strategy fails, you can file non-compliance paperwork and pursue a claim through the Uninsured Workers’ Compensation Fund.
Alexandra Archibald, MBA, CMPE, is the practice administrator for Somerset Orthopedic Associates, P.A., in Bridgewater, N.J.

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Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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