Neurosurgery Coding Alert

Question: When a patient is asked to pay a copay and cannot, are we legally bound to send a written bill, or is a copy of the superbill with the balance sufficient for the insurance companies?

Michigan Subscriber

Answer: Contracts with most insurers state that it is your obligation to collect the copayment and the patients obligation to pay. Insurance companies take them seriously, because they use them to control utilization. The cost of billing these generally exceeds this amount, so a firm office policy should say that they will be paid at the time of the visit, and no later than 30 days after. This will eliminate the need to bill. Patients who violate this may need to be dismissed from the practice.

You can also collect it at the next visit or write it off, as long as it is not done to defraud the insurer or government. For example, if a patient has financial problems, a written agreement should be created between the patient and the practice detailing the exact nature of these problems and precisely what copayments will be written off. However, this can only be for a temporary period, such as a three months, and the patient must sign a copy of the agreement for each and every copayment that is written off.

If you choose to dismiss a patient, be sure you comply with the HMOs rules for dismissal as well as the standards in your state (e.g., letter sent via registered mail with return receipt, coverage for emergencies for a reasonable period of time until a new neurosurgeon is found, or forwarding records to the new doctor after a written release from the patient has been received) to avoid being accused of abandonment. You should also report the patient to the insurance plan. This should occur after two copayments have been missed. The health plan will usually follow up with the subscriber.