Optometry Coding & Billing Alert

Published on Fri Mar 27, 2009 PDF

Prevent hundreds from running out the door with these expert tips.

There are some insurance companies that your practice just doesnt want to participate with. So, if your optometrists are seeing patients with insurance you do not participate with, how can you ensure that your practice still gets paid?

The problem: When you are a non-participating provider with a payer, the patient receives the check from the insurance company directly. But some patients do not,then, use those funds to pay the bill your practice sends. What are your options? According to the experts, you have four.

Option 1: Collect at the Time of Service

Since you know that your practice does not participate with the patients insurance company, you also know that the payer will send the check directly to the patient. Therefore, you can collect the fee for your services directly from the patient while he is in your office.

Post your policy: You need to ensure that your patients know they are responsible for paying for noncovered services. The practice policy should appear in the financial policy you give all patients. Additionally, you should put up a sign in the waiting area stating that payments are due at the time of service. You should also try to let patients know when they make their appointment and when you call with a reminder what they will owe for the visit, as well as the payment methods your practice accepts.

We explain to the patient that the reason for having them pay at time of service is they have chosen to see a non-participating provider, and the insurance company will almost always send the payment directly to the patient since there is no contractual obligation to pay the provider, explains Lori Braidic, billing manager for Womens Care Center Of Columbus in Ohio. We will give them an itemized statement for that visit that they [the patients] can submit to their insurance company for reimbursement. We are not contractually obligated to bill it for them either.

Option 2: Send the Patient to Collections

If you opt not to collect at the time of service, your next option is to send the patients account to a collection agency, to small claims court, or even to the Internal Revenue Service (IRS). Do not be afraid to use a collection agency whenever a patient owes you money and refuses to pay you.

Good practice: Write a letter or a form that states the patient will receive payment from the payer and therefore the patient will be responsible for paying the bill. When the patient arrives at the office, give him a letter regarding the payer payment, suggests Kathy Philp, CPC, director of physician services at Praxis Health Group in Oklahoma City. Have him sign and date the letter, and then put it in the patient file.

The letter should state that the insurance company will be sending the patient the payment, therefore, making him responsible for the services provided. The patient will then need to pay services in full at the time of the visit or arrange to make payments, Philip adds. Once the patient leaves the office and several attempts have been made to try to collect with no response from the patient either by phone or by mail, then turn the patient over to a collection agency or take them to small claims court, she advises.

For the rest of our tips on non-par collections, read the next issue of Optometry Coding & Billing Alert.