Practice Management Alert

There's more than one way to skin a cat and to collect deductibles. Some experts draft a cost quote for their patients, secure deposits from them, or collect Medicare deductibles in advance. Two experienced billers comment on those solutions and provide some of their own answers.

Some experts say you should designate an employee to collect cost quote information from the insurer while the patient is in the office so the patient can discuss finances with the insurer and biller present at the same time, and so there's no breakdown of communication.

This method works in theory but not always in practice when it comes to deductibles. In fact, the suggestion is "virtually impossible" for the orthopedic and pain management practice in Paramus, N.J., where Pam Sharkey is billing manager. "We don't have the time or the staff," she explains.

Instead, she suggests that you recommend to patients that they contact their insurers for deductible information. Sometimes, the patient will take you up on the suggestion. Otherwise, you have to contact the insurance company and then the patient, Sharkey says.

Any additional counseling depends on circumstance. In some practices, the receptionists can collect deductibles up front, says Debbie Pacyna, CPC, practice administrator for the Urology Health Care Center of New Jersey, in Toms River. Only if there's a problem do patients need to receive counseling from the billing department; otherwise, the receptionist can just hand the patient a self-addressed envelope and tell him to send it in, Pacyna adds.

If you're collecting deductibles for higher-dollar-value procedures, particularly surgery, counseling could be acceptable. You might tell patients their financial responsibility regarding deductibles as a "heads-up," but Pacyna's practice brushes by it, making it secondary to patient care. Just let the patients know that payment arrangements are possible, she adds. Since deductibles are usually fixed amounts, there's no element of surprise or contingency, as there may be for insurance reimbursement that's not guaranteed (see article on page 1). "We give the quotes only when the insurance tells us that they pay a percentage," Sharkey says. The deductible is usually an additional, fixed amount.

Securing a deposit for the deductible prior to the service "is not a necessary element," Pacyna says. "I don't think our patients would agree with that." Usually the surgery is life-threatening to some degree, she explains, so securing a deposit might be inconsiderate, inappropriate and, not to mention, untrusting.

The only exception for collecting deductibles might be elective surgeries, e.g., cosmetic or non-necessary procedures, Pacyna says. She cites vasectomy as an example for urological practices. In that case, she "might" ask for a deposit.

Collecting Medicare deductibles in advance for a particular surgery is impractical. Even though Medicare permits you to collect deductible amounts before you submit or process the claim, Pacyna and Sharkey recommend against it.

Pacyna's practice collects Medicare deductibles at the beginning of the year. Collecting deductibles per service ends up costing, instead of benefiting your practice especially for the senior population, Pacyna says. If you have many Medicare patients who go to the doctor every day, or multiple doctors each day, you don't know which bill will hit the carrier first.

You don't know whether the deductibles apply to your claim or a claim for the same patient billed by a different provider. So you might collect money you need to return, she continues. It's much harder to refund the money if the deductible applies to another claim and not your own, she warns.

Instead of collecting deductibles in advance, let your patients know how you collect their deductibles with a sign posted at the front desk, Pacyna says. At the end of the year, alert them that they'll owe a deductible in the beginning of the new year.

At the beginning of the year, Sharkey's practice reminds her Medicare beneficiaries that they may see a bill from her practice.

Verification is not just necessary, it is imperative, Sharkey says.

Here are three tips for verifying insurance deductibles: