January 19, 2020 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC
Welcome to 2020! It is my hope that all of you had a great holiday season and New Year and are well-rested and ready to take on the challenges of this new year head-on and armed with the necessary tools to ensure compliance and streamlined operations.
As part of beefing up your compliance process and mitigating risk, I thought I would begin this year with a topic that everyone loathes, which is figuring out deductibles, co-payment and/or co-insurance at the start of the year. The best way to do this is to have a Practice Financial Policy in place. But the key to being successful with this part of your job is ensuring from the outset that you have clearly explained things to your patients. At the start of each year, every patient should sign your practice policy so that at a minimum when they say, “I didn’t know this” or “You didn’t explain that to me,” you have something they signed that specifically says they read the document and were given opportunities to ask questions about. In short, the signed forms show that patients have acquiesced to your practice’s financial policy, and that you are able to hold them to it.
We live in an age of entitlement and litigiousness where patients threaten legal action or reporting you to the state medical board if they don’t get their way, or even to deter you from collecting what you are entitled to. This is why you have to be two steps ahead of your patients and three steps ahead of any investigatory agency.
This policy is lengthy and intended as a template so you will need to adjust it to make it work for your practice and to ensure it complies with any applicable state laws. Again, please do not take this template and implement it as is.
As always, should you have questions or concerns, please do not hesitate to reach out to NAMAS.
Best wishes in 2020!
Thank you for choosing PRACTICE for your medical needs.
Medical insurance plans can be very complicated and confusing, but we will do our best to assist you in understanding your care benefits and financial responsibility. Our team works hard to ensure we understand as much and as many of the insurance plans that we participate with to try and assist you with understanding your responsibilities as a beneficiary of that plan. However, it is ultimately your responsibility to understand your coverage benefits prior to treatment and any applicable fees you may be liable for.
We value you as a patient and recognize that you need clear, concise answers when it comes to your financial responsibility and our practice will attempt to verify coverage and benefits prior to your treatment. However, it is critical to understand that sometimes payers’ systems are not up-to-date regarding deductible amounts and other coverage determinations that could impact your out-of-pocket costs. We will provide you with a best estimate of costs prior to service when feasible. Please keep in mind that until a claim is filed and processed by your insurance carrier there is no actual way to know what will be paid by your insurance carrier and/or what they will require you as the patient to personally pay. In the event the estimate provided does not cover the full costs attributed to you by your insurance company, we will send you a bill that is payable upon receipt. Please understand, we will make every attempt to minimize confusion but at the end of the day this is the insurance plan you or your employer chose, thus it is your responsibility to understand your coverage benefits, co-payment/co-insurance and/or deductible amounts.
In the event you wish to dispute payment or lack of payment for services rendered by your insurance company, it is your responsibility to engage with your insurance company or plan administrator to settle the dispute. Our practice will not engage in patient/insurance disputes as our main goal is rendering the highest standard of patient care without interruption. Should your insurance company refuse coverage, or determine a portion or the full amount of the bill is the patients’ responsibility, we expect payment for services rendered and failure to comply with our facility policy will result in our seeking damages to the fullest extent of the law within the State of __________ including third-party collection efforts and small claims court.
Our practice will file the claim on your behalf with the appropriate insurance carrier. As the patient, you are responsible for providing our office staff with an up-to-date insurance card and government issued photo identification card. A photo identification card must be presented on the date of service or a valid photo identification card must be present on the patient’s file. If you are new to our practice and present without a photo ID, we will treat you as a self-pay patient until you are able to furnish our practice with a photo ID.
If you present for a visit and are unable to provide proof of insurance coverage at the time of service, you will be required to pay the self-pay office rate for services rendered. Once you submit the proper insurance information and we are able to verify coverage and benefits, we will file a claim on your behalf and upon payment from your insurance company, issue you a refund for any monies paid in excess of the insurance payment. In the event your insurance does not pay or attributes the bill to deductible or patient responsibility, we will credit your account with the funds already paid and if there is a balance, we will send you a bill that is payable upon receipt.
If you have new insurance coverage since your last visit to our office and have not received your insurance card, we may be able to verify your eligibility and benefits through your insurance company’s web-portal. We will require the following information: insurance identification number, group number, and claims address to verify your benefits and estimate your financial responsibility.
Our practice accepts assignment of insurance benefits, which means your insurance carrier will pay us directly based upon your benefit coverage. By signing the applicable form, you consent and authorize the assignment of your benefits to our practice for all rendered treatment and related services.
It is the policy of this office and our staff’s responsibility to collect patient’s financial portions at the time of the visit, including copayments/coinsurance, and deductible amounts.
Our practice does offer a cash pay discount and as such, all charges are collected at the time of service.
In the event you are unable to pay your portion in full at the time services are rendered, we will require a minimum of 50% as a deposit and we will send you a bill for the balance due upon receipt.
Our practice reserves the right to change the terms and condition of this Financial Policy at any time and without notice.
Interest, Financial Hardship and other Items:
Our practice reserves the right to charge interest on late payments of statement balances, and/or to utilize a third-party collections agency. In the event you are facing a financial hardship, you may inquire with our front office staff and complete the necessary paperwork. This does not release you from having to pay for services rendered but offers options for how you can pay your bill. Most payment plans require between 25 – 50% of the service fee to be paid at the time of service and the remainder on a recurring schedule. A credit or debit card will be required to be kept on file for the payments until paid in full.
All fees are due within 30 days of the date of the statement (“the Payment Period”).
Should you fail to pay your balance within the payment period, we reserve the right to add interest and/or suspend services until such time as we receive payment and any other amounts due.
Before signing this Financial Policy, I have been afforded all opportunities to ask questions and to receive answers that made me comfortable with affixing my signature. By signing this Financial Policy, I acknowledge my responsibilities as a consumer and agree to be bound by the terms and conditions of this Financial Policy. Refusal to sign this form may result in services not being rendered.
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