5 ways to collect money up front

We all know that copayments should be collected at time of service. In fact, a pattern of waived co-payments can be considered fraud.* In addition, federal requirements indicate that any refund processing should occur within a 60-day period. As the cost of healthcare shifts increasingly to the patient, up front and accurate payment collections are more important than ever.

Attempting to obtain payment after the visit and processing refunds are incredibly labor intensive and expensive. The following are steps that your front desk should take to successfully collect accurate payments up front. If your operations are already sophisticated in this area, you can use this as a checklist.

Insurance Verification Prior to Patient Visit

Whether insurance verification is done manually or electronically, it should occur at least 24-48 hours prior to a prescheduled visit. Many payers will provide some level of co-pay information in an electronic eligibility response, but it is variable by payer. In addition, co-pay collection can be variable depending on the service provided. This level of determination may not be readily available in an electronic response, requiring office staff to take additional steps after the initial verification to fully understand if copay collection is appropriate. This further determination may require the verifier to place a call to the insurance company or view a payer website to see specifically how they adjudicate particular codes.

Understanding Insurance

It can be difficult to estimate the patient liability prior to services being rendered for various reasons; copay amounts can look very different based on the number of insurance policies a particular patient carries. Communicating with patients to obtain accurate insurance information is vital to the registration process. Eligibility responses typically do not indicate whether a patient has additional insurance plans that may be unknown to your office staff. Do not leave it up to the patient to divulge if additional insurance exists. Train your front desk staff to ask patients directly if new insurance policies are in effect. In addition, loading each policy in the correct filing order is equally important. Often copayments for patients who carry secondary or even tertiary insurance can be waived at time-of-service, as those insurance plan(s) typically pick up any copayment liability left over by the primary insurance following adjudication. Denials often occur when the filing order is incorrect and the claim goes out to the wrong payer first. There are several coordination of benefit rules that office staff should use to determine the correct insurance plan order. Here are a few examples:

•    Birthday Rule: This rule is widely used by insurance companies for children that are listed as dependents on both parent’s insurance plans. This rule states that the parent whose birthday comes first within the calendar year is designated as the primary plan holder. This rule can get more complicated if the dependent child is covered under both parents who are divorced or separated.