CREDIT BALANCES MUST BE REFUNDED
Just a reminder that credit balances are required to be refunded within 60 days of notice. This article may be of interest. The penalty was 2.5x the amount owed. Government programs include: Medicare, Railroad Medicare, Medicare HMOs, TriCare, Medicaid, & Medicaid HMOs. https://www.lexology.com
AMERIHEALTH - PAYING 50% IN CERTAIN CPT COMBOS
Just a reminder that as of August 1st, AmeriHealth changed it's payment policy to pay evaluation and management (E&M) codes appended with modifier 25 at 50% when they are submitted:
- For the same date of service by the same provider as a minor procedure or
- When they are submitted for the same date of service by the same provider as a preventative E&Mâï¿½ï¿½.
- Since AmeriHealth does not want to pay in full for your services, our advice is to not provide them on the same day. If you feel your services are only worth 50%, then no need to change.
COLLECTING CO-PAYS AND BALANCES
The current approach by many providers is to require payment for co-pays and known deductibles when the patient arrives. But that can be difficult for some front desk staff without some training. First, be sure the patient is reminded at the time the appointment is made that their co-pays/balances over 30 days/deductibles will be payable on that date. That sets the expectation well in advance.
Upon arrival, the key is for the Front Desk to always ask for the money (co-pays; deductibles; past due balances, etc.). Some at the front desk do not ask because they are not comfortable and/or trained on what to say. Here is an example/script they can consider using:
"Guarantor X, we are happy to see you today at the office. I see there is a small balance due of $XXX from a previous service. How would you like to handle payment for that today with credit card, check or cash?"
In most cases this will work. However, your front desk needs to be prepared in the event someone says they cannot pay the full amount. This now becomes an art and how they ask questions is very important. For example, front desk should not say "How much can you pay today?" since this reduces your chances of getting the most possible payment. A better option is to ask, "How much are you short?" It's another way of asking the question and maximizes what you can potentially get paid. We also recommend not accepting less the half. Since most office visits are not emergencies, you may be able to safely offer a different appointment when they can bring their copay in full.
Anecdotally, a client told me a few years ago that when the patient could not pay the copay, and was offered another appointment instead of being seen that day, that it took 3 trips to her car before she miraculously found the money for her copay!
Asking questions and communication to your patients is key. The Front Desk is the first line of defense and the more they are prepared, the better off everyone will be.
You can also apply this concept to asking about address and insurance information. Avoid questions like "are you still at the same address?" "do you still have the same insurance." Instead ask "Guarantor X, are you still living at 123 ABC Avenue? Do you still have BCBS as your insurance provider?" Specific questions yield better responses (it's never fool proof, but, it's a great start).
HOW TO PREVENT "NO-SHOWS"
No shows are costly and sometimes show disrespect to the provider. Some ways to minimize are:
- Automated reminder calls/texts.
- A reasonable no-show fee.
- And educating patients WHEN they make the appointment. Something along the lines of "OK Mr. Smith, your appointment is at 3:00 PM on Tuesday, October 24th. Your co-pay is $30. Please be sure to let us know 24 hours in advance if you cannot make it as our no-how fee is $50 which is not covered by insurance." This is especially important for new patients or repeat offenders. Be prepared for some patients to not accept responsibility and push back, but if they do not respect the provider for this, how well will they comply with clinical treatment?
UNITEDHEALTHCARE COMMERCIAL REIMBURSEMENT
POLICIES - STOPPING CONSULTS
UnitedHealthcare Commercial Reimbursement Policies - Stopping Consults From the UnitedHealthcare Network Bulletin (October 2017): "Delay in Implementation of the Revision to the Consultation Services Reimbursement Policy We previously announced that certain revisions to the Consultation Services Reimbursement Policy would become effective for UnitedHealthcare Commercial members on Oct. 1, 2017. In an effort to give care providers more time to adjust to potential changes in their submission of procedure codes for consultation services, UnitedHealthcare will be delaying implementation of the revisions to the Reimbursement Policy for services reported with consultation codes 99241-99245 and 99251-99255."
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