Prioritize Your Patient's Financial Experience

May 13th, 2019 - Wyn Staheli, Director of Research
Categories:   Billing   Collections   Practice Management  
0 Votes - Sign in to vote or comment.

For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a “Patient Financial Responsibility Acknowledgment Form” to help providers with this process. Lately, the lack of pricing transparency has been in the news and even the Affordable Care Act (ACA) attempted to make things better by requiring hospitals to make their prices transparent by publishing their “chargemasters.” However, there are still problems.

Although “surprise” bills are particularly problematic when it comes to hospital bills and imaging services, they can also happen in a smaller organization. When a patient finds out that the procedure or service is not covered by their insurance, as you can imagine, they are not happy about it. Even as a practice, it is often difficult to find out what is covered by a third-party payer.

The best place to begin is to make sure you have an “Informed Financial Consent Policy” which is an official written policy. As part of your policy, you need to make sure that your office has a process which outlines anticipated procedure/item costs and helps the patient understand the role of their insurance. Medicare requires the use of an ABN for noncovered services, but you also need to have a separate form for non-Medicare patients.

A recent article in Medical Economics (see References below) emphasized the patient’s focus when it comes to healthcare services. According to the article, their top priority is affordability. You need to be able to show how your services are affordable compared to other physicians or services. As you’d expect, they also stated that convenience is also essential. Seventy percent of the patients surveyed wanted to be able to sign up for a payment plan online. If your organization is prepared to be able to offer online payments and/or payment plans, just make sure that you meet all security requirements.

Patients also look for a ‘deal’. Just keep in mind that you have to be careful with marketing to ensure that you do not violate any laws. For example, you can’t offer to waive co-insurance or deductibles for either new or established patients. Medicine isn’t like other businesses in that you have to be careful about offering any ‘inducements’.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Billing and Documenting for Therapeutic Exercises versus Therapeutic Activities
July 13th, 2022 - Dr. Evan M. Gwilliam, DC, MBA, QCC, CPC, CCPC, CPMA, CPCO, AAPC Fellow, Clinical Director
Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:
Medicare Advantage (MA) Benchmarking Policies Are Headed for Change
July 12th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
More than 43% of Medicare beneficiaries are not enrolled in Medicare Advantage plans, which were established to control costs and improve quality. However, as noted in the March MedPac Report Executive Summary of 2021, these plans average an estimated 104% of Medicare Fee-For-Service (FFS) spending. How does CMS plan to manage Medicare Advantage plans now?
How Extensions to the COVID-19 Public Health Emergency Affect Healthcare Reimbursement
June 28th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Providers need to begin preparations for how to handle a return to pre-COVID-19 public health emergency (PHE) policies. As the saying goes, "you can't put the rabbit back in the hat." Some COVID-19 PHE policies are so well liked it will be very difficult for the government to return to pre-COVID-19 policies. For now, we have at least the promise of a 60-day notice to all governors precipitating the end of the PHE.
Why You Should Be Using The Two-Midnight Rule
June 23rd, 2022 - David M. Glaser, Esq.
Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has...
Q/A: Service Period for 99490
June 6th, 2022 - Chris Woolstenhulme
Question: If CCM hours/work is to be billed monthly, and CCM tasks are done daily throughout the month, should it be saved until the end of the month to bill, and should each date be billed as DOS in one claim? Answer: According to CMS, “The service period for CPT 99490 ...
Reporting CCM and TCM Codes with E/M Codes
June 1st, 2022 - Chris Woolstenhulme
When reporting CCM or TCM codes, you will only get reimbursed for what is allowed. The E/M office visits can be coded in addition but are not interchangeable with CCM codes. You can bill an E/M visit during the time a patient is under Care Management, however, you can’t count time ...
Q/A: Billing Over the Allowed Amount
June 1st, 2022 - Chris Woolstenhulme
Question: Is there a financial penalty for billing over the allowed amount? Answer: Yes, if you are submitting claims to a contracted provider, you cannot bill over the contracted amount of your fee schedule. This is called balanced billing. There is also the no-surprise rule that protects insured and non-insured or ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association