Collecting those secondary payments and deductibles?
Yes, it is that time again when we are receiving many deductibles being adjusted from our Explanation of Benefits. And this year, we are feeling the effect more than ever.
To make this process run smoothly, make sure to verify that you have internal processes to get the bills out to your patients or their secondary insurers in a timely manner. Remember, your secondary payers have the same timely filing issues as all other payers, and the last denial you want to see is one for untimely filing.
Do you have a written policy and procedure internally for those patients who cannot afford their secondary payment? This has become a big issue with audit procedures, and providers are being asked for their written policy on hardships by auditors.
What forms do you have in place? Who in your company can make the decision to approve or deny a hardship form that has been completed by a beneficiary? If it is denied, who sets up the payment plan?
Accompanying this article, I am providing you with a sample template of a policy you need to put in place if you do not have one. You will need to complete it with your company information and the selected personnel who will be verifying these forms.
I even suggest you obtain copies of patients' bills and any “proof” you can obtain to validate the financial hardship form. Writing off the 20 percent copay or deductible without appropriate documentation is not allowed and should not be tolerated within your operation.
Your policy should read as follows at a minimum:
Financial Disclosure Policy
________________(Name of company) utilizes a financial disclosure form that meets compliance standards set forth by the industry. It is not the practice of (name of company) to routinely waive 20% co-insurance amounts for any patients that are on service or have received services.
Patients are given the choice to complete a hardship form in the event that the 20% will cost them financial hardship in meeting their monthly expenses. (Name of company) will determine if the patient meets the hardship guidelines by utilizing the national poverty guidelines as a benchmark. (Name of person who will assume responsibility to approve or deny form goes here) will be responsible for reviewing the hardship forms and determining if the patient meets these guidelines.
If the patient is accepted, then the 20% co-pay may be written off. If the patient is declined, a payment plan will be set up per the guidelines, on a monthly basis.