It Adds Up

Have you begun transmitting your 2003 dates of service yet? If so, watch those EOBs [explanations of benefits] fly in — with $100 consistently in the “deduct” column. Private-insurance deductibles can — and will — range from $100 to $500, and more.

Let me share with you my experience with reducing the amount of revenue lost to deductibles. About six years ago, I conducted an internal test to see what percentage of deductibles would be reduced if I waited to transmit dates of service at a later date.

I set my electronic claims submission date for Feb. 15, instead of my regular Jan. 8 transmission date. As a result, my rate of reducing deductibles was 62 percent across the board. What a difference six weeks can make!

As providers, we are responsible for making every attempt to collect the 20 percent co-insurance amounts and the deductibles. You cannot automatically write off either of these. If you have a patient that is indigent and meets the National Poverty Guidelines standards, then the patient must complete a Financial Hardship Form and prove that he or she cannot pay you the amount owed to you.

Remember, it is okay for you to deny a hardship form and to set up a monthly, non-discounted payment plan with the beneficiary to meet his or her financial needs. However, it is illegal to advertise that the patient will not have to pay the co-insurance or deductible if he or she will just do business with you.

If you approve a hardship form from a patient, you may write off the 20 percent co-insurance amount monthly, so it will not accrue on your accounts receivables. However, if you do not have a hardship form and you attempt to collect the co-insurance amount, you may not write off this balance for two years, according to Internal Revenue Service guidelines.

Evaluate and audit regularly your 20 percent co-insurance collections and your deductible collections. Re-evaluate each patient’s hardship form every six months.

If the patient’s financial status changes, or if the patient obtains a secondary insurer that will pay his or her co-insurance amount and the deductible amount, you will be the last to know.

Therefore, it is vital that you make sure your intake process is complete and accurate — that you obtain secondary insurance information, and that you call to verify that the insurer pays the co-insurance amount and deductibles for home medical equipment and pharmacy.

When you call third-party primary insurance carriers, always ask if the patient has met his or her deductible. If so, how much and what percentage has the patient met of his or her deductible? Also, ask if a separate deductible applies to HME or pharmacy. Finally, ask if the particular product you are being asked to provide is covered under that policy.

If you are not in the insurer’s network or if the insurer does not pay above what Medicare allows, then you need to let the patient know up front what his or her costs will be.

Take the time to obtain all of the information you can from the patient and the referral sources so that you will receive reimbursement for the services rendered. With the changes in the industry and reduction of reimbursements, you can’t afford not to attempt to collect secondary co-insurance or deductible amounts.

Good luck!

Jane Bunch is chief executive officer of Kennesaw, Ga.-based JB&CS. A reimbursement specialist, Bunch delivers educational seminars worldwide, helps develop corporate compliance plans, and serves as a consultant for fraud and abuse cases. She can be reached at 678/445-1221 or via e-mail at [email protected]