Deductibles, Again

Once again, it is that wonderful time of year when the insurance companies do not have to come up with an excuse to deny your claim — they just put it toward the deductible.

If you have been keeping up with Medicare, you know that the deductible has been increased this year to $124. As for private insurance companies, it is all based on the individual policy. While there is not a lot you can do to keep from receiving deductibles — with the exception of holding claims in the hope that someone else will bill first and get the deductible — there are things you can do in the processing of deductibles that can have an effect on your bottom line.

Traditionally, you will not begin to see the effect of deductibles until the latter half of January for Medicare, or the beginning to middle of February for private insurers. You will need to get these claims turned around and billed to the secondary carrier (if they pay the deductible) or the beneficiary as soon as possible.

In the case of patient-pay deductibles, attaching a copy of the Explanation of Benefits to the statement, and highlighting the column showing how much is owed plus the reason code and explanation, will reduce the number of phone calls you get when the patient receives a bill in the mail. (Make sure if two beneficiaries are listed on the EOB you mark out all the information except that for the beneficiary you are invoicing.)

You may also want to indicate that you are willing to set up a payment plan (assuming you are) or have the ability to accept credit cards for payment (assuming you can). If you do not accept credit cards, then get set up to do so. Many beneficiaries prefer to put their balance on a credit card rather than writing you a check.

One of the biggest challenges is going to be identifying all of the deductibles you are receiving and ensuring their processing. It is time-consuming to go page-by-page, EOB-by-EOB to process each one. However, there are third-party software tools that can assist you in this process.

Another tactic you may want to use to see what your potential cash shortfall will be — and to ensure you do not miss any deductible payment processing — is to place the names of your current rental patients (those with rental items in January and February) on the first column of an Excel spreadsheet. Do not forget those in maintenance. Separate the list by Medicare, Medicaid and private insurance to make this easier.

In a second column, put the dollar amount you receive from these rentals from the primary payer. In the third column, list the amount of the deductible (you should have this on your intake sheet for all non-Medicare beneficiaries).

Then, subtract the deductible from the expected amount received. If the number is negative for a patient (in other words, if the amount you expect to receive is less than the deductible) carry this out for February, March, etc., until you get a positive number.

You can then add up the amount you expect to receive from Column 2 and compare it to the amount in Column 3 to see how the deductibles will affect cash flow. (You will have to add by hand what is left after the deductible has been taken, as Excel will factor in negative numbers.) This will be a great tool for budgeting and to take to the bank if need be. Also, use this list as a check-off as the EOBs are received to ensure you send out all the invoices and patient statements for deductibles.

Another good idea during deductible season is to double your efforts on aged accounts receivable. That money needs to be collected, and it will help to offset any cash flow shortage during the first quarter of the year. If there are items in your aged A/R that are uncollectible, now is the time to get them off the books so you do not pay more taxes than you have to.

Streamlining is the name of the game. With cuts in reimbursement, changes in policies, accreditation on the horizon, competitive bidding coming and all of the daily changes we see, we must make an extra effort to collect deductible amounts not paid and co-insurance amounts. Make sure there is a written policy about this in your company, and stick with it.

Jane Bunch is vice president, HME consulting, for Atlanta-based CareCentric. 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 678/264-4495 or via e-mail at [email protected].