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
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
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
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 BILLHME@aol.com