I’ve yet to meet a pediatric therapist who is in it for the money. Pediatric therapists care deeply about the children they treat and would treat them at no charge if they could.
Unfortunately, copay and deductible collection is the key to your pediatric therapy cash flow. With the increase of high deductible plans since the implementation of the Affordable Care Act, proper collection of copays and deductibles is more important than ever. If the patient doesn’t pay for care, you bear the financial burden.
If that isn’t reason enough, there could even be legal consquences for failing to collect.
Still, collecting copays and deductibles is tough. They are easier to collect at the time of the appointment rather than sending a statement or two (or three) and hoping to get paid, but that isn’t always an option.
So here are a few things you can do to make the process easier.
1. Develop A Payment Policy
A payment policy will give your staff the tools and confidence they need to be successful in collecting copays & deductibles. It will also help everyone understand the expectations for collecting payments (and the steps that will be taken when expectations are not met).
The American Academy of Family Physicians recommends including the following in your payment policy:
When payment is due (e.g., usually the date of service, unless other arrangements have been made in advance);
Who is responsible for payment (e.g., self-pay patients are responsible for the entire amount of the bill; patients in health plans are responsible for any amounts not covered by their insurance);
How co-pays and deductibles will be handled (e.g., co-pays are collected at each visit without exception);
What forms of payment your practice accepts (e.g., personal checks, debit cards, credit cards);
Your practice’s policy regarding nonpayment (e.g., you enlist a collection agency’s help after three months of nonpayment).
We’ve provided a downloadable sample payment policy at the end of this post.
2. Give Your Patients Options
You can make things easier on your patients and yourself by providing a range of payment and therapy options for them to choose from. This could mean paying in installments, or providing different levels of therapy. For instance, two treatments a week might be ideal, but one treatment a week may be more affordable and still beneficial to the patient.
By giving your patients options, you can ensure that the payments are manageable for them, and collecting copays and deductibles will be more manageable for you.
3. Know Your Patient’s Coverage Details
Always verify your patient’s coverage and policy details. It’s not ‘payer details’ – it’s ‘policy details’. A payer can have many different policies with very different coverages. You cannot have that payment policy conversation with a new patient’s family if you do not know what their coverage, copay and deductible responsibilities are.
Your patient may not know how to read their policy and what their responsibilities are, so be prepared to help them understand the details.
Be sure that the patient’s coverage information is up-to-date. January and July 1st are the most common times that policies are updated and coverages change. That means that a diagnosis code that was covered in June might not be covered in July. A $30 copay in December might increase to a $40 copay in January.
Almost all payers have ‘Medical Policy Bulletins’ on their portals, newsletters and other helpful information available. This is a great place to begin.
Now you have three items you can act on today to secure your clinic’s future. And if you have any other advice on collecting copays and deductibles, I’d love to talk to you about it in the comments!
In-House Billing Kit
We’ve put together some resources to help you bring billing in-house. This In-House Billing Kit includes:
- A Verification Questionnaire to use when calling payers to verify coverage
- A 50% off coupon for our billing course, The Essentials of Insurance Billing for Therapy
- A Billing & Collections Checklist to guide you as you interact with caregivers
- A Payment Policy Generator to help you set expectations for caregivers
- 7 Tips to Help with Billing & Collections handout