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.