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.