July 13, 2020

Best Practices - Providers

Prepare the Claim 

1. Financial policy - A common reason patients may not pay their medical bills is that they do not understand what they owe and why. Therefore, before a patient receives any treatment, staff should clearly explain both the total expected cost of the visit and any copays, co-insurance, or deductibles that are required at time of service. Your financial policy should detail which insurance plans are accepted, how out-of-network insurance will be billed, the cost of a self-pay visit, and whether the patient will be billed his deductible or required to put down a “deposit.” The financial policy should be clearly communicated on the center’s website, verbally by the front office staff, and in written materials provided at registration. To assure patient understanding, many centers ask for a signed acknowledgement that patients have received, read, and will comply with the financial policy.


2. Insurance verification - Failure to verify insurance could result in a denied claim and a patient balance that never gets paid. Just because a patient presents an insurance card doesn’t mean he or she is insured. In a recessed economy, people transitioning between jobs often forego COBRA coverage, and some businesses reduce or drop employee benefits. In addition, plans are increasing patient out-of-pocket expense by way of copays, deductibles, and co-insurance. Even when a provider is “in network” with a carrier’s primary PPO, the carrier’s HMO and affiliated plans may not offer a specific benefit or may require referral and pre-authorization. Therefore, prior to treatment, the front desk should contact the insurance carrier to confirm enrollment, coverage levels, and amounts to be collected from the patient.


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When you visit the doctor, the office staff maintains a record of the Dr.'s observations. Later, those observations are handed to the Medical Coder. The coder prepares, organizes and evaluates the documents, making sure they are complete and accurate. Coding specialists are responsible for applying a code for each diagnosis and procedure for insurance billing. This helps avoid a health insurance denial later.