There are now stacks of balance bills for patients who are unable to pay. Many of these patients have been seeing the same doctor for years (primary care or a specialist for a chronic condition). Some patients doctor hop to spread the debt around.

Some patients come in with expired insurance and if eligibility is not checked, the patient gets a free ride at least for a while. Some patients might give a check that will be returned for insufficient funds while others may think twice about using a credit card should your office accept that form of payment. Some people will simply ignore the bill because they are overwhelmed with all the other bills, so what is one more?

Now is the time to set policies for patients who have no insurance. Certainly checking eligibility makes sense even in better times. A partial payment can be advised while making the appointment and if you take credit cards, ask the patient if you can expect him/her to use it. Set up a payment plan at the end of the visit and keep one employee or your billing service informed of the arrangement. Make notes in the computer as to what was discussed. Consider a courtesy on a case by case basis especially if you can obtain payment in full at the visit. This saves time, creates loyalty, and a good feeling among the staff who collected the money.

You know your patients best and when they hopefully obtain insurance again, do you want them going to another doctor who might have been more flexible during this rough patch? Is a collection agency really the answer that may take a portion that is larger than the courtesy you may give? Most people want to pay their bills; be clear on what you are billing them for and communicate your policy with your patients

I felt compelled to respond to the article with the following letter:

“I enjoyed the article by David M, Jaspan, D.O. That I have written over and over in my head as well as lectured to offices for which I consult and bill. As a billing service and managed care consultant, (self-employed) I have often found myself between the insurance company and the doctor. While it is true that some plans are more doctor friendly than others, it is also true that the insurance companies are not always the worst enemy we have. I continuously stress to my clients and their staffs that they are the first ones touching the superbill, charge slip, routing slip, encounter form. The cleaner it is, the more advanced it is in using modifiers and trying some add-on codes that are clearly described in a CPT book/computer program the better the chance to see an improved cash flow. I also try to stress that correct is better than quick, having seen my share of superbills prepared that are sloppy and incomplete in the doctor’s haste to just get them our the door to me to do the billing from my off-site location”

After 14 years in this business on my own where I rely on a salary based on the doctor’s receipts I have no choice but to employ strict policies for myself as well as the offices with whom I have enjoyed long term relationships. And when you call insurance companies as much as I do, it helps to know what I am talking about regarding clean claims.

Fran Glucroft
Medical Office Manager
Fairfield, CT

To be clear, it can be very frustrating to deal with the bureaucracy of Medicare, (translates as the government) but from a billing standpoint, this is not the case in my experience.

I find customer service very knowledgeable, the remits are easy to read with even denial codes explaining what is wrong with a claim. The phone numbers to contact either a person or an automatic information system are very clear. The website is cumbersome, but someone will walk you through it while they remain on the line with you. There are forms for everything if you cannot accomplish something by phone and while it is true the every “I” has to be dotted and “T” has to be crossed, the work I put in yields results. I cannot always say that about the other plans. Sometimes I wonder where the other plan’s rules come from – like a 90 day timely filing limit with NO room for appeal, explanation, or human error. Medicare’s timely filing deadline is one full year! And even after the year, there is another level of payment available with only 10% taken off the top; that seems fair to me in assigning mutual responsibility instead of simply throwing out the claim and forcing me to write an appeal usually in vain.

I know that a major argument against Medicare is the fee schedule, but if you examine your others plans closely, you will find there are non-Medicaid plans that pay the same or LESS than Medicare. And some of those plans make you jump through hoops to get certain procedures authorized, most of which do not require authorizations by Medicare. And there are also many codes that are bundled with non-Medicare plans but the proper use of modifiers can get you paid for each code with Medicare. Even when Medicare sends you a request for information, they have a standard system in place to process your response.

Finally, Medicare replacement plans have become popular of late mostly because it eliminates people from having to carry a secondary insurance. I am very opposed to them not only for the reasons that I like Medicare, but because these plans have wreaked havoc with beneficiaries. The replacement plans are not properly explained to retirees. So not only are doctors having more plans for which they have to obtain authorizations, I have been the bearer of bad news to patients when I have had to tell them that they must have signed some paper that transferred their health insurance to a replacement plan when that was not their intention.

The bottom line is that if you work within the process of Medicare you can spend more time caring for your patients and less time arguing with their insurance.

Fran Glucroft
Medical Office Manager
Fairfield, CT