How to Deal with Patient Responsibility?

1. How to Deal with Patient Responsibility? Medical Billers and Coders

2. As patient responsibility balances climb, practice owners are seeking effective methods of collecting outstanding patient balances and ways to collect more payment at the time of service. Estimating patient responsibility prior to claims adjudication is a tricky business. However, practices can absolutely figure out a payment estimation plan that suits their needs and support the critical task of improving patient collections.

3. There are a few basic doubts about patient responsibility like: • Am I allowed to collect at the time of service when the claim has not been adjudicated? • How to estimate the exact patient responsibility amount? • Whether you should collect the full estimated amount?

4. 1. Am I allowed to collect at the time of service when the claim has not been adjudicated? Practices are having a lot of confusion over whether they’re really allowed to collect the estimated patient responsibility at the time of service. This depends largely on your payer contracts as well as state laws. As more patients are covered by High Deductible Health Plans (HDHP), many payers have become more flexible in allowing the collection of coinsurance and deductibles at the time of service based on the estimated patient responsibility. However, this often requires that you include the amount paid by the patient on your claim when it is submitted. They also require that you process any refunds for overpayments as soon as the overpayment is identified.

5. 2. How to estimate the exact patient responsibility amount? Many practices have been creating their own patient responsibility estimates for years, using a spreadsheet and a sample of their most common CPT codes and the associated allowed amounts for their common payers. When you combine this type of tool with your current process of eligibility verification, you can create an estimate for what the patient’s responsibility will be for the visit, allowing you to have a conversation with them about their payment options. It’s important that your financial policy is up to date to reflect whatever requirements you have regarding payment at the time of service. It is also important that your staff is familiar with those policies and is trained to carry them out.

6. 2. How to estimate the exact patient responsibility amount? Many practices have been creating their own patient responsibility estimates for years, using a spreadsheet and a sample of their most common CPT codes and the associated allowed amounts for their common payers. When you combine this type of tool with your current process of eligibility verification, you can create an estimate for what the patient’s responsibility will be for the visit, allowing you to have a conversation with them about their payment options. It’s important that your financial policy is up to date to reflect whatever requirements you have regarding payment at the time of service. It is also important that your staff is familiar with those policies and is trained to carry them out.

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