As deductibles are reaching sky high, recently we have been receiving increased amount of questions related of how to handle deductibles better.

Aside from political decisions, as Affordable Care Act (ACA), which we have close to no input. It is important to understand "the other side of the coin" before we discuss possible solutions:

  • Patients are signing up for insurance plans and are not aware of their share of responsibility;
  • Increased patient’s frustration which, in some cases, does not understand how does deductible work;
  • Deductible amount extremely high, making the patient almost as self-pay instead of insured.

As a consequence, doctors have been challenged collecting the deductibles from patients. Making matters worse, there is much misinformation out there. Starting with insurance carriers which have been contacting doctors, upon patient’s complaint, stating they are not allowed to collect deductible upfront.

Who told them that? Where is this information coming from?

As of today, there is no effective regulation stating that the doctor can or can’t collect deductible upfront. As per CMS IOM 100-04, Chapter 1, Section 30.1.1, deductible and coinsurance may be requested and accept at the time of or after the provision of the service to which it applies. Although, if the patient overpays, the refund must be issued within 30 days.

The steps listed below will help you to mitigate the loss caused by deductibles, reduce the cost of patient's collection, and increase revenue:

  1. Verify patient’s benefits before seen the patient (benefits ≠ eligibility);
  2. If a patient’s deductible was not met, collect a deposit towards the deductible at the time of visit;
  3. Educate all your patients about your office’s policy, including the collection of a deposit towards the deductible at the time of visit. Also, inform that overpaid amount, will be refunded within 30 days from receiving the insurance’s EOB;
  4. Issue (at least) monthly patient’s refund for overpaid claims.

As we all desire to be efficient and profitable, we must work under the assumption that there will always be opportunities to improve, we just need to look closer, and be ready to review our policies and procedure as needed.