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Tip: Verify patient financial responsibility

Ambulatory Surgery Reimbursement Update, September 23, 2008

Insurance verification procedures are extremely important to your ASC’s proper reimbursement for your cases. In every case verify the patient has the insurance coverage that appears on the insurance card information given to the ASC. Always perform insurance verifications before performing the procedure, to discover what amount the patient owes. Having this conversation with the patient is a must. You can obtain insurance verification information for some payers online, which can save time.

We strongly recommend that ASCs discuss benefits information with patients prior to the surgery and thoroughly inform the patient of the amount the facility expects him or her to pay. Make it clear that the amount owed is due prior to the surgery. If that is a problem, set up a payment plan with the patient and have him or her sign a document promising to pay the portion owed. Make sure the patient understands that the fees you are explaining to him or her are for the ASC owing amounts only, and that he or she will receive separate bills from other providers (such as the surgeon, the anesthesiologist, lab, etc.). Give the patient’s financial responsibility information to the patient in writing.

Collect co-pay and deductible amounts owing from the patient prior to performing the procedure. It is best practice not to wait to bill patients until after the surgery—if your ASC routinely does this you are leaving money on the table! The likelihood that you will be able to collect all of the owing fees after the surgery decreases the longer you wait. It is important to let patients know they have an obligation and they are expected to pay the portion owing in a timely manner.

Note the following:

• Accept credit cards as a payment option for patients—this is very important.  If you don’t accept credit cards, call your bank and set it up so that you can.
• Remind patients to bring their checkbooks with them at the time of the procedure, because you are going to expect them to pay.
• Have the ability to accept cash payments.
• Work out realistic payment plans on the front end with those patients who cannot pay the entire amount owed at the time of service.
• Consider setting up CareCredit or another similar financing service so an outside company can finance patient’s fees and your facility can get your money.

If you are making complicated financial arrangements with a patient or if a patient or responsible party becomes disruptive during financial discussions in a common area (e.g., your lobby), take the parties involved out of the common area to avoid causing concern for other patients and their families.

This tip is brought to you by Ellis Medical Consulting, Inc.

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