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COLLECTING DEDUCTIBLES

 
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COLLECTING DEDUCTIBLES - January 2, 2006 11:06:00 AM   
KIDPT23


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From: Illinois
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This is our first year in private practice and with the new year and deductibles starting over, is there any input on whether to collect the deductibles from the patients or wait til we receive the EOB's. Any input would be great. Thanks!
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Re: COLLECTING DEDUCTIBLES - January 2, 2006 4:20:00 PM   
SJBird55

 

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I collect copays after each visit for patients that have copays.

I don't collect deductibles up front on visits because I have no idea how the insurance companies do the deductibles and deductibles are based on the statements the the insurance company has received. Determining deductibles would necessitate understanding the insurance company's process of claims (which I don't understand in the least).

I'm having enough issues right now with collecting co-pays. I'm collecting and BCBS is paying 100%. In other words BCBS provides me a written fax that the patient has a co-pay amount, but then when I get the check and the EOB from BCBS, BCBS is paying in full and NOT recognizing that the patient should have a figure in the "member may owe" column of their EOB. It's on my "to do" list to figure out how to basically pay them back their overpayment. With just the problems I'm having with co-pays, I don't want the extra hassle of figuring out deductibles.

(in reply to KIDPT23)
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Re: COLLECTING DEDUCTIBLES - January 2, 2006 5:58:00 PM   
tc

 

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The office I used to work for started collecting a set fee, 110$ at each visit after the new year to be used towards the deductible. Once it had been met they would collect the usual co-pay.

(in reply to KIDPT23)
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Re: COLLECTING DEDUCTIBLES - January 3, 2006 4:39:00 PM   
hmgross

 

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TC was that on everybody? Not all plans have a deductible. SJ, I ran into some of that confusion with BCBS. Some plans apply a copay to the initial eval only, others to each visit. I try to have all patients call their customer service number and ask specifically how their plan works. For some reason that seems to be better than dealing with the provider service people--go figure!

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Holly Gross PT

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Re: COLLECTING DEDUCTIBLES - January 3, 2006 8:01:00 PM   
tc

 

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holly- yes, only plans that for the previous year did have a deductible and the plan hadn't changed. fortunately it was the billing staff working with the $$ end, not me, so i don't know the particulars.

(in reply to KIDPT23)
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Re: COLLECTING DEDUCTIBLES - January 4, 2006 5:40:00 AM   
SJBird55

 

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Holly... what's the point of even phoning BCBS to learn of benefits and co-pays/deductibles if they can't even communicate the information correctly? My office manager can call some Caren line or something and get the info faxed to us - it never states no copay on evals or any specific details... I don't have WEB-denis yet - have you used that and does WEB-denis provide more accurate information? if you are finding more accurate information from patients phoning their customer service number, I wonder what information customer service is looking at that is different than Caren?

(in reply to KIDPT23)
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Re: COLLECTING DEDUCTIBLES - January 4, 2006 9:08:00 AM   
KIDPT23


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I am just inquiring on for example: a patient has a $2000 deductible and they have been coming to see us beginning in December. Do we start collecting on that deductible now in January?

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Re: COLLECTING DEDUCTIBLES - January 4, 2006 10:29:00 AM   
SJBird55

 

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I don't know what to tell you, Kid. My son was in the ER at the end of last year. We received a $1,500 bill from the hospital. We have a $2,000 deductible and we hadn't paid anything toward our deductible. BCBSM paid all but $25 toward that bill. Maybe there is a clause in our policy that it is only $25/ER visit? I was expecting to have to pay the whole bill that would be reduced to "reasonable and customary" because of our deductible, but I was in error in that thinking.

What's the worst that will happen if you collect? You will need to be diligent in reading the EOBs and making sure that the third party payer is expecting the patient to pay the deductible. IF the patient overpays because the insurance company did what happened to me up above, well, the issue is easily rectified and you cut a check back to the patient, right? I guess it just depends on your view and how you want to handle it - collect the money up front knowing that you'll have to carefully watch the EOB and make sure there weren't any overpayments (and then have to explain to the patient what happened) OR put the money into whatever accounting system, wait until the third party payer pays, assess what was paid and what needs to be paid and why and then bill the patient. I'd guess it is a personal preference and a business policy of how you'd like to do it.

(in reply to KIDPT23)
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Re: COLLECTING DEDUCTIBLES - January 5, 2006 10:38:00 PM   
hmgross

 

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SJ--I think that the reason it works better for us to have the patient call their customer service # is because of all the different plans, copays and deductibles. It also puts some of the responsibility onto the patient. After all they are told that they are ultimately responsible for knowing what their particular plan is all about. I do know we have run into trouble when a patient is covered by 2 Blue Cross plans when one of them is Federal.
We really try to keep patient refunds to a minimum--it messes up the stats and trying to figure out how much MNCare tax to pay each quarter.
Just like anything else, you have to figure out how much time you want your staff to chase after 20 bucks, or just wait to see how the first EOB pans out.

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Holly Gross PT

(in reply to KIDPT23)
Post #: 9
Re: COLLECTING DEDUCTIBLES - January 6, 2006 6:25:00 AM   
SJBird55

 

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Holly, I spent a couple of hours on the phone with BCBS Michigan. The lady I spoke with was quite helpful. I'm waiting on getting Web-Denis. I believe having access to that will eliminate some of the issues I had.

A patient contacting the insurance company is good because of their responsibility, but relying on them for obtaining appropriate information may have problems. (And from my perspective, it just becomes a verbal kind of thing, whereas I prefer things in writing.) I'm beginning to understand more about that company's products, but wow, I get quite confused with the various packages and what's in network and what's out of network. Heck, I've got a sheet of paper with BCBSM outlined for me to understand what is what with just the main options BCBSM has.

I don't mind writing a check to refund a patient if there was an error. My goal is to not participate in a few years so I'd rather have patients in the community getting a taste of paying something out of pocket right up front. I'm just working on changing a mindset.

(in reply to KIDPT23)
Post #: 10
Re: COLLECTING DEDUCTIBLES - January 7, 2006 11:32:00 AM   
hmgross

 

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SJ, if you don't mind, let me know how that goes for you and I can talk to my office manager.
Are you a PPS member? I get those newsletters and there was something recently from the PT (Phil something starts with a T) who advised against going to a cash practice--I know there have been others on the forum who encourage it, although I could never imagine it working here. I am still open to the idea of collecting up front, maybe down the road. I have only been in business a little over a year and just have too much on my plate to even think straight sometimes!

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Holly Gross PT

(in reply to KIDPT23)
Post #: 11
Re: COLLECTING DEDUCTIBLES - January 7, 2006 12:14:00 PM   
SJBird55

 

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It'll take me 2-3 weeks to get Web-Denis and my office manager left a message with our field rep to come to our office to educate us on using web-denis after we get it. AND, supposedly, via web-denis, the ICD-9 code you want to use can be assessed as payable or not payable AND the CPT codes that are payable for that ICD-9 code. Sounds like it could be quite helpful. Also, web-Denis has all the eligibility and benefit information for each subscriber. AND you can view the status of your claims via web-denis. I am also maybe assuming that when a physician refers a patient, I'd be able to assess that account with maybe the ICD-9 the physician used and maybe create consistency in billing between the physician and myself.

I am not a PPS member. Correct me if I am wrong, but for the cost of being a member they seemed to be more heavily weighted toward beginning a PT practice. I decided against paying the higher membership fees for their section because it didn't appear that what they could do for me would be too helpful.

This fall I just joined the health policy and administration section because from what they had, it seemed that their section might be more valuable in staying on top of the ever changing rules and regulations. I could be wrong. I'm also a member of the geriatric and the orthopaedic sections.

In regard to the cash practice deal. Frankly, I'm not enjoying the third party payer bullcrap. I just opened 6 months ago and yes, I'm getting a handle on some of their crap, but you know, I envision a whole lot more fun just not participating, having patients pay up front, billing the service out for them (and adjusting my cost to reflect the cost of doing that for them), letting them collect their own money and worry about yacking at BCBSM. From what I have been seeing in this short time, BCBSM responds pretty darn quick to every claim. Guesstimating, within 2 weeks. That's pretty darn good, really. So technically, the patients will pay me and they'll get some response from BCBSM within a couple of weeks.

It is a mind set though. Dentists collect up front... quite a few surgeons collect up front... why not physical therapists? If someone can't afford paying all up front, well, we can always set up a payment plan - credit card companies do that, why can't we? Can you tell that I really don't want to deal with insurance companies?

Granted though... Medicare and BCBSM are my biggest payers - maybe if I had the web-denis I might not be have as great of a desire to be non-participating in nature. My beef isn't with the payments, but more with ICD-9 denials and the required documentation. If we didn't participate, we could go back to documenting as we wish, eliminate a bunch of crap and focus more on the legal reasons for documentation and consistency of treatment sessions. I know I could be a whole lot more efficient. Technically, the CPT codes wouldn't have to be specifically followed either - so that eliminates a bunch of crap. Heck, I'd love to charge sessions by the time I spend - like a lawyer does. It sure would be a whole lot easier.

(in reply to KIDPT23)
Post #: 12
Re: COLLECTING DEDUCTIBLES - January 7, 2006 4:51:00 PM   
katieptatc

 

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SJ - I totally aggree with you about your "Beef" with the ICD9 codes and the denials. Currently My company is droping United Health Care because of that reason. They changed their policy this year and are now dictating how we can treat patients. On the intial eval - we can not touch the patient beyond what is necessary for the eval. You can not treat on the first visit, not suppose to (according to UHC) instruct in a HEP. Then you have to submit a 5(or more) pages to the insurance company - some of which has nothing to do with your evaluation, and wait 72 hours for them to get back to you and tell you how many visits you can see this patient - all for the whopping price of $29.00 for the evaluation. What's happening to our health care system.? It seems that we are being pushed to move towards a cash busniess......

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Katie MSPT, ATC

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Post #: 13
Re: COLLECTING DEDUCTIBLES - January 7, 2006 5:56:00 PM   
SJBird55

 

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In a nutshell, Katie, the third party payers don't want to pay any more than they have to.... the less they pay, the more profit they make.

(in reply to KIDPT23)
Post #: 14
Re: COLLECTING DEDUCTIBLES - January 8, 2006 3:26:00 PM   
mgcali

 

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Katie - Is the issue with UHC across the nation or just where you are? I was thinking of contracting with them, but now......

I'm just starting my practice and I'm wondering if I would be better off not contracting with anyone? I know of a chiro in the area who is getting off all provider lists. She compared with a colleague of hers and found she would be better off not being a provider.

Any thoughts?

(in reply to KIDPT23)
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Re: COLLECTING DEDUCTIBLES - January 8, 2006 6:06:00 PM   
katieptatc

 

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I am not sure about the UCH problems being nation wide - I will check into it and get back to you. i know that my company has decided across the board to stop taking them - and I work for a nation wide company. As far as other contracts - I have mixed feelings - sometimes it's great and some times it not so great. Contractiing with Worker's comp and auto carriers can be good thing - depending on the rules and regulations of CA. Talk to other therapist in CA and see what they think. Good Luck.

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Katie MSPT, ATC

(in reply to KIDPT23)
Post #: 16
Re: COLLECTING DEDUCTIBLES - January 9, 2006 2:36:00 PM   
katieptatc

 

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The problem with UHC is nationwide with all the paperwork. But there are a few group plans that are exempted from the paper work. Most of the groups on the list are national or large companies.

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Katie MSPT, ATC

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Post #: 17
Re: COLLECTING DEDUCTIBLES - January 12, 2006 10:52:00 AM   
mgcali

 

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Thanks for the update. I think I'm only going to contract with Medicare and Blue Shield. Because of PTPN, I cannot contract with most carriers here (CA) anyway. Between them and the POPTS, it sure makes it difficult for independently owned clinics unless you're already well established and have contracts.

(in reply to KIDPT23)
Post #: 18
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