Over the last ten years, the cost of care has increasingly shifted to patients. This has been done through increasing co-pays, co-insurance and deductibles. Many of the ACA plans rely on patients to shoulder 40% of the cost of their care — even Medicare is now tracking at about 25% out-of-pocket cost to patients.
Gone are the days of the low co-pays, no deductibles and co-insurance. Employee deductibles increased 67 percent from 2010 to 2015, and we’re not talking about $100, they are now $1000 and up.
Out of HIX Exchange products, the Bronze Products carry a $3000 individual deductible, and cover only about 60% of the expected medical expenses. Then, there is the additional risk that the patient did not pay premiums, which you will learn about 90 days later.
And remember, eligibility and benefits, even when checked online are not guaranteed.
In other words, the financial risk is increasingly being passed on to physicians, expecting physicians to not only absorb the higher cost of administering these patient financial responsibilities, but ultimately the loss when the bill goes unpaid, all the while chasing patients for their portion of the claim.
It is reported that 50% of patient financial responsibilities become bad debts to physicians, about $45,000 for primary care physicians a year, and over $65,000 for a specialist.
The risk is all on you.
There is a technique to greatly reduce your risk. I would not say that it guarantees payment, but it is the closest thing to a possible guarantee. Start by establishing an office policy which requires a contingent credit card authorization for each patient visit. Obtain the patient’s authorization to bill their credit card for any patient responsibilities not paid at the time of service, but identified when the EOB comes in.
Continue to bill as you usually do, collect what you can identify in co-pays, deductibles, and co-insurance at the time of the visit, and bill the insurance. Then, if the insurance remittance indicates that the co-pay, co-insurance, or deductible was greater than what was estimated, or if the claim is denied, you bill the patient’s credit card, using the authorization you have on file.
If you do establish such a policy, the most important thing is to advise your patients of this requirement when they make an appointment, and when they arrive at the appointment. A letter to new patients or a notice among your registration materials to give full disclosure will do the trick. A well scripted letter puts the blame on their insurance carrier for not guaranteeing that the information they provide is accurate, and that you have to have such a policy because administrative expenses add nothing to better patient care.
This technique is becoming more widespread, and patients are used to providing their credit cards to guarantee payments, when conducting business- think hotels and car rentals.
Will some patients complain? Yes, and then you have a choice. Give a one-time exemption to existing patients if they seem surprised, but remember those that complain the most, are often the ones that are going to cause you problems when paying the bill. If they register a complaint with their insurance carrier, remind the carrier that if they would guarantee that the patient would pay their portion, or if the insurance carrier would confirm the information they provide at the time of verification of benefits and eligibility, you would not need to have such a requirement. Rest assured, you are not charging a patient for covered services. This is consistent with your payer participation contract, that makes you reconcile for collecting co-pays, co-insurance and deductibles.
Do not charge the card until after the insurance company advises you of the patient’s responsibility. Then you can drop a note in the mail, thanking the patient and showing them what their insurance paid, and how much their card was billed.
With patient responsibilities expected to pass 30% of the costs of the care you render in 2017, what is your plan to reduce your financial risk?