AS WE enter 2017, there is more uncertainty and confusion than ever with respect to health insurance and patient benefits. This is a great opportunity for your practice to shine by being on top of these critical issues for your patients.

Deciphering a patients’ benefits is generally straightforward for managed vision care plans. However, medical benefits are a bit more challenging. We also have the obligation of disclosure to patients. Moreover, we should have in place a credit policy that doesn’t create an accounts receivable nightmare.

FACTOR IN DEDUCTIBLES

Headlines this fall spoke to a rise in deductibles for medical plans. The 2017 Medicare Part B deductible is $183, compared with $166 in 2016, according to CMS. Many patients with commercial medical insurance plans may also experience higher deductibles as rising premiums reduce buying power. It is important for you to know these deductible structures for the plans that you are a contracted provider for; it will affect both your office policy and your communication obligations to the patient.

DISCLOSE COST OF SERVICES

If you are providing medical services to a patient who has yet to meet his or her deductible, it is critical you inform him or her of the cost of the office visit, special ophthalmic procedure or surgical procedure and get permission to proceed before actually performing the service in question. A patient has the right to refuse your care and, as the owner of the contract, the patient has the ability to dictate how it is used. If you perform the procedures without disclosure, it creates a very uncomfortable situation and, very often, an upset patient.

DESIGN A PAYMENT POLICY

The question often comes up, do you collect in full from the patient at the time of visit or do you bill the carrier and then try to collect the balance from the patient later. Sometimes, this is spelled out in your provider contract with the carrier, but most times it is a business decision. If it were me, I would rather be in the position of writing a refund check to the patient, should something be covered, rather than trying to collect an amount later. The cost associated with collecting the balance can easily escalate and erode the profitability of the service provided.

BE AWARE OF NONCOVERAGE POLICIES

With respect to use of an ABN (Advance Beneficiary Notice of Noncoverage), a form presented when a denial of payment is expected from Medicare, realize this form is specifically designed for Medicare Part B patients. You should be very well versed on when to use it and the modifiers required for each situation, with respect to Medicare. While it can be adapted for most commercial plans, it is not appropriate for Medicare Part C (Medicare Advantage Plans) beneficiaries. Also, these carriers generally have their own waiver of liability forms and policies that you must use with their members. Follow the rules for accurate reimbursement.

REVIEW AND ADAPT

Communication policies are an essential metric of patient satisfaction and, very often, practice success. Maybe it’s time to learn about each of the policies, hit the “reset” button on your existing communications procedures and streamline them for the current healthcare environment. OM

DR. RUMPAKIS is founder, president and CEO of Practice Resource Management, Inc., a consulting, appraisal and management firm for healthcare professionals. Email him at John@PRMI.com, or visit tinyurl.com/OMcomment to comment on this article.