by John Yodonise

December 23, 2018

Getting Paid in 2019 Graphic

With the new year approaching, it is time to review your office policies and procedures to make sure your practice is getting paid for the services you perform. Every year bring new challenges and this year will be no exception.


Affordable Care Act Changes

The Affordable Care Act (ACA) is under attack and has recently been ruled invalid by a Federal Judge. Appeals have been filed and the fight is just beginning, this will be another case for the Supreme Court to decide. CMS is forging ahead with registrations for 2019 while they wait for a final ruling. Even if the ACA is upheld, the penalty for not having insurance has been dropped and an estimated 3 to 13 million people will be dropping their health insurance. You should look into creating an office policy to regularly check patient's benefits to make sure you are not treating uninsured patients.


Short-Term Health Insurance Plans

Another trend expected to grow in 2019 is Short Term Health Insurance, also known as gap health insurance. Generally speaking, the short-term health plans are cheaper than regular health plans but they offer shorter coverage terms (usually 3 to 6 months, maximum 1 year limitation), have higher deductibles, and do not cover certain services. A strong office policy to regularly check patient's benefits will be needed to make sure their insurance is valid and covers therapy services. We are seeing a rise in claim rejections for "Services Provided After Termination" that keeps you from getting paid for the treatment you provided.


Association Health Insurance Plans

Another trend gaining traction in 2019 is Association Health Insurance plans. They are a favorite of small business and self-employed workers. Like short-term health insurance plans, they often have higher deductibles and service exclusions so it is important to verify their benefits to make sure therapy services are covered.


Verification of Benefits

If you have not picked up on one of the most important themes for 2019 yet, verification of benefits has become critical to the financial success of therapy practices. Creating an office policy to check benefits regularly will prevent the patient's from running up a large balance that you will have a difficult time collecting later. Some of the key items to look out for include:

  1. Uninsured Patients - with patients dropping insurance or having short-term health insurance plans, you must identify uninsured patients. In 2018 we began seeing an increase in a claim denied for "Expenses incurred prior to coverage" and "Expenses incurred after coverage terminated". Be sure you are verifying all insurances and not just the primary insurance plan.
  2. Increased Copay and Deductible Amounts - with the new year comes new copay and deductible amounts for the patients. Many times the only fees you will collect will be the patient's deductible so it is important to collect some of the deductible amount upfront at the time of service (if allowed by your contract with the insurance company) to keep the patient from being surprised with a large amount due two or three weeks into treatment. Collecting the correct Copay amount at the time of service prevents a patient's from receiving statements or your practice from writing refund checks to the patients. The statistics for 2018 show that approximately 60% of the copays not collected at the front desk at time of service are never collected. Remember, your contract with the insurance companies REQUIRES you to collect the copay or make efforts to collect the copy unless you have a hardship form on file.
  3. Authorizations of Service - Authorizations are quickly becoming the number one issue for many therapy practices. Be sure to ask if authorizations are needed upfront or if they are needed after a certain number of visits. Use your EHR system to track the authorizations, several insurance companies are lenient and will allow you to retroactively get authorizations for visits but an increasing number of insurance companies are denying visits that were not authorized and you will never get paid for the services you provided.
  4. Patient Education - many patients have no idea what their insurance plans cover or what coverage changes are in effect for the new year. It is a good policy to have a Verification of Benefits form and a Financial Policy form signed by the patient after you review it with them.

Accelerated Payments

If you have an insurance company paying you with a credit card, be sure to Opt Out of their accelerated payment plan. You lose between 2% and 3% in service fees from the credit card charges. You do not have to accept these credit card payments and they must tell you how to opt-out and get a check issued for your services.


Minimize your patient Accounts Receivable

There are many steps you can take to minimize your patient Accounts Receivable.

  1. Review and update your financial policy form
  2. Review and update your verification of benefits form.
  3. Check your state's debt collections laws especially the statute of limitations to avoid legal issues. For Medicare patients, you cannot charge collection fees or interest, only the amount Medicare shows as allowed on your EOB.
  4. Recent changes in credit score computations have devalued medical bills so many debt consolidation counselors are advising clients to pay their medical bills last because they have the least impact on their credit scores.
  5. Be sure to accept credit and debit cards from patients so they can pay their balances easily.
  6. Investigate patient portals so patients can pay their balances online or Credit Card on file programs. With all the data breaches in the news, patients are becoming reluctant paying by credit card over the phone. The easier you make it for a patient to pay, the easier it is to collect their balances due.
  7. Investigate text messaging to remind patients they have a balance due and electronic statements. Many practices are already using similar services to remind patients of their appointments, it may be time to expand the service to remind them they owe a balance as well. The number one reason patients use for not paying their balance is they did not receive the statement via mail and did not know they had a balance. Make sure your financial policy has a section authorizing you to use text messages or electronic statements if you choose to use these methods to help your collection efforts (double check HIPAA regulations).

These are just some ideas on how to keep getting paid for your services in 2019. Do you have any favorite ideas that has helped your practice? Let us know and we can add them to our list.

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