Allowed to Change

January 3, 2008

It's that time of year again; Time to brace yourself for deductible and copay changes, effective January 1, 2008.

It's that time of year again; Time to brace yourself for deductible and copay changes, effective January 1, 2008. Here's a rundown:

  • Traditional Medicare Part B - The deductible will become $135 for all covered services, with the copay remaining at 20 percent of the allowable amount

A key point to remember is that the Medicare Part B monthly premium will increase as well, to $96.40 per month for a couple filing a joint return with income at or below $164,000. This is important to know - there may be families that elect to drop Part B coverage, which means no Medicare payment to physicians for covered services.

  • Medicare Advantage - Each plan may change its deductible or copay as well. For example, Humana Gold Choice will now have a $15 copay for primary-care office visits and a $30 copay for specialist visits for all Medicare-covered services.

  • All other payers - Of course, there will be deductibles and copay changes for each insurance company. Poll all your payers for these updates.

The big question to ask your patients and payers is: "What changes will occur

for you,

come the first of the year?" For patients, notate any changes in their records. For payers, create a spreadsheet that lists CPT and HCPCS codes down the left side and your payers (including Medicare) across the top. Populate the spreadsheet accordingly with the new allowances. Review this spreadsheet with your front-desk staff so that they fully understand the new amounts they need to collect from patients. Instruct them to ask patients these key questions:

  • Have you changed insurance carriers? May I see your new insurance card? (Staff: Scan card, or at least make a copy).

  • Have you met your deductible for this year?

  • Will today's payment be with cash, check, or credit card?

Provide your staff with the means to determine whether a patient has an outstanding balance - either electronically or a list given out each day. If a patient visiting the office that day does indeed owe the practice money, your front-desk staffer should add this amount to the amount due for the current visit.

Also, stay cognizant of the changes an increasing number of patients are making to high-deductible, health savings accounts. These plans are becoming more popular or are becoming mandatory by many employers. Collection of these amounts should be done after the visit to make sure you know the level of service (E&M) and diagnostic services provided to the patient for that visit. The first-of-the-year collection will be for the full amount of the allowable since most high-deductible plans reach maximum at $2,500 or more.

Making the collection at the time of visit is the most efficient method for collections. Awareness and training of the reception staff will make the start of 2008 collections a great one!

Owen Dahl, FACHE, CHBC, is a nationally recognized medical practice management consultant with over 24 years of experience in consulting for and managing medical practices and author of Business! Medical Practice Quality, Efficiency, Profits. He can be reached at odahl@houston.rr.com or 281 367 3364.