Talk to the patient

If Ive said it once, Ive said it a bazillion times. YOU MUST TALK WITH YOUR PATIENT! This isnt just medicine. This includes finance. Talking must also be done before the visit. Like working AR, doing things on the back end doesnt work. Doing things on the front end is the best way to do things.

Think of wanting to take a trip to Walleyworld. Before you get into your car, you make sure all your luggage is packed, you have your hotel confirmed, you check your oil, water, tires, gas and you make sure that youve done what you can to make the trip go well. The worse thing to happen is while on the way, you blow a rod through the engine because you didnt check the oil and there was none or you get to the hotel and they dont have a room and they cant find any reservation.

When the patient makes an appointment, you verify their insurance benefits and when the patient comes in, you speak with them about the claims process, their out of pocket expenses, and your practice financial plan. If you dont, plan on a disaster in the making. Mr X comes to see your doctor. No one speaks with Mr X. Mr X provides ABC insurance but it terminated when he left his job and he didnt ask for COBRA coverage. You bill Mr X and now he is on the warpath on a mission to make your life and that of the doctor as miserable as possible. Mr X believes you are comitting fraud, so he goes everywhere on the internet to gather as much information as possible to use what he can find against you. Mr X accuses you of being inept and making mistakes. He doesnt have ABC, but has XYZ and blames you because YOU didnt send the claim to XYZ. He says if YOU did your job right, the claim would have been paid by XYZ. But, YOU made the mistake, so he shouldnt have to pay for it and what you did was ILLEGAL!

Now, lets say ABC was good insurance but they applied the payment to Mr X's deductible. You send a bill and now Mr X blames you for not doing your job because he says ABC should have paid this 100%, so he wont pay you a penny. THIS IS YOUR MISTAKE. Next, you get a call from ABC Insurance. They have Mr X on the line with you. The insurance rep chastizes you for billing Mr X and says you have to write off the bill and they are turning this over to their fraud department. Mr. X is now steaming and comes on the line to scream at you or worse, comes to your office and screams at your receptionist in front of all the patient in the waiting room.

Can these be prevented? Yes, speaking with your patient beforehand, going over their benefit manual and your financial plan can educate the patient so that there is no confusion. If the patient comes in for a cranialrectalectomy, and this is a procedure you do all the time, you know the code is XXXXX and the charge is $Y. You can show the patient that you verified this is a benefit they are entitled to receive, their insurance pays $X and they have $Z to fulfill of their deductible. If you elect to bill the patient, which is what you can discuss beforehand, the patient wont be so confused when a bill is received for their deductible.

Trying to talk with an angry patient after the fact and sending a claim to an invalid and unverified insurance company can cause problems. If you verified that ABC terminated, you can discuss providing valid insurance coverage and verify what is provided. You want to be smart with what you do. In my opinion, doing thing on the backend, doesnt work.

If Im a patient of yours, and I come to you to have an ingrown toenail removed, you can bet I know what codes should be charged for the visit. if you bill me for XXXX, YYYYY and ZZZZZ, and when checking out, you tell me I need to pay $125 for a tube of ointment, which can be bought locally for $5.99. plan on me using all my knowledge and experience in paying you only for XXXX and refusing your $125 cream. I dont need to use the internet to know if you are pulling something over me. One thing to remember, a pissed off patient is soon to be an ex-patient and you may be an ex-biller or an ex-provider. Smoky The Bear says you can prevent forest fires. You can prevent a patient-provider disaster. That 5-10 minutes of time before we are seen can prevent so many problems after the fact. You cant tell the patient you dont have the time, especially when you have me sitting in your waiting room for 45 minutes beyond my appointment time and I can hear you BSing behind the window.

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