To avoid unnecessary delays in collecting the patient responsibility, it is a great idea for your staff to look for a pattern on how the given insurance company reimbursement policy and medical necessity policy apply to which CPT codes.
For example, according to GHI medical billing policy- CPT code 94200 is part of Diagnostic Testing and therefore a $20 copay applies to this code.
Letting the patient know what her/his financial responsibility for the visit is going to be, BEFORE the office visit will reduce confusion and help your office to reduce the number of uncollected revenue.
****Please note that if you are billing with code 94200 or 94060 the copay of $20 will be applied to that code instead.
Recently, I had a patient that contacted me, to inform me that her Employee Benefit Card was frozen since June. She was so distraught that she was not able to go to the doctor appointments because she was told we overcharged her for a visit.
What?! One thing that I value the most is honesty. “Fraud”- this word that does not sit well with me. I cannot admit or deny that I have seen any medical billing fraud, but it is something that I do not kid about!
Of course, I calmed her down and explained her that there is a perfectly good explanation why we charged her that specific amount for the visit instead of her usual copay. I assured her that I will get to the bottom of this and find out what is going on, and would contact her once I finish my research.
Anyway, after doing some research, I found out that we charged her for 2 DOS’s (dates of service), since she did not pay for her last visit. She used her card on that specific dos to pay for two.
However, what she nor I were aware of is that she cannot charge more than her copay per each visit.
Luckily, I was able to help this patient by sending an explanation along with the EOB, from her insurance, to the Employee Benefit Card Services. She was able to lift her suspension from the card and use it again.
The moral of this story: as a rule of thumb, use your Benny Card to pay only your copay and no more than that amount. Otherwise, you will be in the same situation as this patient and would have to go through the same ordeal.
As for Provider office front staff: make sure to charge only the copay for the given visit. Hint: if you have more than 2 people in the front desk it is extremely helpful to make a list of the patients that do have the Benny card, this way everybody in the office is on the same page!