AboutAdelaide Rose Expertise Any questions related to Revenue Cycle Management and homecare/facilities operation processes.
Experience I have been in the healthcare industry since 1992. My experience comes from working in a multi-physician practice setting, homecare, ambulatory care and consulting engagements with a "Big 5" firm.
Question When a patient comes in for a visit, is it illegal to collect the coinsurance or deductable for that date of service. We have person in our office that says you can not collect money from a medicare patient, the only way you can collection on from them is if it is from a previous date of service.
Answer Terri,
Assuming that you are an in-network provider, you may not collect any of the patient's responsibility until the claim is processed. The exception, of course being co-pays. Co-pays stay the same regardless of claim processing and therefore you can collect.
However, co-insurance or deductibles may vary depending on when the claim is processed. For example, you may see the patient today and when you called the insurance company they told you that the patient had a $100 deductible that has not yet been met. Coincidentally, the patient saw another doctor whose claim will be processed tomorrow and the entire claim will be applied to the deductible. By the time your claim is processed, the deductible will be met and payment will be made to you. Had you asked the patient for $100 up front, now you would have had a double payment.
You may ask for a deposit, if you have reason to believe that in case the patient will be responsible for any charges, they may not pay you. Again, this should be based on prior experience with the patient. I emphasize that this should be only if you had issues in the past.
