Money In Your Pocket: Balance Bill

December 4th, 2014 - Donna Weinstock
Categories:   Accounts Receivable|Payments   Billing   Insurance   Reimbursement  

             

Do you routinely balance bill your patients? Do you send the statement as soon as you hear from insurance or do you wait until the end of the month?

Balance billing your patients is essential for several reasons. First, it increases your revenue. It may not seem like a lot of money, but the balances of $10 or $20 add up. For surgical balances, the revenue can increase more quickly. Revenue is essential to the practice’s viability. The sooner you bill a patient, the sooner you can collect the coinsurance.

Practices should send the statements as soon as they receive the explanation of benefits from insurance. It may seem as if it is a lot of extra work, but the increase in prompt revenue will more than offset the time it takes to send the statement. Waiting until the end of the month puts off the potential for quick turnaround of payments.

Assuming you send statements at the end of the month, it can be several weeks until a patient is billed if an insurance carrier remits payment at the beginning of the month. That could be money in your pocket that isn’t there.

Additionally, by sending a statement directly after receiving the EOB, the patient most likely will be expecting the statement. He/she will probably have received their EOB at about the same time as the practice. Hopefully, the patient will pay more promptly. Weeks or months later, the visit may be out of his mind and he may be less likely to pay promptly.

Equally important is that most, if not all of your contractual agreements with the insurance carriers require you to balance bill patients. Insurance carriers assume that the patient is paying his portion of the claim. When this does not happen, both the practice and the patient are in violation.


When an insurance company realizes that the patient was not balanced billed, they may ultimately deny future claims and/or require refunds from the practice. The practice could be penalized for not balance billing.

If a patient does not pay his coinsurance, it is then up to the practice to determine how to proceed.  A practice may choose to continue pursuing collections, may send the patient to collection, or potentially write the balance off as a bad debt. It is always best to have a policy and procedure for collecting balances from patients.

Following the policy will help the practice stay compliant. This should help to eliminate bad debts as your patients will realize that your practice requires payment. Payments by patients will significantly increase your revenue. The sooner the patient pays, the sooner your bank account will grow.

Additionally, it is important that practices send their statements monthly. This also increases the revenue. When a practice sends statements sporadically, they lose revenue. Those patients that are making monthly payments on their account may not be regular when their statement is not regular.

Bottom line, it is essential that the practice bill coinsurance in a timely fashion. This allows the practice to increase revenue. Increasing revenue is important to the financial viability of the practice.           

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association