Collection and Insurance in California, Research Paper Example

Introduction

In the new technology age, healthcare information is moving at the speed of light. The healthcare industry in California is relying on some traditional ways of verifying deductible information, however, the healthcare industry has begun to relay on electronic verification. There are several ways to check for patient’s deductible information in the state of California. If the patient has commercial insurance or Medicare/Medicaid, they can verify online or with a phone call. California Medicaid has a specific location to verify California Medicaid. This website will give you specific information concerning the patient’s deductible information.

California has the same traditional ways of check for deductible information on patients, however, California does have some different resources that will help with finding deductible information. California has some of the most complex healthcare rules onhealthcare coverage, eligibility, co-payments and deductibles. There is an organization called California Health BenefitsAdvisors (CAHBA) that can assist with understanding benefits and deductible information. CAHBA is a very well-known California health insurance clearinghouse that allows people find healthcare information and advice concerning the rules and regulations of the Affordable Care Act and Covered California. The healthcare policy holders are using any resources available that helps them understand their individual benefits and deductible information (California Health Benefits Advisors (CAHBA), 2013, pg.1). The states are being proactive in educating patients about deductible and benefit information. California has many more services that represent the patient during any discrepancy or disagreement about payments, benefits, deductible amounts and coverage.

Verifying Deductible Information

In the office and clinic setting the staff have several ways for verifying insurance deductible. The first way is calling the 800 number on the back of the patient’s insurance card. The second method is to contact the patient’s eligibility department depending on carrier. For example, Aetna has a dedicated number to verify eligibility/deducible information. The third way to verify deductible information in California is using a clearinghouse like Emedon that can verify the deductible information electronically. The fourth way, the doctor’s office can check deducible information for a patient in the doctor’s office is using the carrier’s online eligibility verification. At least 95% of payers have an online tool that members and providers can look up patient deductible information.

Collecting Patient Co-pays

Most clinics and physicians’ offices lose money at the start of the year because they do not have a system in place to ensure deductible information is correct and staff usually are not accustomed to asking for deduction or co-pays.  It’s hard asking people for money. I have to be careful about what I say and how I say it, to come across the right way. The best way to go about medical billing collection on these balances is to avoid being pushy or rude(MB-Guide, 2014, pg1.)It’s important for the physician office to develop a script for everyone to use when patients arrived for the doctor’s visit. The staff for medical offices are not collection agents, it’s difficult for them to ask for money because they have been condition to help not asking for money. Offer a script to your front-end practice staff to achieve consistent messaging when requesting payments at the time of service. This can help your practice staff become more successful when talking to patients about their financial obligations at the time of service.(American Medical Association, 2013, pg.1).

January is the month that most of the healthcare carriers recalculate annual deductibles for their members. However, there is conflicting information because the old rates from last year and the new rates may not have been updated in the carrier’s eligibility system.  The practice of starting the deductible balances again at the start of the year, indicates a big increase in patient responsibility for many practices. The best time to collect these deductible or co-pay balances is when the patient arrives for the appointment or when the patient is checking out.

The best method is to request for the payment before the patient visits the physician. It has been proven that patient are less likely to pay in full once they leave the clinic, hospital or physician’s office.  The balances are much more difficult to collect after the patient has left the office. The best way to keep the patient from being upset is to notify them before they come to the visit about their deductible. This gives the patient to become angry at the insurance company and not the doctor’s office. Secondly, the patient is not surprised about the deductible information. Thirdly, many times the patient may not have a big deductible but the system was mistaken. The physician office needs to adopt some inner office practices to ensure they collect the patient’s share of the payment and keep the patient from being upset.  There is a website called MD Everywhere(2013) that does an excellent job about sharing some tips for clinics and physicians when trying to improve their collection activities:

• The medical office that employees informed the patient of the deductible before the schedule appointment.
• The patient will received automated reminder phone calls about the deductible payment.
• The best tool for patients to keep them from getting upset is reminding them on a phone hold message that all deductibles will be collected at time of service
• Teach staff about not collecting deductible amounts from patient with Medicaid or Medicare because many of them have supplemental insurance or balances paid by both. This will prevent refunds by the physician office.
• Each patient should be given a flyer during the office visit offering to pay the deductible online before coming to the office
• Creating a display in the front office flashing that patients deductibles must be paid for the office visit
• Always recertify patients insurance on January 1, of each year. This is when the patient’s deductibles amounts are changed.
• Ensure the insurance verification process is accurate because the patient’s well visit or immunization do not require deductible.
• The patients deductible information should be verified each time the patient visit the office because they amounts could be meet if the patient is seeing multiple doctors each month. Check the deductible amount before the patient comes the visit and check it again when the patient arrives for the office visit.

Most patients do not understand when they have to pay a co-insurance, co-pay or deductible. The clinic and physician office should have a designated insurance specialist to explain the patient coverage. In order to make sure the patient does not get upset, the patient should be contacted before the office visit about any deductibles. Many patients do not like surprises when they come to an office visit. Sometimes, they do not bring enough money for deductibles. The phone allows the patient to reschedule until they have the deductible payment.The change in healthcare in California has brought about the State of California Office of Patient Advocates which is equivalent to Obamas healthcare.gov. This is a website that assist any patient in the state of California about benefits and deductible information.  The Covered California is the healthcare reform gateway for health insurance. This website is a clearinghouse for patients to pick and choose healthcare coverage and compare benefit deductible information.Covered California is a new health insurance marketplace where you can apply for health plans. You may also qualify for tax credits to help pay your insurance premiums (Covered California, 2013, pg.1).his overed California is the healthcare reform gateway for health insruance.efits and deduction informaiton.fit dedicticle inf

References

American Medical Association. (2013). Practice management center. Retrieved from http://www.ama-assn.org/resources/doc/psa/poc-scripts.pdf

California Health Benefits Advisors (CAHBA). (2013). California health benefits advisors. Retrieved from http://www.cahba.com/aboutus.htm

Covered California. (2013) Covered California. Retrieved from http://www.opa.ca.gov/Pages/CoveredCalifornia.aspx

MB-Guide. (2014).Medical billing collectionadvice for getting patient balances. Retrieve from http://www.mb-guide.org/medical-billing-collection.html#ixzz2t4ZMc4bb

Medi-Cal. (2013). What is Medi-Cal? Retrieved from https://www.medi-cal.ca.gov/Eligibility/Login.asp

MD Everywhere. (2013). Surviving Deductibles in 2014. Retrieved from http://www.mdeverywhere.com/surviving-deductibles-in-2014/