In-Office Payment Policy

The payment policy for your medical office should explicitly state that payments are due at the time of service. It should be posted in the office, listed on all billing forms and communicated to patients before their appointment. But having a payment policy is only the first step. Enforcing the policy is what is most important. It can be difficult because you don't want to be in the situation of refusing care for someone who needs it. Many patients will have insurance, but some procedures might not be completely covered by the insurance provider. Train your front office staff on the payment policy and how to communicate this policy to patients in a respectful and assertive manner.

Timeliness

It is your goal to collect all money due from patients at the time the service is due. But sometimes you don't know how much is due until after an insurance claim is processed. The key to collecting residual patient payments is communicating with patients as soon as possible about the balance on their account. This can be increasingly important if a patient has an upcoming appointment because you will need to collect the balance prior to additional charges being accumulated. In addition, if there is an error in processing from the insurance company and an appeal needs to be filed, the patient must act quickly to respond within the required time. Assisting them in that process starts with your timely communication.

Finding Solutions

Many circumstances can arise that affect a patient's ability to pay. While you need to ensure that necessary money is collected, you don't want to tarnish the relationship with the patient. Offer solutions such as payment arrangements in order for patients to pay off their balances. Unfortunately, some patients will not honor payment arrangements. Your payment arrangement, therefore, must be accompanied by consequences and clear, enforceable terms. For example, you can require that patients make an initial payment to start the payment arrangement and if payments are not made on schedule the patient cannot be seen. Patients' personal situations vary so you should be willing to be flexible and work with patients that want to meet their obligation but perhaps don't have the resources at the moment.

• Write your practice's by payment policy so it is understood and communicated accurately for staff and patients.
• Invoices should clearly show the amount due and when payment is expected. The faster you mail invoices, the sooner you'll be paid.
• Contact late payers every 10 to14 days to remind them of your payment terms.
• Have "address service requested" printed on your outgoing envelopes. The new address information will be provided by the post office when a patient moves without providing you a forwarding address.
• For more difficult collections situations, train your staff to be firm but courteous. You want to maintain a good relationship with your patient even when you expect to be paid in a timely manner.
• Some accounts will forever remain uncollected; learn to identify them early so you don't waste time and money pursing them.

Billing Surgical Trays In An Office Setting

A surgical tray is a sealed set of reusable or disposable instruments that are opened for use in a surgical procedure.  The codes associated with the instruments are 99070 and A4550. If you try to bill separately for the surgical tray, it will likely be denied because commercial carriers consider their use to be inclusive to the evaluation and management fee.  If your practice uses many surgical trays, the best way to be reimbursed is to have the insurance carriers factor their cost into the RVU's or contractual allowances for your practice. Addressing the cost on the contract side will save you denials on the billing side.  

Medicare will allow infrequent surgical tray billings for certain procedures. Breast Biopsy (19101), Cyst Excision (19120) and Lesions separately identified by a radiological marker. (19126) are reimbursable using HCPCS A4550. However, such procedures are outside of an office setting.