Flo Murray managed a successful practice in Southern California before she opened a chiropractic insurance billing business. She is a consultant in insurance billing, staffing, and paperwork management.
When done consistently, financial consultations with new patients can form the basis for a very satisfying practice. Done properly and timed correctly, a financial consultation gives the doctor and patient the opportunity to establish a real doctor/patient relationship without worrying about money. The financial consultation let's the patient know the monetary obligation. Once the patient has agreed to paying those fees, the doctor can now relax and treat the patient and delegate their staff to collect the fees.
It usually is appropriate to have two financial consults with your new patient. In my experience, here is the best time to do these consults. Let's discuss the general insurance patient. On the first visit, the patient fills out the new patient forms, and the front desk asks for insurance cards or forms. (When booking the new patient by phone, your staff needs to ask the patient to bring these items to their first appointment). If the appointment is set for later in the day, and staff will not be able to verify insurance when the patient is in the office, you might allow the staff member to ask for the insurance information over the phone, depending upon your feelings on this subject.
I recommend your office doesn't ask the patient, "What type of insurance do you have?" over the phone. I recommend you welcome all new patients to the practice whether they have insurance or not. If, however, the patient asks whether the insurance will cover their visits or not, then surely get the information from them and tell the patient you will have it checked out. Then ask if the patient wants to schedule the appointment regardless, or find out if they are covered first.
While the patient fills out forms in the office on this first visit, and since their benefits have not been pre verified, the staff member says to the patient, "Do you mind if I call your insurance company to verify what your chiropractic benefits are on this plan?" The patient will most often respond by thanking you for doing this service. The staff member calls and verifies the insurance benefits, using a comprehensive form which reminds the staff member to ask all the necessary questions.
A minimal verification form has a place for the annual deductible amount; amount met already; percentage or flat rate paid for each visit; per visit limitations; annual limits and any used; and where to send the bill.
There is nothing wrong with asking many questions on your verification call. It avoids having to call the insurance company back later. You questions may deal with CPT codes (perhaps massage codes you frequently use), or if supplements or supports are covered, etc. If you are in a particular managed care plan or member of another "group" which will affect the payout rates for this patient, it would be prudent to discuss this with the insurance company. Always make a note of the person's name who quoted the benefits and the date and time they gave you the information.
Assuming that this first financial verification was being done by the staff, either before the patient went back for his consult or while the doctor was doing their initial consultation with the patient, it frequently works quite well for the doctor to end a consultation with the patient by telling him they would like to do an exam and some x rays (the diagnostic work up) before recommending whether or not the doctor can treat the patient. The doctor then tells the patient they are going to step into another room to treat another patient and have a staff member come in and explain the costs of the diagnostic work up.
The staff member comes in to see the patient with the insurance verification in hand. If they have not been able to get through to the insurance company, explain nicely to the patient, "Mr. Jones, the doctor wants to do an examination and take two views of your neck. The cost for this is $125. I was unable to get through to your insurance company today, so we will collect this amount from you today. Do you wish to pay by check, cash or credit card?"
If staff did get through to the insurance company and the news is favorable, such as the deductible has been met, then staff would say to the patient: "Mr. Jones, the doctor wants us to do an examination and take two views of your neck. The cost for this is $125. Your insurance benefits should pick up 80 percent of the cost, so we will ask you for only $25, which is the 20 percent. If for some reason your insurance denies payment for these items, we will send you a bill for the balance."
The patient then agrees, or a discussion ensues whereby the patient explains that they can't pay their portion. Now is the time to discuss the $125 and how and when it can be paid. If the staff member has been given the authority to work out these matters for you and does so, the patient is then led into the exam room and readied for the doctor.
After the diagnostic work is done, most often you would have the patient come back into the consultation room where the x rays are ready to be explained to the patient. After making your recommendation for care (for example, three times per week for three weeks) and getting the patient to commit to this care, the doctor then excuses themself to treat a patient and asks a staff member to come in and explain the costs for these nine "treatment" visits. (This then becomes financial consultation #2).
The staff member needs to know which therapy will be done in addition to the doctor's manipulation on each visit. They can explain to the patient what the cost for each visit is expected to
be, let's say $85 per visit. With the patient's insurance expected to pay 80 percent, the cost to the patient will be a $17 co pay per visit. If the patient agrees to this and the staff member and patient agree to either a daily or weekly collection schedule, then the patient is sent to a treatment room for the first treatment, or scheduled.
The above example assumed that the patient came in for care because they were in some pain or having some problem, that they could afford the care plan that the doctor laid out, that they didn't think chiropractors should work for nothing but were happy to pay for service. There are of course a lot of scenarios which might have to be worked out in some cases, but the basic format of explaining what a patient's obligation is before the diagnostic or treatment work is done worked extremely well in the practice I managed for six years.
On occasion, a new patient decided not to begin any diagnostic work or treatment work because of the cost. But the doctor was not in the position of "abandoning" the patient later because the patient couldn't pay, or angry because they ended up giving free treatment. It was handled properly up front by both doctor and staff. If the staff is not trained for financial consults properly, then the doctor can do them.
There are many places to invest in "financial consultation" workbooks which have both scripts and verification forms. Most management consulting firms have them. When you attend seminars, take the time to look over the materials for sale in the lobby. You can probably order them through catalogs of chiropractic supplies, or you can design your own forms and scripts that should be used consistently in your practice. Have them put into one binder as "master copies" and make photocopies for use as needed. If you have frequent staff turnover, then you will still have the basis for new staff members to learn this part of their job.
Personal injury patients will have a different type of financial consult done. A personal injury financial questionnaire is prudent in that your staff member asks questions relevant to the case, which will ultimately determine who is going to pay the bill for medical care, i.e., the patient's own insurance, the third party who admits fault, or the patient themselves? Who is going to distribute the money at the end, the patient or an attorney? Does the patient understand that they are ultimately responsible for their bill if all else falls apart?
Do you have all of the personal injury verification forms on file for use: Medpay verification, attorney verification, third-party liability verification, group health verification? Did you have the patient sign all forms that might be needed in this case: attorney lien, patient lien, power of attorney to endorse checks, assignment of benefits? When patients don't want to sign forms that are not directly needed at this time, such as the attorney lien when they have no attorney, I always tell them that office policy means they have to sign all the forms unless they want to pay for each visit daily. I explain that many patients have changed the way their case is to be handled and that we need the forms in the file so we don't forget to get them signed later. Most patients agree to sign them all so that they can get the doctor to handle the case on a lien basis.
Medicare financial consultations are also important. It is prudent to know what the allowed amount is for your 98940 manipulation code in your county, and also the 98941 and 98942 codes if you will be adjusting more than two areas of the patient's body. Their 20 percent co-pay is based on the allowed amount set by Medicare. You can also charge your patient for exams, x rays, therapy, supplements and supports if their secondary carrier does not cover "items that are not covered by Medicare." You just must disclose these costs to the patient up front. That is also a rule established by Medicare. Verifying the patient's secondary carrier benefits will form the basis of most financial consultations with Medicare patients.
Please be aware that some patients that still carry their Medicare cards have actually signed away their benefits to an HMO. If you are not in the HMO and don't do your homework with the patient, you could be stuck having treated a patient who is not covered by Medicare. Can you still collect from the patient? I think in most cases you can, but many of these patients will elect not to seek treatment at your office if they know up front they will have to pay themselves. It is better not to have "grumbling paying patients" out in the community who feel they were ripped off. They frequently do not understand their own benefits. They expect your office to understand their benefits better than they do!
Most of you are used to doing financial consults with your cash patients. Because you know they do not have insurance, they then ask what the treatment will cost, and you are happy to tell them. It is important to extend the same courtesy to all of your group, Medicare and PI patients so they understand that if insurance doesn't cover it, they will receive a bill from you. It is much more costly to treat insurance patients for free than to treat cash patients for free. All of the labor that goes into verifications, billing, forms and phone calls costs money.
Time spent wisely in doing proper verifications, financial consults and remembering to collect at the front desk for co pays and deductibles will go a long way in making your practice a happy place to visit for all of the new patients to come. People will not stand at the front desk grumbling because they were with a bill for $195 that they didn't expect. When they refer you to their friends and family, they will refer people to you who can afford to pay.
I'm sure you are all probably aware that the laws changed recently which now legally allow you to charge your cash patients a different price than insurance patients. This California legislation states: " ... a health care provider may discount his or her fees to uninsured or underinsured patients, without the discounted fee being deemed to be the health care provider's 'usual, customary and reasonable fee.'" It was signed into law on April 14th and is known as SB 1255. It is now much easier to do a financial consult with your patient knowing that you can actually quote two different prices during the financial consult if you don't know whether their insurance has chiropractic benefits or not.
For example: "Mrs. Jones, I could not get through to your insurance today. The doctor wants you to have five treatments. If we discover that you have no chiropractic benefits on your plan, and you pay for each treatment every time you have it, then we will only charge you the cash discount price of $40 each visit. However, if your insurance does cover the service, and you want us to do your insurance billing for you, we will charge our regular prices and your co pay portion for each visit will be $12.50." After all the years of worrying about someone hearing us do this, or being afraid to say it, now it is legal.
Good luck with your financial consults. Making it easy for the patient to understand sometimes means giving them a handout after the staff is done with the financial consultation, which puts in writing what you have agreed to. It should be a "master form" with some blanks on it so that all the staff needs to do is fill in the blanks and hand it to the patients. Some doctors actually have their patients sign this sheet, thereby having them acknowledge that the fees and their portion was explained fully to them. If the patient really is in pain, they can have their spouse look over the sheet that night and feel more comfortable knowing what the care is costing them.
Flo Murray
Doctor's Services of Buena Park
Buena Park, California
Tel: (714) 826-3949
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