owed and providing compassionate care to patients who need to
undergo surgery. Here's how our business office strikes the perfect
balance.
Know the contracts
Each member of our business office staff understands patients' insur-
ance plans better than the patients themselves. We upload the terms of
the contracts into our billing software, which we audit twice per year to
ensure the correct payment rates are generated when we input CPT
codes. We train our staff on the calculations used to determine payment
rates and patients' co-pays. When we contact patients a week before sur-
gery to inform them of their financial responsibilities, we can have an
informed discussion about the benefits. It also helps that we assign staff
certain specialties so they gain a clinical perspective.
We view ourselves as benefits coordinators. Patients want to know
how we calculated their deductibles, so we're prepared to go over the
math with them during the insurance verification phone call. We look
up the procedure's CPT code to determine our facility's contracted rate.
We'll then disclose to a patient that we submit a bill for $14,000 to the
insurer, which pays us $4,000. Of that $4,000, the patient might be
responsible for a $2,000 deductible. Their plan might cover 80% of the
remaining $2,000, so they owe an additional $400.
One of 2 things will happen. The patient will tell you that he'll bring
the deductible on the day of surgery or inform you that he can't afford
it. Patients sometimes reveal very personal details about their finan-
cial situations, so it's important for us to hear why they might not be
able to afford their surgery and empathize with their predicaments.
In-house payment plan
We offer an in-house payment plan to patients who can't afford
6 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 6