Article

BUSINESS: Coding Strategy

Improve the Billing Process

Doing so can result in a better patient experience

The patient experience in our office must include the protocol we follow for communicating with our patients the cost of the visit. As we all know, this process can be slightly more complicated in optometry than in other professions, as many patients have both medical insurance and managed vision care coverage, but rarely do they understand the difference. Last month, we discussed what to do when a patient gets confused about which insurance is being used to cover their visit and, yet, we didn’t spend much time talking about the actual conversation that must be had.

Here is the consistent and straightforward protocol we follow in our practice for each patient, thereby enhancing the patient experience and avoiding negative reviews. Also, I provide an additional step.

PROTOCOL

  1. Collect all insurance information from each patient at the time the appointment is made.
  2. Verify all insurance benefits before the patient visit.
  3. Notify patients — before they show up at the office — the expected costs for the visit.
  4. Explain to patients their insurance coverage again at the time of their visits, before they see the doctor. (Most practices have one or two employees who have complete knowledge of the insurance plans for which they are providers.)
  5. Obtain all insurance-required patient signatures that establish patients' consent to charges as determined, and remind patients that they are responsible for knowing their benefits, and that they will be responsible for any insurance-allowed charges encountered, should the insurance not cover the charges, likely due to copays or deductibles.
  6. If the individual insurance plan agreement allows, collect all copays before the patient begins the visit.
  7. If, during the patient encounter, it is determined that further testing is needed, have your team notify the patient of the tests needed and the patient responsibility for the testing. Then, confirm that the patient consents to treatment and charges.

ADDITIONAL STEP

Put it in writing. Insurance can be complicated for the patient to understand, and it is easier for everyone in the practice, including the patient, if a pre-populated form is used that delineates all the information outlined above. Fill in the blanks on the form with the exact amounts for each patient, have the patient sign the form, which will include any insurance-required statements, and keep a copy of this form as part of the patient record.

Additionally, post a sign that clearly states the practice’s refund policy, for example, no refund. It should also include that payment is to be made when the service is rendered.

OVERCOME OBSTACLES

Marvin Kraushar says, in his book “Risk Prevention in Ophthalmology,” “The establishment and continued nurturing of the physician-patient relationship can overcome almost any problem that arises. The optimal means by which to accomplish this is to establish a feeling of collaboration with the patient through shared decision making.” Explaining insurance benefits ahead of time, giving patients the opportunity to decide what they can afford and why they should choose us will set us apart from others and help to set the stage for an exceptional patient experience. OM