Medical Billing Services | Estimating Patient Out-Of-Pocket Responsibility

Medical Billing Services

According to some sources patients are currently the third-largest payee category in the US following managed medical billing services as well as Medicaid. This means that now isn’t the right time to let those due payments go unnoticed! One of the most effective ways to collect those due amounts. Is to avoid surprises on the part of the patient. By informing them when they are making appointments. What their responsibilities will be following the time their insurance providers have paid.

Medical Billing Services

Practitioners are usually unwilling to collect estimates of patient liability at the time of service. Due to confusion as to the legality of being able to collect it. As a majority of patients are covered under high-deductible health plans. A lot of payers are becoming more flexible. When it comes to accepting coinsurance and deductibles to be paid at the moment of treatment. The amount of the payment made by the patient needs to be listed on the form of the claim. Before it is sent for payment to the provider. Payers will also require that any payment that is overpaid by the patient be immediately returned.

Doctor offices are able to give an estimate of the cost upfront to patients. Can help reduce the cost of an unexpected bill. Which could cause issues for the patient and ultimately, for the practice. Doctors have a long history of developing relations with their clients. However, the shock of a bill can end this relationship in a matter of minutes. The reason is that no one enjoys such a surprise. Some patients are unable to cover an unexpected bill.

Payment Collection Process

If you’re considering enforcement of the timing of the payment collection process. In your overall revenue cycle plan highly recommended you should review your payer agreements. You might also consult an attorney in healthcare to get clarity about state laws. Whether payment can be made to patients prior to claim adjudication.

This is dependent on how proficient your office is with regard to monitoring the accounts of your patients. It is also important to determine the extent to which the practice management system is able. To support the process of collecting patient funds. There’s also the administrative burden of dealing with the issue of overpayments. If the patient is not far from meeting the deductible amount. It’s probable that you’ll eventually have to make the refund. One instance where this could happen, regardless of your best efforts in knowing what they could have to pay. Is if the claim of another company is processed prior to the claim being processed. In this scenario, the deductible could not be due.

Must Be Aware of Your Patients

It’s also important to note that you must be aware that your patients’ FSA (flexible credit card). It is also known as HSA (healthcare expenditure account) and is linked in with insurance. We should have an active credit card. The ability to charge your patients immediately. After the services have been rendered is an excellent way to be paid on time. Additionally, you can be authorized to charge an amount in advance following the adjudication.

For those who already have the FSA or HSA connected to their medical insurance plan, it is possible to think about taking an on-file credit card method instead of taking the estimated amount. This can help you avoid the need to issue any refunds if the estimate isn’t accurate. Also, if a different provider’s claim comes in before yours it could affect the remaining deductible for the patient. There are reports that show practices are only able to receive 50% of the liability. After the patient leaves their offices, to increase your collection rate. You could consider taking a percentage of the estimated total at the moment of service.

Medical Billing Services Reimbursements

Many practices have been successful in measuring patient responsibility for a long time. By using an Excel spreadsheet that lists the most frequently employed CPT codes. The costs for reimbursement to their most common payers. Together with your current method of determining eligibility. This will allow you to get an approximate estimate of the responsibility of the patient to be for their visit. Then, you can engage them regarding their payment choices.

The process of estimating a patient’s liability is only one part of the process of collecting patient information. It is essential for your policy on financials to be clearly stated and current. It should be clear the requirements you have for paying at the point of service. The expectations should be established up in advance prior to when the services are provided to prevent confusion. It is essential that your employees are familiar with these policies and properly trained to follow them.


To enhance the effectiveness of the collection process for patients. The process should be improved along with the overall medical billing function. Medcare Medical Billing Services (MSO) offers billing services that include estimating the responsibility of the patient module, as well.