The basis of a strong medical office financial policy is an understanding between the medical office, the insurance company, and the patient. The medical office is responsible for verifying the patient’s coverage, verifying if a specific service is covered, and verify the co pay amount so it can be collected at the time of the visit or service. The insurance company’s responsibility depends on whether the doctor is contracted with them or not. The insurance company is responsible for the timely processing of medical claims.

The patient is responsible for paying their co pay at the time of the visit and paying any other balances within a reasonable time after billed. The medical office needs to ensure that each patient is aware of their billing policies and how they affect each patient. A patient needs to understand that the medical office will file a claim with the insurance company as a courtesy but it is ultimately the responsibility of the patient to ensure their insurance company processes and pays the claim.

A patient also needs to be aware that their co pay is expected at the time of the visit, any deductible or coinsurance is expected when billed, and that if their bill remains unpaid the medical office may choose to no longer service them. If a member of the medical office staff does not enforce the policies in place in regard to collecting patient balances it could make it more difficult to collect at a later time and may mean that the money due will need to be written-off as uncollectible which could adversely affect the profitability of the medical office.

Of course, there are some patients who do not have insurance and in that instance a patient pay agreement would need to be drawn up to protect the practice. A collection manager should be responsible for writing the procedures and ensuring that all members of the staff are trained and adhering to the policy. A collection specialist should adhere to guidelines regarding calling patients and trying to collect balances. A good collection agency should be available for the hard to collect debt.

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