Will you get paid for the patient you are about to see?

BACKGROUND

New York is a highly competitive market for providers. Getting paid inaccurately can sometimes mean doctors going out of business. As with several doctors, one of our clients does not participate with all insurances offered in the region. Therefore, some of her patients come from insurances that are par (short for participating) and some others from non-par (short for non-participating).

CHALLENGES

While non-par payments can be negotiated, there’s no guarantee that the physician would get paid. This puts the physician in a precarious situation where she does not know if she would get paid for the next patient she’s about to see. A lot of doctors waste time and money in trying to get paid after seeing non-par patients and eventually write those claims off. It’s a better approach to decide what’s your strategy for handling non-par claims before hand rather than after the fact.

WHAT WE DID

We developed a system for this client to categorize all patients seen on any given day into par and non-par. We also conduct real-time eligibility on patient’s insurances to guarantee payment for services that are going to be rendered. The client then decides whether to go forward with seeing a patient knowing that she would get paid by insurance or by the patient. She sometimes chooses to offer services for free but she does so knowing fully well what she’s doing instead of getting hit by a denial much later in the billing cycle.