Obamacare and Deductibles – Get the Money Up Front!

Obamacare is bringing up a bunch of questions for chiropractors. Questions like, how will Obamacare and the new exchange plans affect my Chiropractic practice? What will I need to change in my practice to stay successful?

The biggest changes in the 2014 exchange plans so far when compared to the average individual/employer plans is that patient responsibility is a larger part of the plan.

There are many plans available for patients ranging from Bronze to Platinum. Bronze plans provide a lower monthly premium but coverage doesn’t kick in until a very LARGE deductible has been met. Depending on the plan the patient has they will owe a co-insurance percentage on the allowed amount after the deductible has been met.

This simply means that there will be high out of pocket costs for patients. Even platinum plans still have large deductibles (some in the thousands of dollars) and co-insurance responsibilities in many cases. Here is what I recommend:

  • Understand the advantages and disadvantages being an in-network and out-of-network provider. All of these new plans are going to have large out-of-pocket responsibilities for patients after the deductible has been met when seeing an out-of-network provider. If you have a practice that is, or your goal is to become a practice that is, highly efficient, treats only covered services (and bills cash at the time of service for non-covered services), and you are hoping to increase your patient volume, then it may be best for you to join all the networks and market patients from those groups.
  • Know the efficiency of your office! Discover how your office can improve. Do you use Electronic Health Records? Is your service Cloud Based? Does your EHr come packaged with your Chiropractic Billing and your Scheduler to maximize efficiency? Are the Chiropractic treatment records set up in a way that you can create fast and compliant entries? Does your staff have an internal process to follow? Is your staff turnover rate high? Could you use the assistance of a Chiropractic Billing Service Company or outsourced billing? These are questions you should be asking and answering to determine if there are gaps to fill, processes to refine, training that your staff requires. Your office is likely able to grow without making any staff investments, but make sure your processes are set in place to handle the growth without imploding.
  • Evaluate your patient collections practices. The best practice for collecting patient responsibilities is up-front payment and not payment through a patient statement. Be sure to perform a thorough insurance verification for every patient to determine Chiropractic benefits and what specific services will be covered. Calculate the cost of the patient’s care up front. Communicate with the patient what their treatment plan is through a Report of Findings. Agree on a payment plan that will allow your patient to make payments through the course of the treatment (or up front) so that they are not dealing with a large bill that they did not budget for or anticipate. If a large percentage of your patients are exchange plan patients, you can expect to receive very little to no insurance payments for their treatment. If you do not collect early and often from your patients, you will find that your clinic struggles with low collection rates and high expenses to pursue outstanding AR.
  • Be a communicator and educator about Chiropractic wellness care. Teach your patients the benefits and importance of wellness care. Inform them and help them to appreciate that despite not being a service covered by their exchange plan, chiropractic care is still important.

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About the author

Todd Crabtree

Todd Crabtree

Founder & Chief Technology Officer. Founded Clinic Doctor Inc. in 2004, to innovate the providing of insurance billing services to healthcare providers in chiropractic clinics that lacked the resources to pay for qualified billing professionals.

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