Put it in Writing to Ensure Copayment Receipt

Maintaining a successful practitioner-patient relationship requires
cooperation between both parties. Practitioners bear the majority of the burden
in providing the best possible service for patients. Those patients, on the
other hand, are responsible for directing the practitioners, and for paying for
that service.

That unified front is more difficult in today’s uncertain economic
climate, however. Many business owners have felt the strain as patients become
less willing than ever before to pay for devices and services.

As the president of O&P Billing Solutions, a medical billing and
collections agency, and owner of Restorative Health Services Inc., a patient
care practice, Aaron Sorensen, CPO, LPO, has firsthand experience working with
both patients and practitioners to collect reimbursements for services.

First, Sorensen recommended that O&P practitioners verify
patients’ benefits with their third party payers as soon as they are
referred to the practice. Several payers have begun outsourcing certain aspects
of patient benefits — like ancillary services and orthotic and prosthetic
care — in a tiered process to third party administrators. This process may
significantly change the fee schedule.

“That has been more rampant this year than any time before this
— at least that’s what we’ve experienced,” he said.

In Sorensen’s O&P practice, he provides patients with a written
explanation of the verified benefits. The explanation states that the office
contacted their third party payers on a certain day, and found the specific
amounts left to be paid toward their deductibles, as well as the percentages of
the charges the patients are responsible for after the devices and services
have been provided.

Additionally, Sorensen ensures that the patients understand that this
information serves only as an estimate, and is subject to change based on any
number of factors.

“Patients seem to understand it better and appreciate that
we’re [letting] them know that kind of information on the front end,”
he said.

Even when preparing patients for their liability ahead of time, however,
business owners may still run into difficulties collecting the payments. Since
the current economy has proved uncertain for so many, Sorensen told O&P
Business News
that he finds that more patients are unable or unwilling to
pay their deductibles and copays.

The copay for O&P devices and services comprises more than a typical
doctor’s office copay, he noted. A visit to the primary care physician may
carry a $10 or $20 charge — or no charge, in some cases, for a wellness
check-up or other preventive services. Not so for an O&P appointment where
the patient receives a prosthetic device costing tens-of-thousands of dollars.

With some patients, Sorensen said he may be able to discuss less
expensive prosthetic or orthotic options that still meet their medical needs.
In other cases, he can honor patients’ requests to repair, adjust or
modify their current devices to last for another several months or even a year.

“I think either people are scared, and they’re keeping the
money they have, or they truly don’t have the money because they’re
out of work or they’re helping support a family member who is out of
work,” he said.

Changing insurance plans also affect people all over the country. To
save money, many companies have switched to different plans or different third
party payers offering lower fees for the company in exchange for a greater
financial burden for their employees, meaning higher deductibles and higher

To help his patients meet their copays and deductibles, he offers
various payment plans depending on the patients’ needs. His office staff
works out payment plans and draws up documents for the patients to sign.

With potential health care reform changes coming in the next few years,
business owners must make smart decisions to offer the best care for their
patients, while maintaining their own businesses. Sorensen said he sees
verifying benefits up front as a smart business decision for collecting

Instituting this process can help businesses collect those copays and
prepare both parties for high payments ahead of time. — by Stephanie Z.


Sorensen’s perspective on ensuring copayment receipt is helpful at
this time for our industry. Many O&P practices are owned by clinicians. As
clinicians, we have a general business concern in our practices. During a
recent decline in our economy, this article highlights an important part of
those concerns, of which, most notably, is money collection. Verifying
benefits, collection of payments and establishing clear communication with your
patients up front is essential for a good overall relationship with your

A wise humanitarian friend once told me, “No money, no

— Mo Kenney, CPO, FAAOP
Owner, Kenney

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