LESIA CRAWFORD
FINANCIAL AGREEMENTS
A NECESSITY, NOT AN OPTION
M
edical billing is different
from Dental billing. How
often have we all heard this
statement? It’s true. However,
that doesn’t mean that sound
practice and reasonable
protocols should just get
tossed out le fenêtre. Far
too often, dental practices
forego financial agreements
when it comes to sleep apnea
treatment. This doesn’t make
sense. You wouldn’t do this in
any other part of your practice
and you shouldn’t. Patients
are left with a big question
mark regarding their financial
responsibility and you’re
opening yourself up to trouble.
Practices should have a firm
protocol established to ensure
patients understand their
financial responsibility and you
are collecting the estimated
amount due or billing the
patient after insurance pays.
This should not be a surprise or
a burden to your patient.
If you are in-network with
the Medical plans, you should
know your allowed amounts
and calculate the patient’s
financial responsibility based
on their remaining deductible
and co-insurance. Most in-
network contracts do not allow
the provider to collect the
deductible and co-insurance
until after the claim has been
processed and paid. Most
contracts will only allow the
provider to collect the co-pay
amount. As a DME provider,
this falls under “specialty” and
co-pays typically range from
$40 to $150. After the claim has
paid, you bill the patient their
remaining balance.
If you are out-of-network with
the plan, you will not have to
abide by their fees and will
often be asked to negotiate or
discount your fee. If you do
agree to discount your fees,
you then have a contract for
the single claim for the patient.
This will not make your office
“in-network” or obligate
further discounts on future
claims.
A clear financial agreement
will ensure both the office
and the patient understand
what is expected for payment.
Deductibles and co-insurance
should always be discussed
and if you are not in-network
with the plan you can ask
for payment upfront based
on the eligibility check. DS3
has a great tool to conduct
an eligibility check and get
instantaneous results. Keep in
mind if your fee does not have
any room for a discount send
the negotiation back as “no
negotiations” and you are free
to balance bill the patient.
DS3 offers several financial
agreements in the software
under the “Forms” tab. If you
would like a copy of GoGo
Billing’s agreements please
email me and I will be happy to
send you a copy.
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Lesia Crawford
CEO of GoGoBilling
Lesia Crawford is the CEO
and co-founder of GoGo
Billing, a firm specializing in
medical billing for dentists
with an emphasis on Dental
Sleep Medicine for the past
8 years. She possesses
over twenty years of dental
experience as an assistant,
office manager, consultant.