Identifying patient in limited benefit plans

Limited benefit plans often feature deductibles and benefit caps. Unlike deductibles, which are predictable and finite, these policies have benefit limits that can crop up at any time.

It’s critical that you identify patients who are enrolled in health plans with limited benefits and plan for how payments will be made if and when the patients reach their caps. This is especially true if the patient is undergoing a course of treatment that cannot be interrupted without raising issues of patient abandonment. Consider the following questions:

1, Can your front-office staff identify patients enrolled in limited benefit plans by their ID cards or as part of the precertification or eligibility verification process?

2. Do your staff know how to determine whether patients enrolled in limited benefit plans have other resources available to cover medical expenses if they exhaust their benefits?

3. Do you have the technology to “swipe” the patient’s ID card? Credit card?

4. Are your staff trained and authorized to set up payment plans?

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.