Doctors still mystified by what patients owe

These days, there's lots of talk about how real-time claims adjudication--or even claims estimates--will help doctors determine, on the spots, how much patients owe above and beyond their co-pay. In reality, though, few practices have such technology in place, so the co-pay is all they're able to collect when a patient comes in for a visit. And far too often, that's all that patient ever pays.

This is a particularly big issue of late, given that patients are carrying increasingly large co-pays in deductibles, rising from $1,260 in 2001 to $1,522 in 2006, according to a recent report by HHS. A separate report by management consulting firm McKinsey & Co. concluded that doctors collect only about half of what's due from patients, resulting in bad debt ranging anywhere from $14 billion to $30 billion annually.

This happens, in part, because doctors simply don't know how much to request. According to a new survey by healthcare communications network NaviNet Inc, which contacted 1,279 medical practices, medical billers and billing offices, 49 percent weren't able to estimate the amount patients owed at the time of care other than the pre-set co-pay.

Once patients walked out the door, the practices' track records were quite mixed at collecting what they were owed from patients. About 12 percent said patients paid their bills as requested, 57 percent of those responding said they got "most" of their money once the practice figured out what was owed, and 31 percent said they received part of their fee.

To learn more about this issue:
- read this American Medical News item

Related Articles:
Humana, BCBSFL offer real-time claims adjudication
MN requires insurers, providers to file electronically

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