Money In Your Pocket: Balance Bill

by  Codapedia
November 19th, 2015

By: Donna Weinstock (Dec/04/2014) 

Do you routinely balance bill your patients? Do you send the statement as soon as you hear from insurance or do you wait until the end of the month?

Balance billing your patients is essential for several reasons. First, it increases your revenue. It may not seem like a lot of money, but the balances of $10 or $20 add up. For surgical balances, the revenue can increase more quickly. Revenue is essential to the practice’s viability. The sooner you bill a patient, the sooner you can collect the coinsurance.

Practices should send the statements as soon as they receive the explanation of benefits from insurance. It may seem as if it is a lot of extra work, but the increase in prompt revenue will more than offset the time it takes to send the statement. Waiting until the end of the month puts off the potential for quick turnaround of payments.

Assuming you send statements at the end of the month, it can be several weeks until a patient is billed if an insurance carrier remits payment at the beginning of the month. That could be money in your pocket that isn’t there.

Additionally, by sending a statement directly after receiving the EOB, the patient most likely will be expecting the statement. He/she will probably have received their EOB at about the same time as the practice. Hopefully, the patient will pay more promptly. Weeks or months later, the visit may be out of his mind and he may be less likely to pay promptly.

Equally important is that most, if not all of your contractual agreements with the insurance carriers require you to balance bill patients. Insurance carriers assume that the patient is paying his portion of the claim. When this does not happen, both the practice and the patient are in violation.


When an insurance company realizes that the patient was not balanced billed, they may ultimately deny future claims and/or require refunds from the practice. The practice could be penalized for not balance billing.

If a patient does not pay his coinsurance, it is then up to the practice to determine how to proceed.  A practice may choose to continue pursuing collections, may send the patient to collection, or potentially write the balance off as a bad debt. It is always best to have a policy and procedure for collecting balances from patients.

Following the policy will help the practice stay compliant. This should help to eliminate bad debts as your patients will realize that your practice requires payment. Payments by patients will significantly increase your revenue. The sooner the patient pays, the sooner your bank account will grow.

Additionally, it is important that practices send their statements monthly. This also increases the revenue. When a practice sends statements sporadically, they lose revenue. Those patients that are making monthly payments on their account may not be regular when their statement is not regular.

Bottom line, it is essential that the practice bill coinsurance in a timely fashion. This allows the practice to increase revenue. Increasing revenue is important to the financial viability of the practice.      

References:

Money In Your Pocket: Balance Bill. (2015, November 19). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/money-in-your-pocket-balance-bill-27947.html

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