To Hold, or Not to Hold – That is the Question. Delaying Claim Filing to Avoid Deductibles.

By Joe Laden, Vice President Client Management

Effective collection of patient insurance deductibles is an increasing problem for anesthesiologists.  Anesthesia claims are usually ready to file a few days after the date of service and can typically reach insurers before claims by the hospital and the surgeon. If the anesthesia claim hits the payer first and the patient’s deductible has not been met, all or part of the anesthesiologist’s claim will not be paid by the insurer and will be due from the patient. Collecting directly from the patient is costly, time-consuming, and, in many instances, results in bad debt.

One possible solution to the problem is to delay sending anesthesia claims to payers, hoping that during the delay, the hospital, surgeon, and other providers would have submitted their claim. The result would be that the other providers would have consumed the patient’s deductible by the time the anesthesia claim reaches the payer. To do this, the anesthesia practice would hold billing all anesthesia claims for several weeks.

However, this simplistic approach has several flaws. First, many payers have no deductible or a minimal deductible, so these claims should not be delayed. This includes Medicare, Medicaid, workers compensation, and auto insurance payer types.   Delaying claim filing to payers that may have large deductibles can have drawbacks.  First, the patient may have met the deductible during healthcare events before the current anesthetic. For example, a patient undergoing a heart operation probably has already exhausted his or her deductible with tests and procedures before surgery. Delaying claims for patients with a deductible that has already been met, or a patient who has no deductible is a waste of time, unnecessarily delaying cash flow to the practice.  Because most deductible years start on January 1, the strategy of postponing claim filing is less effective towards the end of the year because it is likely that healthcare encounters of all kinds have exhausted the patient’s deductible, reducing the effectiveness of the filing delay. If the practice decides to delay filing to specific payers that are subject to large deductibles, it may be wise to reduce or eliminate the delay during the calendar year.

It is not useful to delay filing in the case of patients who have funds saved in HSA accounts and who will pay the deductible amount after the claim is adjudicated. Unfortunately, the practice cannot know in advance if a patient will pay promptly from their HSA or other funds. Some patients may have limited funds and can partially pay their deductible, so claims filed first will be paid by the patient, but claims filed later will not be paid.

Will holding claims help your practice?   One way to find out, your practice may need to experiment, delaying claims to specific payers and analyze the results.

Joe Laden is the Vice President of Client Management, AdvantEdge Healthcare Solutions, and a nationally recognized anesthesia expert and speaker, working with anesthesia practices across the country to improve their billing and coding operations.

Stop by The AdvantEdge Healthcare Solutions booth #125 at Practice Management 2020 in Las Vegas January 17-18, 2020 and meet with Brice Voithofer, Vice President Anesthesia, and Kevin McDonald, Senior Vice President Sales and Marketing about your Anesthesia group practice billing and coding needs.