Sample Billing and Collections Policies and Procedures Manual
Section 5 - Billing Procedures
D. Payment Due From Patient

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Subject: Payment Due from Patient When No Cash is Received

Policy:

1. All patients not completely covered by insurance must make payment on their account.
2. All co-pays should be collected before the visit. Deductibles and balance amounts should be collected at discharge.
3. In those cases where no payment is made, a pre-addressed envelope and form showing amount due should be given to the patient to encourage sending in the payment.

Procedure:

Estimate the amount to self-pay by checking the back of the patient’s insurance card for help and using these basic assumptions:

• Self/no insurance - 100% of the sliding scale amount at time of service
• Commercial Insurance - 100% self-pay and bill the insurance company for the patient.
• Worker's Compensation - 0% self-pay
• Medicare - 20% of the allowable (plus deductible if not met)
• Medicaid - 0% self-pay
• HMO - Co-pay or flat amount per visit. For HMO patients, verify that the office is a participating provider. If not, the patient is self-pay.

Note: The office must expect payment at time of visit for all patients unless the office has signed specific contracts.

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