By Revenue Cycle Specialist Susette Bader-Sherwood
This week’s billing tip is related to how CAHCs use a sliding scale when attempting to collect co-pays or deductibles from clients:
There is no specific rule from MDCH on how to handle this and it is left up to the discretion of the CAHC. It is important that your Billing or Fiduciary policy reflect your current practice. This is part of the MDCH site visit review.
You are allowed to base the sliding scale and the ability to collect co-pays on the child or the family. We have CAHCs that base it on the family and others that base it on the child. The key points on this issue are:
- The ability to collect a co-pay or outstanding balance can not present a barrier or burden to the client receiving care
- Sites that do attempt to collect a co-pay/balance will generally give it two attempts and then stop. They never turn the client over to collections.
- This co-pay process should never involve a confidential service that would put the health care provider/client relationship at risk. This is often a key issue why sites do not attempt to collect any private payment from clients.
- It is very challenging for centers to confirm private insurance deductibles and co-pays. They generally only have access to CHAMPS (which is Medicaid and may have some COB information associated with Medicaid) or Web Dennis (which only includes the BCBS products).
For more information, email Susette Bader-Sherwood or call her at (517) 908-0847 ext. 233.