How To: Manage Client Deductibles
Many times, clients may have a deductible to meet before their insurance benefits begin paying. Claims should still be submitted to the client's insurance company, as this will keep them informed of how much the client has spent out-of-pocket and when they should begin paying on claims. TherapyNotes has a field to record the amount of the client's deductible. Click Patients > Patient Name > Billing Settings tab. When the box is checked to indicate that this client has insurance, you will see the deductible field.
You can enter the total amount of the client's deductible in this field for your reference. This field does not automatically update to reflect the remaining amount of the deductible as this is determined directly by the client's payer. Delays in processing claims, seeing other providers or specialists, healthcare costs for family members, and much more may all contribute to how quickly a deductible is met.
Quick Tip: You can always check the amount remaining for a client's deductible by contacting provider relations or using the provider's website. It is often a good idea to double check the deductible amounts at the beginning of the plan year, as they typically reset.
Since the deductible amount is paid by the client until it is met, you would need to bill the insurance your full fee, then assign the amount the client is responsible for. To manually move the responsibility to the client, please follow the steps below.
Click on the date of service.
For clients with in-network payers: Type the client responsibility amount in the "PT AMT" field. Click the green "Save Changes" button.
For clients with out-of-network payers: Patient Amount equals "Rate" minus "Coverage". If the rate is $100 and the insurance is covering $0 because the client needs to meet their deductible, put $0 in the "Coverage" box. This makes the Patient Amount owed $100. If the insurance company indicates the client is responsible for only a portion of the charged amount, enter the remaining amount in the "Coverage" box. If the rate is $100, and the client will be responsible for $76.54, enter the remainder of $23.46 in the "Coverage" box. Click the green "Save Changes" button.
Enter an insurance payment for $0 and write off any remaining insurance balance, or check the box that designates the item has been approved by insurance. This will ensure that you will not have any outstanding balance due by the insurance company, making it easier to track claims that still need to be paid.
Quick Tip: Using TherapyNotes' assisted ERA payment posting feature can make this process significantly easier. When the ERA indicates that the client is responsible for paying toward their deductible, TherapyNotes will automatically assign the correct amount to be due by the client and write off the remaining insurance balance when you post the payment.