This guide provides recommendations on how to determine the patient responsibility (co-pay, co-insurance, deductible) prior to a patient’s visit in order to maximize the experience for your practice and the patient. Your practice is ultimately responsible for collecting patient responsibility.

Determining the patient responsibility:

Access the Zaya portal to view the benefits information for your patients. You will be able to see information such as co-pay, co-insurance % and unmet deductible amounts. 

In the case of a co-pay you can quote your patient the amount displayed.

In the case of co-insurance or deductible your practice will have to quote based on the expected codes used. Use the chart below to determine charges. 

Here are some best-practice recommendations from our practices:

• Maintain a copy of the Zaya Cost Calculation chart in the front office for quick reference

• Encourage therapists to consistently bill the same amount of units per patient visit

In case of Overpayment/Underpayment:

Zaya will share final patient responsibility with your practice upon receipt of the EOB. 

Patients may have a credit balance at the end of their plan of care. How you handle this is at your practice's discretion. Some options include offering cash services or providing refunds upon discharge. 

Conversely, additional patient payment might be required based on final coding. We recommend seeking patient permission to collect the difference between the initial estimate and the final amount. You can do so by presenting a patient-responsibility form, like the template that we provide in this article, to your patient before the first visit. 

Use a patient-responsibility form to help manage the patient's expectations:

• To best manage the patient’s expectations and ensure a clear transparent communication, we recommend translating the patient responsibility information into a patient-facing form. You can use your practice's specific form or download our template attached to this article.

In summary: Simplifying Patient Responsibility Collection:

1. Patient Responsibility Form: Obtain a signed Patient Responsibility form from each patient to manage their expectation and facilitate the collection process.
   

2. Detailed Notes: Utilize the Notes section on the Patient Responsibility sheet to outline any variations in amounts across visits. This helps patients visualize upcoming costs (e.g., Visit 1: $150, Visits 2-5: $80, Visit 6+: Patient Responsibility Met). This clarifies when patient responsibility collection stops due to reaching the deductible or out-of-pocket maximum

3. If applicable, correct the over- or underpayment when Zaya confirms final patient responsibility.

4. Patient Card on File: We recommend having a patient's card on file at the start of the plan of care to streamline charging patients for each visit at the date of service.