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Accepting HSA and FSA payments

Credit Card Machine  - AhmadArdity / Pixabay

As a cash accepting practice (and even insurance), sometimes patients will want to use their HSA and/or FSA cards. Can they do this? YES! You simply just swipe their card with your card processor as you would with any other credit card. It is that simple! Be aware though, that often times these companies will want documentation to prove that it was for a covered health related cost, so this article is predominately about that.

First off, once you receive the payment, the money is yours. If the claim is denied by the HSA/FSA company, the patient will be responsible for the cost, not you as the clinic owner. So, there are no worries there. Once you are paid, you are paid!

How often do the HSA/FSA companies request documentation from your patients? Not very often from my experience. I would estimate maybe 5-10% of the time, if that… Regardless, you need to be prepared for this inconvenience as it will happen.

The HSA/FSA companies will want to see 3 things:

  1. The clinical documentation showing the medical necessity of the visit.
  2. The ICD-10 codes associated with their visit.
  3. An itemized invoice of charges.

These are basically the same things you would include with a superbill if a patient wanted to submit their charges to an insurance company for reimbursement, so keep this is mind. Luckily though, the HSA/FSA companies do not seem to be as stingy with approving the transaction.

One aspect of this process you need to be aware of is that the documentation needs to show medical necessity. These companies are not going to pick apart your documentation like an insurance company would, rather they just want to see “proof” that the transaction was legitimately for a health-related purchase. So, it is important that you ensure the documentation you provide to your patient shows an obvious medical need.

Examples of this would include:

  1. IV infusion therapy: patient needing to improve hydration status or boost immunity.
  2. HRT: treating symptoms of low motivation, low libido, fatigue, etc.
  3. Weight loss: helping the patient achieve a healthy weight.

It is not difficult to show medical necessity even with a niche clinical service, but be aware that this needs to be included with what is submitted.

The other 2 things you that need to be present are the ICD-10 codes and the itemized invoice. The ICD-10 codes could be problematic for a cash practice as you are not required to use these in your documentation. Keep this in mind when providing the patient the documentation they need. A quick Google search can provide you a few ICD10 codes to use if your EMR does not populate these for you.

In terms of the itemized invoice, this should be easily available in your payment processor or within your EMR.

The big take home message here is this: ensure you provide your patient all the documentation they need so they can be reimbursed. This will not only be beneficial to your patients from a financial aspect, but it will make your life as a clinic owner easier because if you do not provide everything the HSA/FSA company wants, the patient will be coming back requesting MORE documentation that they are requesting. This is BUSY work for you…

I would also advise adding that you accept these forms of payment on your website. You never know, it might just convert one person visiting your site into a paying patient!

Now, go forth and start swiping those HSA and FSA cards to your hearts content!

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