Front-end administrative staff play one of the most important roles in the patient financial experience. You are often the first person a patient speaks to about their insurance, and your ability to explain key terms—especially deductibles—can prevent confusion, reduce billing complaints, and build patient trust from the very beginning.

But deductibles can be confusing even for seasoned staff, and explaining them in a clear, calm, and patient-friendly way requires practice. This guide breaks it down into simple language and helpful scripting you can use in real interactions.

Medigap, also known as Medicare Supplement Insurance, plays a crucial role in the patient billing and reimbursement process. For healthcare administrative staff, understanding how these plans work ensures accurate communication with patients, cleaner claims, and fewer billing delays. Unlike Medicare Advantage plans, Medigap policies do not replace Medicare—they simply fill the financial gaps left after Medicare Part A or Part B pays. This can include deductibles, coinsurance, and other out-of-pocket costs depending on the plan type.

In practice, Medicare always pays first. Once Medicare processes a claim and determines its allowed amount, it automatically forwards the claim to the patient’s Medigap plan (known as the crossover process). The Medigap insurer then evaluates the remaining balance and pays their portion directly to the provider. When staff understand which parts Medicare covers and how Medigap steps in afterward, they can confidently explain patient responsibility, navigate coverage questions, and ensure accurate claim routing.

A clear grasp of Medigap fundamentals empowers front-end staff to provide better service, reduce confusion, and support a smoother revenue cycle for both patients and providers.

In medical billing, reports are a key part of understanding both patient care and financial activity. Two commonly confused types—Date of Service (DOS) reports and Post Date reports—serve very different purposes. DOS reports track when care was provided, while Post Date reports track when charges, payments, or adjustments were entered. Knowing the difference ensures accurate analysis, cleaner reconciliations, and better decision-making for both providers and billing staff.

When it comes to family health insurance, understanding out-of-pocket maximums can get tricky. Does it matter if the individual or family maximum is met first? Absolutely. The order can impact both what patients pay and what providers should collect. Once either maximum is reached, no additional copays, coinsurance, or deductible amounts should be charged for that member—or for the entire family if the family maximum is met. This guide explains how the two limits work together and why it’s important for both patients and billing staff to keep track.

New Physical Therapy Prior Auth Requirements to start April 1, 2024

Fidelis Care QHPs Rebranding for 2024

New UHC ID Cards coming 04/01/2023

In March 2023, AIM Specialty Health®* will transition to Carelon Medical Benefits Management Inc. This transition is a name change only, and there will be no process changes. The new name will not impact the way AIM works with health plans and providers. In March, any operational assets that mention AIM Specialty Health (such as determination letters) will adopt the new Carelon Medical Benefits Management Inc. name.

Tips and tricks directly from NGSMedicare on how to appropriately document medical records.

Complex health insurance plans simplified.