Tag Archives: insurance
Posted on 09. May, 2010 by Editor.
You’ve offered discounts, payment plans, and more,but you still haven’t received payment from a patient. You may be forced to do a write-off at this point, says Steve Verno, CMMC, CMMB, NREMT-P, a medical billing consultant and educator in Orlando, Fla. Your practice is justified in writing off a patient’s balance in the following situations:
1. The cost of collecting a balance is more than what the patient owes. For example: A patient’s balance due is $3 after all insurance payments. The administrative cost to bill and collect is at least $15 per statement. “You don’t spend $15 to collect $3,” Verno says.
Posted on 06. Feb, 2010 by .
Question: A patient came to our office for a routine exam with the same insurance card she’s had for years. We charged her the standard copay of record. Then I found out her employer changed the terms of the insurance, so the copay she paid was short by $20. What went wrong?
Answer: You might easily assume that when a patient has the same insurance company, the copay is the same as it has always been. But unless you check first, you won’t know the patient’s coverage has changed until after the fact.
Best practice …
Posted on 29. Oct, 2009 by .
Not enough hours in the day? Are you always looking for ways to save time? Many medical offices report that sending out new patient packets in advance of the patient’s visit greatly reduces the number of incidents at patient check-in and saves time.
“Normally, it would take patients 15-plus minutes to complete the forms,” says Stephanie Mayer, front desk receptionist for a pediatrician in Queens, NY. “Also, there is the distraction of other patient activity in the waiting room, which could keep patients from concentrating on forms they are supposed to complete.”
Put forms online
If you are not already doing so, talk to your practice administrator about putting new patient packets online.
“Sending or having a patient access our packets from our Web site gives the patient the opportunity to input the information leisurely and accurately, and if needed, the time to research dates, reference medications, and obtain past medical history, says Suzanne E. Keith, practice administrator at Michael W. Goodman, MD, PC, in Chattanooga, TN. “Also, bringing or e-mailing the information in advance allows our office to make a chart and reduces the patients’ wait time.”
Posted on 27. May, 2009 by .
If you’d like a glimpse of what your coding or billing job might feel like to a patient, check out Anna Wilde Matthews’ tale of trying to decipher her $36,625 bill after she vaginally delivered a healthy baby. “Bringing my newborn son home was a joy. Figuring out the hospital bill wasn’t,” Matthews writes in the Wall Street Journal.
Follow Matthews as she dissects her bill, wrangles with Aetna’s customer service system, and tries to understand why some seemingly incidental things are so expensive. ”The experience left me befuddled,” she writes.
I’m a little befuddled by some of the story’s details as well, such as a $530.29 epidural tray at Cedars-Sinai Medical Center … More …
Posted on 09. Apr, 2009 by .
If you bill for services to children, you’ve run across kids who are covered by more than one plan. You often have to decide which parent’s insurance plan covers a child.
Take a look at this handy cheat sheet to ensure you pick the correct one every time.
Dependent Child Whose Parents Are Not Separated or Divorced, or Dependent Child of Parents With Joint Custody
You will typically follow the “birthday rule” in these cases. The birthday rule says that for a dependent child of parents who are not legally separated or divorced, the insurance of the parent whose birthday falls earlier in the year is the primary carrier, says Deb Flanagan, recovery unit manager for Inland Cardiology Associates in Spokane, Wash.
Posted on 24. Mar, 2009 by .
These days, many metro areas have ‘room’ for only one or two insurers, reports American Medical News. And some insurance company mergers “have resulted in physician complaints of plans using their market power to drive down payments,” AMNews says.
Market with the most consolidation? Look to Alabama, where BCBS of Alabama holds sway. Parts of Florida have the least consolidation, where even the mighty UnitedHealthcare has a measly quarter of the market share … More …
Posted on 16. Mar, 2009 by .
Until now, UHC used a ‘progressive RVU methodology’ to set reimbursement rates for procedures. Translation: Reimbursement could drop without warning.
Now, UHC will base its reimbursement rates on the 2008 RBRVS … More …
Posted on 06. Mar, 2009 by .
How it works: When the patient comes in, a biller enters CPT codes associated with the plan of care. The tool breaks down what Cigna will pay, and then estimates the patient’s portion.
Cigna tested the tool at 13 hospitals and with 250 physicians, AMNews reports. Pilot phase participants report that, without the tool, they underestimate what the patient will owe and are left with the task of collecting the difference later … More …
Posted on 04. Mar, 2009 by .
The Obama budget released last week wants to save Medicare $260 million with ‘radiology benefits managers.’ These watchdogs likely will focus on how many scans are done, because that’s easy to count.
But monitoring scan quality could save the Medicare more money, reports The New York Times.
Here’s why: Insurers reimburse providers just as much for a blurry scan done on an old machine as they do for a high-quality scan done on cutting edge equipment. And a bad scan can cost insurers more money in the long run, because it can lead to unnecessary surgeries and rehab.
Then there’s the self-referral problem … More …
Posted on 23. Feb, 2009 by .
The American Medical Association isn’t stopping with the $350 million United Healthcare settlement. Now, a class action suit involving the AMA has set its sights on Aetna and Cigna.
Still at issue: The fact that United Healthcare owns Ingenix, the supposedly ‘independent’ research outfit that has supplied UNH, Aetna & Cigna with reimbursement rates. The providers in the suit allege a conflict of interest … To read the AMA’s press release and the court complaints, go here …
FACT: Last year, family & internal medicine practices lost out on $9 million of their rightful reimbursement. Get the strategies YOU need to appeal.