Misconceptions About Collecting Payment From Patients

Misconception 1:  If Patients are making payments you cannot sue them to collect

Whether or not to take a patient to small claims court or send the patients account to a collection agency depends on the amount outstanding and the person’s likely ability to pay.  If a patient is making regular payments on the account that has been agreed upon in writing, then you cannot sue for payment.  If the patient is not meeting those requirements then you have the right to sue for payment.

Misconception 2:  When you mail statements makes a difference

Statements should be mailed out to insure arrival on the first of the month.  This is not a good idea.  So many companies follow that rule so what happens is the patient receives multiple bills on the same day and most likely your bill will be ignored over their car or mortgage payment.  Sending out statements the second week of the month and mid-week is a good time because most bills are sent during this time and will stand out amongst all other mail.  Sending a statement in a colored envelope such as beige or gray will also draw attention to it.

Misconception 3:  Legal restrictions make collecting harder

Most state laws prohibit unreasonably harassing debtors by calling their workplace, at night or on weekends.  With that said, the laws are not really that restrictive.  Calling people at home or at work is not harassment until they tell you to stop, and maybe not even then if you are reasonable about it.  However, if personal calls can jeopardize their jobs then that would not be ethical and will not help for you to collect money that is owed to you.

Misconception 4:  It’s so hard to reach patients at home

Good collectors try every phone number they can find.  Some offices complain and say that the patients are never home so they don’t even bother calling.  Some offices stay open after five, usually when people are coming home from work, this would be a good time to call.  Also some offices start early in the morning.  Try calling then when possibly their getting ready for work or making breakfast.  A quick brief call is all that needs to be made.  You don’t want to make the patient upset which could cause them to never pay you.

Misconception 5:  Sending patients to a collection agency is bad business

Some physicians are afraid of sending patients to collections due to them telling other potential patients or the referring doctor.  Instead, when the collection process is polite and reasonable, the doctor will gain more respect from the patient and no one will value the services you provide more that you do yourself.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246 

 

 

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Commonly Asked Medicare Q & A

As an outsourced medical billing company I get many questions regarding Medicare.  I will keep track of these questions and publish some of them periodically on my blog.  Below are answers to three commonly asked questions.

Do Medicare rules apply to patients who don’t have Medicare?

Medicare has rules called “conditions of participation” regarding facilities and home care agencies and these rules apply whether or not the patient has Medicare.  In order for the facility to maintain its Medicare provider status, it must meet the conditions of participation.  On the other hand, Medicare only stipulates that these rules only apply to Medicare patients and do not have any connection with other payers.  So if there is a patient that comes in for an office visit and they do not have Medicare or any other type of insurance and will be paying for the visit themselves, the provider does not have to accept Medicare’s rates and does not have to meet Medicare’s required documentation or disclosure requirements or Medicare’s performance measures.

What constitutes an “Initial Visit” for Medicare billing?

For example, if a patient comes into the office to receive results of a sleep study can this be billed as an initial visit?  An initial visit or a “new patient” visit is a face-to-face visit.  If you are going over and giving the results of the sleep study with the patient present and have given further instruction and have a treatment plan, this is an initial visit.  If the patient is not present when giving the results, then this is not a visit.  According to Medicare, a patient qualifies as a new patient when they have not been seen in over 3 years.  If the patient has not been seen for over 3 years, an initial visit can be billed.  If a patient visits the hospital, then one initial visit per patient per hospitalization is allowed.  All other visits while the patient is hospitalized are to be billed as subsequent visits.

Can more than one Nurse Practitioner bill a Medicare patient on the same day?

In some cases this is allowed.  For example, if there are two Nurse Practioners one being the primary care nurse that bills Medicare one diagnosis and the other Nurse Practioner being in a specialty practice bills for a different diagnoses on the same day.  Will the bills for these visits through two separate practices and two separate provider numbers be paid by Medicare?  Yes. According to Medicare rules, both claims would be paid.  The reason they will be both paid is due to their being two different diagnoses on each claim and the bills are being generated by two separate providers.  However, when there are cases of two Nurse Practitioners who have billed for the same day with the same diagnosis, it is likely that one of these claims will be rejected by Medicare.  In this case, it is extremely important that the Nurse Practitioner has justification through their progress notes to back up their claim.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

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Billing Practices That Can Be Costly Part II

In part II of this article we will further discuss costly medical billing practices. In some cases, these have led to the loss of medical licenses for false reports include billing unnecessary services, double billing, upcoding or altering CPT codes, unbundling and false diagnoses. 

Unbundling is when you charge separately for a visit or a procedure that is normally part of another procedure or visit.  Double billing is when you bill for the same procedure multiple times on different dates. 

Upcoding refers to using a higher procedural code than what was performed.This includes billing for services that the patient did not receive or using codes that are at a higher level of what really took place during the visit or procedure.  Some examples of that are where a practice submitted bills for office visits for established patients on days where the office was closed, where the physician was not in the office or on vacation and on holidays and weekends when the office is closed. 

Another example is when a physician billed for office visits for parents and siblings when one child was brought into the office for a visit.  The parent had never been seen before but the physician used all the information provided for the insurance where the parent was the subscriber of the health plan, so it was easy to gain access to bill under the parent as well as the child.

Some health care providers advertise “free” services.  When the patient arrives it appears to be a “free” service but ends up being charged for the office visit and other procedural codes.

Other costly practices include failure to produce or complete medical records, which are required to back up billing codes, delegating treatment to individuals that are not qualified or it is not in their scope of practice, and performing procedures and tests that are not with valid consent from the patient.

Billing fraud leads to higher premium assessments by the insurance companies.  HIPAA prohibits billing for medical services “that a person knows or should know are not medically necessary.”  Also violating HIPAA laws and guidelines can result in monetary penalties up to $10,000 and an additional cost of 3 times the dollar amount for each claim.  These crimes are also punishable by up to 10 years in prison or even life in prison if a patient dies as a result of fraudulent activity.

Billing fraud is costly for all those involved, the practice, the doctor and their license and more importantly the patient.  Fortunately, most health care providers are honest and dedicated to helping and providing the best care for their patients and only want what’s best for them and their medical practice.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

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Billing Practices That Can Be Costly – Part I

Obviously, to receive proper reimbursement it is very important to have accurate coding practices for all health care practitioners however; here are several reasons.  A group that is often involved in the billing process is nurse practitioners. Generally they are billing for their own services or they may be using a billing form (superbill) provided by their employer by marking procedural codes and diagnostic codes in order to bill for their services.  The responsibility for the accuracy of the coding and billing, as well as for maintaining medical records that support the diagnosis code and procedural code that is being used to bill for specific services, is the professional provider or the nurse practitioner. 

Keeping up to date with accurate coding procedures is very important when billing to receive maximum reimbursement.  However, due to new codes being added, modified or deleted, this may cause an impact on reimbursement.  Sometimes the definition of a code may not be so clear.  That’s why it is vital to utilize sources that are available to the medical community.  Such as workshops, online information and online telephone consultation services for health care providers to get better clarification on a code before billing.

It’s also important to remember that even if billing by the physician or nurse practitioner is outsourced to an outside billing service or a trained billing clerk that is onsite, it is the person on whose professional licensure the care and billing are based is the person that is responsible for accurate billing.  A nurse practitioner or a physician still has to learn something about reimbursement and coding.

Any health care professional who knowingly cheats on coding to enhance their reimbursement, can be guilty of both civil wrongs which is considered a “breach” of the insurance contract, and it’s considered a crime, which can lead to costly legal fees.  Billing fraud can also result in having to return part or all of the wrongly paid money, fines, loss of their professional license and possibly serving time in prison.

How do fraudulent claims get noticed?  There are several ways.  Some insurance carriers have fraud detection software which they use to analyze data.  When unusual billing patterns are discovered, they initiate an investigation.  Sometimes it is the patient that is complaining about the amount of the bill or services that were billed.  Employees have revealed on their good conscience of fraudulent practices and don’t want to be part of the scheme or it violates their own ethics.  Bottom line is physicians or other health care providers who engage in this type of behavior have been costly and have led to them no longer being able to practice in the medical field.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246 

 

How To Handle A Bounced Check From A Patient

More and more patients are bouncing checks more than ever because of the economic situation.  It’s really important to focus on prevention and also to have a plan in place if you do receive a bounced check. 

Having a financial policy in place is a good start.  Right away patients know their responsibility and they are also informed of the consequences of violating that policy.  The policy should every so often be updated and every time there is a change, the patient should sign the new policy upon arrival for their appointment. 

The staff should also be active in efforts to make sure patients pay their bills.  They need to be well trained and keep the lines of communication open about the financial policy.

It’s important to copy the patient’s insurance cards and driver’s license when they first arrive to the office front desk registration.  Having the patient’s driver’s license helps to identify the patient and also it shows the correct address of the patient, which should be matched up against the address on the check.  If the address does not match, it would be wise not to accept the check.  Accepting company checks is something you may want to avoid also because a company is usually a protected entity, so if the check were to bounce then the practice has very little recourse when trying to collect payment from that patient.

The financial policy should also include what the consequences are when a check bounces.  If there are bank charges, make sure the policy indicates that the patient will be responsible for those charges.  A good website to see what laws for each state is www.ckfraud.org/penalties.html.  This website is the National Check Fraud Center and it lists bad check laws.  Also in the financial policy it would be helpful to reference the laws straight from the website itself. 

Consider using a check-scanning system from a company that guarantees that the check has been cleared.  The money is immediately deposited into the practice’s bank account and there is no need to visit the bank with a paper check for depositing.  Common reasons why a check is bounced is due to insufficient funds, closed account, stop payment or because they have been forged.  When any of the above situations happen, it’s good to investigate to determine if this is the case and also making a phone call to the patient and document the phone call.

If a patient bounces a check and the check is settled eventually by the patient, it’s a good idea to convert the patient to self-pay by cash, credit card or debit card.

These few steps can help to recover and prevent checks that have bounced and keep the cash flow going.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

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A Brief Guide on Documentation and Coding

A provider has the responsibility for making sure that the correct level of service was provided and the proper code was used for billing.  This duty cannot be passed on to someone else.  The physician provided the service, they have to decide what to bill.  They know better than anyone what services were provided. 

The first step is to decide what the diagnosis is.  An ICD-9 code is then used to describe the diagnosis (soon to be ICD-10).  The next step is to code the treatment by using a CPT code.  Which describes the treatment the patient received or the visit that took place.

A common misconception is that downcoding can help avoid audits.  Unfortunately, not only is that not true but it cheats the physician from receiving payment for services they deserve.  So it’s important for providers to document their services accurately and keep track of the time they have spent with the patient in order to be able to bill for the proper services rendered.

Some physicians are hesitant to use a new CPT code because they rationalize that the insurance company won’t pay for it.  It’s just the opposite, if the insurance company sees that a certain code for a service is not being used often, they may be less likely to cover it.  If the physician feels this way, for their sake it’s important to have good documentation to justify using a new code or any code for that matter.

It’s important to evaluate what sort of impact your coding will have on your patients.  In some cases, if a particular code is not paid for, the charge will be passed onto the patient.  Billing a particular CPT code or “-25” modifier may be justified, but it also could cause a problem if a large portion of your practice complains about having to be responsible for these charges. 

A practice that keeps up to date with coding changes and who follow proper coding procedures will do well overall.  Changes happen all the time and if the person handling the physicians billing is not up to date, it could cost the practice a lot of money.  Attending coding seminars, commercial resources online or subscribing to newsletters is helpful in keeping up with the changes.  Some practices or healthcare providers who are in a large group still have to be mindful of coding procedures and not just rely on those who are doing the actual billing. 

Physicians should have clear knowledge and understanding of billing and coding practices in order to be able to be the most accurate and precise as possible.  Having good communication with the insurance biller is also key to correct and accurate billing.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246

Tips For Running A Productive Medical Private Practice That Thrives

Running a thriving private medical practice can have its every day challenges.  There are quite a few aspects of running a practice that contribute to keeping your staff and yourself productive.  One of the first issues is your staff.  Having a good staff can mean everything to an efficient practice.  It’s important to hire friendly, reliable and resourceful people to help run your office.  Understanding your staffs strengths and weaknesses is important in order to optimize the work flow. 

Having an office manager can help to relieve the physician from every day office issues and endless paperwork.  It’s also an advantage to “cross train” your employees so that each staff member is interchangeable in most aspects of the office if it gets really busy or if a staff member is out of the office for a period of time.

Another important issue is having an onsite biller or an offsite billing service to handle all the insurance claims and patient accounts.  A good and qualified biller is key to a productive office.  A good relationship with your biller is crucial.  A physician who is running a private practice needs to know how to bill.  Physicians didn’t realize when they were in medical school that they would become a small business owner.  In reality, that’s what physicians become whether they like it or not.  So it’s important that this is a priority when starting a private practice.

Have quarterly promotional events at your office.  Become involved with your local community, for example with the local chamber of commerce.  Get to know other physicians in your area.  A strong relationship is more fruitful and beneficial for your patients.

Another area to concentrate on is the cleanliness of your office.  Nothing is worse than walking in as a patient to a dirty and messy physician’s office.  Patients want to feel welcomed and comforted by the environment they are in before they see the physician.  A professional cleaning company is a good idea to have in order to keep the office looking clean and welcoming.  Their also should be staff members assigned periodically to check the restrooms to refill the soap dispenser, toilet paper and any other paper products.  A sign should also be posted in the restroom the importance of washing your hands after using the facilities.  Most office’s close at lunch time and that would be a good time to straighten up the waiting room from the mornings patients.  This area should also be checked throughout the day. 

Doing small things such as these can make a world of difference to your practice and more importantly the patients will feel that they are in good hands and are valued.  Happy patients mean more referrals; here’s to your thriving business!

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246