Medical Billing Forum

Billing => Billing => Topic started by: margemib on April 21, 2009, 01:09:45 PM

Title: write-off
Post by: margemib on April 21, 2009, 01:09:45 PM
Michele
can a provider charge a patient for a bal. that the ins. did not allow if he is a PAR provider?
margemib
Title: Re: write-off
Post by: thatcuteblonde on April 21, 2009, 01:37:21 PM
MY understanding is If they didn't allow it because it's above the contracted rate, then no. If they didn't allow the entire charge for reasons such as medical necessity or maxed benefits, then you can charge the full rate.
Title: Re: write-off
Post by: Pay_My_Claims on April 21, 2009, 03:04:39 PM
MY understanding is If they didn't allow it because it's above the contracted rate, then no. If they didn't allow the entire charge for reasons such as medical necessity or maxed benefits, then you can charge the full rate.

Not always. Just because a benefit has been maxed does not make it the clients responsibility. Check your denial codes carefully. Also someone should be verifying coverage prior to obtaining services for services that have max (physicals, refractions, blood draws etc)
Title: Re: write-off
Post by: thatcuteblonde on April 22, 2009, 08:35:00 AM
If benefits have been maxed you always have the right to collect from the patient. Granted you should not continue to treat a patient without notifying them that they have maxed their benes, but under no circumstances does any insurance, contracted or not, have the right to tell you that you cannot collect at least the allowed amount from the patient.

I agree that you should read your RA codes. I've personally encountered numerous issues with UHC since PHCS merged with Multiplanwill and bills are being discounted regardless of our non participating status. Since we were contracted with PHCS, it superceded all other agreements and obligated us to write off excessive amounts, even though we should have been able to collect on them as a non participating provider.

Know your contracts and their regulations. Companies like United Healthcare are finding ways to discount bills by up to 80% through outlets like Multiplan, TRPN and other subsidiaries. If you are billing for a specialty like pain management, you can see a huge loss of revenue due to write offs of this nature. If you think the amount they are allowing is unfair, you might want to look at the pros and cons of remaining contracted and look into your options.
Title: Re: write-off
Post by: Pay_My_Claims on April 22, 2009, 10:50:29 AM
You can't collect from a medicaid client who's benefits have been maxed. They have allowances on procedures (eye exams, physicals dme equipment, chiropractic visits etc) once they max, you CAN NOT bill them!
Title: Re: write-off
Post by: thatcuteblonde on April 22, 2009, 11:02:00 AM
If a patient receives Chiropractic care and maxes their benefits they are still obligated to pay for the additional treatment they receive. You are not required to treat a patient for free simply because they are out of benefits.
Title: Re: write-off
Post by: Michele on April 22, 2009, 09:21:28 PM
If it is a Medicaid patient, make sure you know the Medicaid laws for your state.

Michele
Title: Re: write-off
Post by: Pay_My_Claims on April 23, 2009, 06:51:21 AM
If a patient receives Chiropractic care and maxes their benefits they are still obligated to pay for the additional treatment they receive. You are not required to treat a patient for free simply because they are out of benefits.

Honey, that is part of your job to determine PRIOR to service if the patient is covered or not!! It can depend on the insurance they have and the contract you have with the insurance provider. My advice for anyone is to check their benefits because not knowing and billing a patient for care they have already received will keep your AR loaded with self pay balances that will probably end up being w/o as a bad debt!!!
Title: Re: write-off
Post by: PMRNC on April 23, 2009, 04:43:05 PM
Charlene is right, there are state Medicaid plans that do NOT allow you to bill visits after a patient has exhausted the benefit limit.  Verifying benefits PRIOR to the visit is the only way to be sure!

Linda Walker
PMRNC
www.billerswebsite.com   
Title: Re: write-off
Post by: thatcuteblonde on April 27, 2009, 08:31:34 AM
Well in Wisconsin, we are allowed to bill them if they continue to receive care after their benefits have been exhausted. They are allowed 20 visits per year, period and anything after that is on a self pay basis. Though the laws may be different in other states, we notify the patients up front that these are their benefits and should they choose to receive care after those 20 visits have been used, they will be responsible for it on a self pay basis so under no circumstances do we simply continue to treat only to inflate our A/R by not notifying the patients of their benefits. The choice to continue with treatment is theirs, as we clearly state in our financial agreements after verifying benfits and before they begin with their treatment.  ;D
Title: Re: write-off
Post by: Pay_My_Claims on April 27, 2009, 08:41:09 AM
Well in Wisconsin, we are allowed to bill them if they continue to receive care after their benefits have been exhausted. They are allowed 20 visits per year, period and anything after that is on a self pay basis. Though the laws may be different in other states, we notify the patients up front that these are their benefits and should they choose to receive care after those 20 visits have been used, they will be responsible for it on a self pay basis so under no circumstances do we simply continue to treat only to inflate our A/R by not notifying the patients of their benefits. The choice to continue with treatment is theirs, as we clearly state in our financial agreements after verifying benfits and before they begin with their treatment.  ;D

The key to your statement is that you NOTIFY them prior to. There is absolutely nothing wrong with that, and we practice that with our DME provisions with medicaid clients also.