Medical Billing Forum

General Category => General Questions => Topic started by: Charles on February 04, 2009, 01:41:07 PM

Title: Financial Responsibility From
Post by: Charles on February 04, 2009, 01:41:07 PM
Does anybody know where I can get a hold of one of these on the net?
Thanks
Title: Re: Financial Responsibility From
Post by: Pay_My_Claims on February 04, 2009, 03:01:38 PM
Not sure if you are looking for a "blank" form or an example

here are some that other facilities use....

http://www.sugarlandeye.com/images/Financial_Responsibility_Form.pdf

http://www.bcm.edu/pdf/consent-and-aob.pdf

http://www.americanhomepatient.com/product/AOB%20070703.pdf

http://www.eyegaze.com/files/file/pdf/Assign%20Benefits_0.pdf
Title: Re: Financial Responsibility From
Post by: Treas on January 05, 2011, 11:08:42 AM
I have a client who does not get paperwork completed for clients she sees in her home office.  I have sent her forms numerous times and she just ignores them stating that the client willfully came to her home so by default they are saying okay to treatment and billing.  Am I liable for false billing if she does not have these forms completed?  Should I be requesting copies of the forms for my records?  What would you do?
Title: Re: Financial Responsibility From
Post by: PMRNC on January 05, 2011, 02:26:11 PM
What forms? You don't give nearly enough information to advise you.