Author Topic: Can we do retro billing for private insurance?  (Read 2225 times)

jcfenfen

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Can we do retro billing for private insurance?
« on: April 13, 2010, 05:04:04 PM »
Hi,

My husband just started a clinic, and he's going to be contracted with  most major insurance comapnies, however, they won't take place until 2-3 months later after they have done the credential check, just wondering can he still see patients and retro bill the insurance company afterwards? or the service he provides now is considered free before the contract take place? Any suggestion is greatly appreciated.  Thanks. 

Meli

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  • Melissa Turner
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Re: Can we do retro billing for private insurance?
« Reply #1 on: April 13, 2010, 08:37:50 PM »
Hi there,

Congrats to your husband on starting the clinic!  I'm sure this is a huge undertaking for both of you.  Any services provided before the insurance contracts are in place do not have to be 'free'.  They can be billed to the insurance carriers as out of network but be sure to communicate this to the patients prior to seeing them.
Melissa Turner, CPMB
Mainstream Services Inc.
www.msmbinc.com

Michele

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Re: Can we do retro billing for private insurance?
« Reply #2 on: April 13, 2010, 08:38:48 PM »
That depends on each carrier.  For example, on the Medicare application you have indicated the date he was going to begin seeing patients on the application.  So he would be able to see patients during the time the application was in process but hold the billing until the application was approved.  Some insurance carriers date the participation based on when the application was received, some date them based on when the contracts are signed, and others based on when the process is complete.  So on the commercial carriers, it all varies.  You can still file the claims though, the patients may have out of network benefits.

Michele
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Pay_My_Claims

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Re: Can we do retro billing for private insurance?
« Reply #3 on: April 13, 2010, 09:32:04 PM »
That depends on each carrier.  For example, on the Medicare application you have indicated the date he was going to begin seeing patients on the application.  So he would be able to see patients during the time the application was in process but hold the billing until the application was approved.  Some insurance carriers date the participation based on when the application was received, some date them based on when the contracts are signed, and others based on when the process is complete.  So on the commercial carriers, it all varies.  You can still file the claims though, the patients may have out of network benefits.

Michele

Yes, and NC Medicaid does the same thing.

DMK

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Re: Can we do retro billing for private insurance?
« Reply #4 on: April 14, 2010, 11:15:54 AM »
I think it's really important that you start out in business with the attitude that NOTHING is free.  Your husband's services have value.  Medicare can be retro billed, and most likely will be paid as long as your application indicates the date you started seeing patients.  Other insurances should be billed for out of network benefits and patients notified right up front that if there are not out of network benefits the appointment will be $XX.  You could offer a cash discount if paid at time of service in case there is no out of network benefit, but put a dollar amount on his services right from the start.  This trains your patient's to appreciate the services and gets them used to paying their co-pays or deductibles or something at time of service.

I can not stress enough the value of training your patients right from the start.  I learned the hard way.  We were very casual about money, not wanting to pressure the patients, trusting that they would pay their bills when the time came.  Not so much.....  Now when we have a new patient, I check the insurance while they're in the office, tell them their benefits and how much they will owe.  I get some payment at each service.  If they can't pay in full, they at least pay some.  And cash discount means they pay at time of service so I don't have to bill them.  Not bill them and let them pay when they get around to it.

I wish you and your husband the best of luck and really appreciate anyone willing to be a health care provider in this day and age!  Give him a kiss every day and express your gratitude that he chose a noble profession!  Then go get the rewards for him!

Dina

jcfenfen

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Re: Can we do retro billing for private insurance?
« Reply #5 on: April 14, 2010, 05:54:45 PM »
Thank you all for sharing your experience and knowledge with me, I can't appreciate it enough.  Dina, thank you so much for your warm support and advice on cash collecting, I was very hesitant about collecting money from patients because I'm afriad to scare them away ( I don't even collect co-pays) but with your encouragement, I will be more brave now :)