Author Topic: EOB'S  (Read 2974 times)

ellie

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EOB'S
« on: February 07, 2011, 05:02:08 PM »
We bill for a Dermatologist for the facility. Patient's pay up front. Not sure yet what they are paying for the facility charge ( still trying to determine this )

We bill the insurance company as a courtesy for the patient. Patient's receive check from the insurance carrier

!!!!!!! Isn't the doctor losing money ?????????

He is not contracted with any carriers as of yet.

What would be the reason that the office does not have any copies of any EOB's ?? Have only gotten one EOB.

Out of Network ? Michelle I would really like to talk to you if I could.

Thank you

PMRNC

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Re: EOB'S
« Reply #1 on: February 07, 2011, 05:52:39 PM »
There are many practices who do NOT want the hassle of insurance billing.. and I think with Obamacare we are going to find more of them popping up.
Are they losing money? Maybe, but you would need to check with all the carriers and determine and analyze fee schedules. Certainly participating with some carriers means an increase in allowable's (higher fee schedules) but then you don't have the costs associated with patient billing for chasing down deductibles, copay's.  So maybe it just works out for some practices. A lot of homework will have to be done to really see if the practice will do better financially.   I'm a firm believer that if it aint broke, don't fix it.

If I think a provider will be better for getting into panel's I will first do the research and then present to the provider. But like I said, there's usually a good reason they don't want to deal with the insurance. I've seen many practices BETTER off this way.

 
Linda Walker
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medauthor

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Re: EOB'S
« Reply #2 on: February 07, 2011, 07:41:46 PM »
Quote
Michelle I would really like to talk to you if I could.


Me? or the site owner, Michele?   ;D
Michelle Rimmer, CHI, CPMB
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Owner-ABA Therapy Billing Services
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medauthor

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Re: EOB'S
« Reply #3 on: February 07, 2011, 07:50:16 PM »
I don't think the doc is losing money if the patients are paying up front; he gets his full price and then the patients are reimbursed whatever----if it's applied to their deductible....if they only get a %...whatever.....he still gets his full price...right??
Michelle Rimmer, CHI, CPMB
President-Professional Medical Billers Association
Owner-ABA Therapy Billing Services
Author, 'Medical Billing 101' and 'Coding Basics: Understanding Medical Collections

Pay_My_Claims

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Re: EOB'S
« Reply #4 on: February 07, 2011, 07:53:36 PM »
@ Rimmer, true. We do a lot of up-front and billing non-assigned for patients. They sign the disclaimer etc. The only reason he would need the EOB is to really evaluate if his fee is too low. If the insurance company is paying 100% of what he billed, his fee schedule is probably too low and needs to be reviewed, but I highly doubt that.

ellie

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Re: EOB'S
« Reply #5 on: February 07, 2011, 08:48:52 PM »
they have never dealt with insurance companies, i don't think they even have a fee schedule. they have the physician and the facility and we are filing the facility claims for them, not even sure if they have a fee schedule ? Really, Really confused !!! I need some guidance ??? I guess I need to know what my role is here.

thanks for your help, do I sound stupid, hope not

PMRNC

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Re: EOB'S
« Reply #6 on: February 08, 2011, 06:45:08 AM »
Well your office, even if cash pay only should have some sort of a fee-schedule, meaning a fee assigned to each code. Even though you are not billing insurance companies it is still wrong to apply different fees for the same procedures. It's better all the way around and fair if you charge the same for each patient. You should also document all patient statements with discounts you may offer as well because if they submit to insurance and you are discounting fees and it's not marked on their statement, the patient is going to get extra money.  :o  For hardship cases, it's also best to document these financial hardships as well. 

Also I said Maybe they could be losing money, it really depends on a lot of variables, such as where the practice is located. For example, if you are in a larger/mid size city, patients will more likely go to a doctor who will bill their insurance and they just pay their copay's. For example, where I live right now, there are two doctors (pediatrician and GP) who make out quite well as cash-only, however if they took their practice into the nearest city, they would surely lose in patient volume which of course = money.
Our nearest city has many employers with employee's covered by one or two of the same major plans. And then of course you have Medicare and Medicaid which can be prevalent in many areas.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
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DMK

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Re: EOB'S
« Reply #7 on: February 08, 2011, 10:53:36 AM »
The chiropractic profession is taking a big turn to "cash only" practices and dumping all insurance.  Our office is staying with insurance because, in our town, there are so many Medicare patients and State workers with insurance and we want to continue seeing them.  People here tend to go where their insurance pays, they will even give up a doctor they love if he's not on their plan!

I may make a lot of people angry, but I don't think "Obamacare" is going to be good for the medical industry.  There will be MORE paperwork, you will wait longer for care and tests, and you will not be getting the best doctors (they're bailing out of private practice at an astounding rate).  You will see nurse practitioners and physician's assistants (not that there's anything wrong with that, some are great).

Cash practice works well for many, but the doctor needs to understand (Particularly if they are a dermatologist) that people will go where their insurance will pay!  As long as money stays tight, people will take advantage of the benefits they have already paid for.

Michele

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Re: EOB'S
« Reply #8 on: February 08, 2011, 11:10:13 AM »
Ellie,
 
   If they are billing the facility charges out to the insurance as a courtesy, are they getting paid by the patient?  I can't tell from your post but it looks like maybe they aren't being charged for that?  If they are billing as a courtesy they should be collecting up front, or at least have arrangements with the patients for getting the insurance checks signed over.  My big issue with non par is getting the money from the patient.  If it's not collected up front or there is no incentive for the patient to forward the payment, it's a hassle! 


Michele  (with one 'l'   ;D ;D ;D )
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ellie

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Re: EOB'S
« Reply #9 on: February 13, 2011, 11:33:00 AM »
At this point I am not sure what they are collecting, no patient ledgers to look at yet as they don't even have any I believe. I don't think our liability is to work them anyway ??? The office girl is filing for the physician and we are doing the facility billing for non-cosmetic procedures and filing as a courtesy for the patient. He has no contracts with any insurance companies as of yet. I gave her a list of EOB's I need for the facility so we can show what we have collected for them. She only stated she had one. I called the insurance companies and have gotten information that some of the payments have gone directly to the physician for the facility, so surely she is getting the EOB's attached. I get the feeling she does not know what she is doing. So the information that I receive from the insurance companies regarding these charges, I do not know yet what they have or have not collected from the patient and the patient could be receiving FREE money !!!

PMRNC

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Re: EOB'S
« Reply #10 on: February 13, 2011, 12:41:15 PM »
Quote
At this point I am not sure what they are collecting, no patient ledgers to look at yet as they don't even have any I believe. I don't think our liability is to work them anyway Huh The office girl is filing for the physician and we are doing the facility billing for non-cosmetic procedures and filing as a courtesy for the patient. He has no contracts with any insurance companies as of yet. I gave her a list of EOB's I need for the facility so we can show what we have collected for them. She only stated she had one. I called the insurance companies and have gotten information that some of the payments have gone directly to the physician for the facility, so surely she is getting the EOB's attached. I get the feeling she does not know what she is doing. So the information that I receive from the insurance companies regarding these charges, I do not know yet what they have or have not collected from the patient and the patient could be receiving FREE money !!!

Goodness, I'd love to see there set of book....NOT  ???   Can't tell you what to do, but if I were YOU. I'd stop immediately and tell them to get their stuff together.   ??? ::)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com