Author Topic: personal injury/chiropractic  (Read 4154 times)

ruthie72

  • Jr. Member
  • **
  • Posts: 90
personal injury/chiropractic
« on: July 19, 2011, 08:19:58 AM »
HI,
I was approached by a chiropractor to just do his personal injury patients billing, i am unclear on the process of this..Do i bill the health insurance or the auto insurance? Do i still do electronic claims? Thanks for any input. Also he says there is a time limit on how fast these claims must be submitted, can someone please tell me what that is? THANKs.... :)

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: personal injury/chiropractic
« Reply #1 on: July 19, 2011, 10:23:33 AM »
Depends on what state you're in. 

You should bill the patient's auto insurance 1st IF there's med pay on their policy and they've made a claim.  This will be the highest reimbursement for the doctor.  You may have to send treatment notes with each bill, and it will be a paper claim.  EVEN IF THE ACCIDENT WAS THE OTHER PERSON'S FAULT if there is med pay on the patient's policy bill it.  The two auto insurance companies will sort out the finances when the claim is settled.  Impress this upon the patient!  They will say "it was the other guy's fault, why should I have to pay?".  The patient pays for this coverage (med pay) on their policy so they can get the treatment they need, when they need it.  If the other guy has low limits on his policy, then the patient's uninsured/underinsured coverage should kick in. 

If there is NO MED PAY on their policy, you would bill their health insurance, electronically just like a normal claim. HOWEVER, the health insurance may want to know if there is other insurance responsible for paying this claim.  You would let them know there's no med pay, or it's 3rd party.  Some health insurance will expect to be reimbursed when the claim settles.

If it's a 3rd party claim (the patient has no insurance or med pay and they expect the other party to pay the bills) it's up to the doctor whether they get an attorney or sign a third party lien.  The doctor is under NO obligation to accept a 3rd party claim and can expect payment for services at time of service or he can set up a payment program.

We've found that when it's a 3rd party claim, either the attorney cuts the doctor's bill or the patient gets the money and doesn't pay the bill.  3rd party has been a losing scenario for us for years.

Hope this info helps.

ruthie72

  • Jr. Member
  • **
  • Posts: 90
Re: personal injury/chiropractic
« Reply #2 on: July 19, 2011, 03:07:02 PM »
Thank you so much that was very helpful. I do have one more question, when you say bill the auto insurance..do i fill out a CMS 1500 and send to them as well? I have never billed an auto insurance before so unaware of the procedure, and i need to send forms for each claim? Every time the doctor sees the patient i need to do their claim and send notes with it to the auto insurance? thanks so much...I appreciate you taking the time out to help me. Ruth

bumbleb

  • Newbie
  • *
  • Posts: 29
Re: personal injury/chiropractic
« Reply #3 on: July 19, 2011, 08:11:44 PM »
I bill PT only, but I hope this helps. I've found the different ins co have different requirements.

I usually contact them directly to let them know we are treating the patient and find out exactly what they want. Some want it on CMS-1500, others just an itemized bill.  Some want everything at the end of therapy (at discharge), others say to send it as you treat.  Just depends...

They all will require the notes as well as the billing, and I always send a copy of the Lien the patient signed. If they let you send the claims while treatment is still ongoing, I will bill every cpl of weeks, not after each session.

Like DMK mentioned, if a lawyer/3rd party is involved, it's a whole other thing...
Bren

QueenAlicia

  • Sr. Member
  • ****
  • Posts: 347
Re: personal injury/chiropractic
« Reply #4 on: July 19, 2011, 11:16:25 PM »
Hi Ruth ;)

ruthie72

  • Jr. Member
  • **
  • Posts: 90
Re: personal injury/chiropractic
« Reply #5 on: July 20, 2011, 09:13:43 AM »
HI Alicia
thanks so much for referring me to this site!! As you can see i got my answers...Have a great day!!! ;D

ruthie72

  • Jr. Member
  • **
  • Posts: 90
Re: personal injury/chiropractic
« Reply #6 on: July 20, 2011, 09:41:44 AM »
Thanks so much DMK and BumblB!!!YOU guys are great!! Have a wonderful day! :)

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: personal injury/chiropractic
« Reply #7 on: July 20, 2011, 10:37:34 AM »
Yes on the CMS 1500 form.  And it's up to you and/or the doctor if you want to bill each visit, once a week, etc.  With chiropractic, the treatment is usually pretty  close together for the first few weeks, then they'll space the treatment out as the patient improves.  Our office bills out 3 times a month, period.  I use EClaims for my electronic stuff but I print and mail my own PI and Work Comp claims because they always have to have attachments.

Also, the doctor's notes should be GOOD notes.  Not just a check the box, check the chart, notes.  They need to be a thorough SOAP note.  If he doesn't do this already, he should know that ALL insurance companies can request notes at any time.  Medicare can hold payment until they get notes, and other companies can demand a refund of claims paid if the notes are no good. 

Best of luck to you!

ruthie72

  • Jr. Member
  • **
  • Posts: 90
Re: personal injury/chiropractic
« Reply #8 on: July 22, 2011, 07:30:05 AM »
Thanks so much..you dont know how helpful you have been? Maybe one more question..i am not quite sure how to bill for this..i do not think we are allowed to do percentage billing in Florida..what would i charge a flat fee? and what are the going rates, he says he usually has about 18 of these a month...Any feedback would be helpful..thanks..

Sportsmom

  • Newbie
  • *
  • Posts: 48
Re: personal injury/chiropractic
« Reply #9 on: July 22, 2011, 08:37:27 AM »
I would highly recommend calling the auto insurance and making sure they don't need pre-cert for the services.

Also make sure that there medical is not primary to their auto, in some states you can choose to have your medical primary over your auto.  Even if you're in an auto accident. 

ruthie72

  • Jr. Member
  • **
  • Posts: 90
Re: personal injury/chiropractic
« Reply #10 on: July 22, 2011, 09:41:48 AM »
thanks you so much..in that case i would bill the health insurance first correct?

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: personal injury/chiropractic
« Reply #11 on: July 22, 2011, 10:24:09 AM »
Yes, bill the health insurance first in that case.  Be sure to the doctor understands also that if he's contracted with the health insurance company he agrees to take the allowed amount.  If the auto insurance is secondary, they may only pay the deductibles and co-pays per the contracted rate OR they may pay their contracted rate.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4709
    • Solutions Medical Billing
Re: personal injury/chiropractic
« Reply #12 on: July 24, 2011, 07:40:49 PM »
FL is a fee splitting state.  Flat fee is really a good way to go.  We just released our newest book on "Pricing your Medical Billing Service" and it covers 4 different methods of charging, including flat fee.  It has formulas on how to calculate as well.

http://www.medicalbillinglive.com/pricing-your-medical-billing-service.shtml
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

PMRNC

  • Hero Member
  • *****
  • Posts: 4218
    • One Stop Resources & Networking for Medical Billers
Re: personal injury/chiropractic
« Reply #13 on: July 27, 2011, 04:27:26 PM »
I also would never do percentage if you are just going to be doing PI claims and also, if you have never billed WC, NF/Auto or PI, I wouldn't start out with those, there is a lot that goes into these claims and they are RARELY straight forward. Also you are left waiting a long times sometimes to get paid.  JMHO..
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ruthie72

  • Jr. Member
  • **
  • Posts: 90
Re: personal injury/chiropractic
« Reply #14 on: July 27, 2011, 09:41:27 PM »
Thank you both so much for you replies..unfortunately this is where i must start since i have been trying to get providers for 4 months. This is my first Bite LOl...I will succeed and you all have made it so much easiers for me..Thanks again!!!