Author Topic: Medical Billing for Substance Abuse Center  (Read 2595 times)

medbillgirl

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Medical Billing for Substance Abuse Center
« on: October 06, 2011, 11:23:48 AM »
I have a pending client for Substance Abuse Billing.  The patients pay the center upfront in full, the administrator would like for us to bill the patient's Insurance carrier so that the patient can be REIMBURSED DIRECTLY from Insurance.

The ADMIN. of the facility does not want the Insurance to know that the patient paid in full upfront.  (DOESN'T MAKE SENSE.) The ADMN. of facility only wants to advise insurance that the patient has met their deductible. 

Can this be done LEGALLY in the STATE of FLORIDA or is this DOUBLE BILLING?

My understanding is, that in order for insurance to reimburse a patient they must be aware that the patient paid the facility and how much.  SO that the Insurance can determine how much to reimburse depending on the policy.

Michele

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Re: Medical Billing for Substance Abuse Center
« Reply #1 on: October 06, 2011, 07:35:47 PM »
It sounds to me like the ADMIN is misinformed or doesn't understand the process.  Many providers mistakenly think that they can "inform the insurance carrier that the patient met their deductible".  That is not how it's done.  I don't know why the ADMIN would care if it is indicated that the patient paid up front.  It shouldn't make a difference.  The insurance plan either will reimburse for the service or not - not based on if the patient paid or not.  It isn't double billing if the facility doesn't plan on keeping the funds.  But you would think they would want to make sure any reimbursement went directly to the patient.  There is a place on the UB04 to indicate prior payments.  The patient paying in full is a prior payment.  Unless the ADMIN could give me a very good explanation (that I agreed with and made legal sense) I wouldn't be able to bill without indicating the patient payment.

This one leaves me scratching my head!   ???
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medbillgirl

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Re: Medical Billing for Substance Abuse Center
« Reply #2 on: October 07, 2011, 10:29:26 AM »
The ADMIN and the owner of this facility are clueless about the billing process.  They have not been successsful with any pior billing.

The facility requires upfront payment from the patients and NOW need to bill the insurance for the sole purpose of reimbursing the patient. 

HOWEVER, I do not understand if it is too late to notify the insurance carriers about patients that have been treated sometime ago and the facility did not do any ins. verification to begin with. 

Since the facility has not VERIFIED benefits, can they (the Ins.) back out of reimbursing or paying?   Is it ever too late to bill the Insurance for back services?

Michele

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Re: Medical Billing for Substance Abuse Center
« Reply #3 on: October 07, 2011, 05:56:07 PM »
Well, it's never too late to bill.   The question is, will they pay.  Many insurance carriers require notification for rehab.  Also, they have timely filing limits.  If the facility told the patient they would file the claim and that the patient would get reimbursement this could be a problem for them.  However, if they didn't tell the patient they would file the claim and they are now doing it as a courtesy, that is different.  But the patients should have inquired on if the claim was filed if they were looking for reimbursement.  Ultimately it is the patient/insured's responsibility to know their insurance benefits and what is required (for notification and timely filing of claims).
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PMRNC

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Re: Medical Billing for Substance Abuse Center
« Reply #4 on: October 12, 2011, 06:49:02 AM »
Quote
The ADMIN and the owner of this facility are clueless about the billing process.  They have not been successsful with any pior billing.
:o :o :o

I'm still scratching my head that a facility thinks all drug addicts are going to pay up front??  And yeah I have to say that's a no no if they are reporting to insurance and not providing the payments.. especially with an assignment of benefits.. !! 
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Michele

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Re: Medical Billing for Substance Abuse Center
« Reply #5 on: October 13, 2011, 06:58:57 AM »
Believe it or not, most inpatient D&A rehab facilities get full payment up front and do not par with insurances.  At least most of the ones we've encountered.  I would think it would be a lot harder to get paid after the treatment.  Some of the treatments are court ordered, some are emergency admits, and they can't come if they don't pay up front.  That is why we ended up starting to do forms, people desperately need to submit the claims to their insurance for reimbursement because they had to pay up front.  We had one where the father & son both went at the same time.  Family was out upwards of $40k.
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medbillgirl

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Re: Medical Billing for Substance Abuse Center
« Reply #6 on: October 13, 2011, 05:21:16 PM »
Thank you for all of your replies.  For the time being this center decided to hire a person as their biller instead of outsourcing.  We shall see how that goes for them. 

Michele

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Re: Medical Billing for Substance Abuse Center
« Reply #7 on: October 14, 2011, 12:38:21 PM »
Sounds like it may be better for you anyway.  If they insist on doing things wrong, they will eventually get in trouble and you don't need to be a part of that.
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