Poll

If a doctor refuses to bill insurance for patients who have coverage and he is participating in their plan, Is the biller in any way responsible for such practices?

If insurance is billed and denied, is the full amount billed to the patient?
0 (0%)
Should and insured patient be paying cash fees?
0 (0%)

Total Members Voted: 0

Voting closed: July 30, 2012, 06:00:10 AM

Author Topic: Cash Billing of insured patients  (Read 2151 times)

irmawalker

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Cash Billing of insured patients
« on: July 25, 2012, 06:00:10 AM »
I have been doing billing for a chiropractor for just over a year.  I had no experience in this field but have learned a lot.  The doctor will bill a patient cash if he decided that the coverage may not pay or is the patients copay is the sames as his cash price.  He is under contract with major insurance companies and I have repeatedly told him he must bill the insurance.  Am I right?  Could I be held responsible to the insurance company for not complying with the contract?  Should I report this pracrice to the insurance company?  If the provider rep is aware of this, shouldn't she report this or request an audit?

PMRNC

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Re: Cash Billing of insured patients
« Reply #1 on: July 25, 2012, 09:32:24 AM »
Quote
I have been doing billing for a chiropractor for just over a year.  I had no experience in this field but have learned a lot.  The doctor will bill a patient cash if he decided that the coverage may not pay or is the patients copay is the sames as his cash price.  He is under contract with major insurance companies and I have repeatedly told him he must bill the insurance.  Am I right?  Could I be held responsible to the insurance company for not complying with the contract?  Should I report this practice to the insurance company?  If the provider rep is aware of this, shouldn't she report this or request an audit?

I don't want to be harsh, but yes.. the MINUTE you KNEW what he was doing you were libel. What you do depends on the following information

Are you an independent contractor or billing company?
Are you an in house "employee"?
If you are an independent contractor or billing company, hopefully you have a compliance plan that would address your next steps on how to handle this particular situation. If you are employee, then hopefully the practice has a policies and procedures plan along with compliance plan that again, would address this situation. What he is doing is wrong, there's no question there. UNLESS he has a financial hardship documented he is committing fraud.    If you are an employee I would let the provider know that you will not be doing those billings for him because you can be held responsible. There are a TON of case precedences on file where the Office Manager and / or biller were held independently responsible and libel for fraud/abuse. 

If you are a billing company, then you should again inform the provider that you will not be further participating in these billing. Your contract should have a clause for terminating a client in cases where fraud is suspected or known, regardless you want to make that your first step.  I'm not necessarily thinking you would report this anywhere because you knew it was wrong but continued to participate so that cause of action wouldn't get you a good result, I would think terminating him (via certified mail/return receipt) would take care of the issue for yourself. Again, if you were operating as a billing company or independent contractor make sure you hold on to all of your source documents in case there is an audit, just because you make him go away doesn't mean the problem will go away and you never know if it will come back and bite you. Document everything, every conversation, keep all emails, letters, contract, etc. to cover yourself as much as possible.

It all boils down to whether you are independent biller/company or employee.   


This is a small example of why billing companies HAVE to have compliance plans and practices must also have compliance plans along with Policies and Procedures, that would be the first place you would go to find the answer to this and many other questions :)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

DMK

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Re: Cash Billing of insured patients
« Reply #2 on: July 25, 2012, 10:36:50 AM »
Although I understand the DESIRE to make it easier for the patient financially, the doctor doesn't get to make those choices once he's agreed to contract with an insurance company.  He/She is OBLIGATED to fulfill his part of the contract by collecting co-pays, deductibles, and patient portions AND the patient is obligated to fulfill their part of their contract with their insurance company.  You don't get to pick and choose!

As a side note, you as a biller can really help the doctor by protecting him/her from anything that smacks of insurance fraud.  They should have policies in place that cover ALL the patients.  Just because one patient has less than stellar insurance they shouldn't be given a different "deal" than someone who has great insurance.

In our office Blue Cross is the worst payer, Blue Shield is the best payer.  Why should the Blue Cross patient get a better deal than the Blue Shield patient?  They get the same service. It's not the doctor's fault that they have a particular insurance benefit.   The doctor can also defer the "money" discussions to the office manager and let them be the "bad guy".  They can then stand on the law and the contractual agreements made with the insurance companies and really make a strong point the the doctor doesn't set these contracts, the insurance company does.