Author Topic: Out of Network Chiropractic Provider  (Read 8602 times)

SnyderKristine

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Out of Network Chiropractic Provider
« on: May 14, 2014, 03:02:33 PM »
Hi All,

First of all I am so happy to announce that things have started falling in place for me. I have signed my second client that is Chiropractor from the state of Georgia.

This chiropractor is out of network and chooses to offer payment plans to its patients. Now I have never billed for an out of network provider but the front desk executive is so helpful and wanted me to help them, I could not refuse.

I need help with this. Please pour in all the information you think I should know as a biller of a out of network chiropractor. Should I bill claims to all the insurance patient's provide, whether they have OON benefits or not. I am sure about Medicare that we do have to bill, but not about other payors.

I have so many questions in this. Please assist !!!

PMRNC

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Re: Out of Network Chiropractic Provider
« Reply #1 on: May 14, 2014, 03:16:03 PM »
Well hello there Reetu Singh.
Linda Walker
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kristin

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Re: Out of Network Chiropractic Provider
« Reply #2 on: May 14, 2014, 04:45:08 PM »
Out of curiosity, what do YOU think you should do? You started the billing service, which means you should have a basic knowledge of how to bill. And the questions you are asking are quite basic, no offense.

I mean, if I was your client, and I came across this post from you, I would end my contract with you, because I would think you didn't know what you were doing, at all, and it would hurt my cash flow. Again, no offense, I am just calling it like I see it.

SnyderKristine

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Re: Out of Network Chiropractic Provider
« Reply #3 on: May 15, 2014, 06:15:19 PM »
Hello Linda,

Well it's Reetu Singh Malik!!! My Full name.

SnyderKristine

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Re: Out of Network Chiropractic Provider
« Reply #4 on: May 15, 2014, 06:24:52 PM »
Out of curiosity, what do YOU think you should do? You started the billing service, which means you should have a basic knowledge of how to bill. And the questions you are asking are quite basic, no offense.

I mean, if I was your client, and I came across this post from you, I would end my contract with you, because I would think you didn't know what you were doing, at all, and it would hurt my cash flow. Again, no offense, I am just calling it like I see it.

Kristin,

Referencing back to my post, I did not ask how to bill. But my main concern was understanding the billing behind "Out Of Network". I have worked before for a lot of providers, but I never handled billing for a OON provider. And that's the reason why I asked this!!

As far as my client is concerned, she knows very well things about me and my level of knowledge. Her cash flow has been ruined by a local biller who was not professional and hence made her reconsider her decision. She signed a contract with me because no matter what I am willing and trying to help her!!

I know you guys are against off-shore outsourcing and all, but I am also not here to favor any one of those. I started my own company because I saw that companies out here are not doing their job properly and ethically.. And I don't want to work for any one of them and be like them. So here I am all alone.

I know Linda would be offended and I see what is coming towards me. But I have no offense against her as well. It's her opinion and she can speak it out loud.

I use Kristine Snyder as an alias name and that does not affect my work in any way!!! Though that is for Insurance companies and patients, my clients know me personally very well.

Anyways you guys at the forum have really been helpful, so far at least  :'(!!

kristin

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Re: Out of Network Chiropractic Provider
« Reply #5 on: May 15, 2014, 09:30:21 PM »
I am not coming at this from where you are billing from/where you live. You could be on the moon  doing your work for all I care, so long as you know what you are doing. Which, frankly, I don't know that you do, based on your previous posts at this forum.

You did ask how to bill in your first post in this thread, specifically how to bill for an OON provider. So I will ask you again...what do YOU think you should do? What has your research into this subject shown you? Have you done any independent research, maybe called a few insurance companies, etc?

Instead of asking the forum to " Please pour in all the information you think I should know as a biller", why not tell us what you have already figured out from your research, and if there is something you are still not clear on, ask for help with that specific area?


PMRNC

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Re: Out of Network Chiropractic Provider
« Reply #6 on: May 16, 2014, 12:38:32 AM »
YOU posted under false pretenses.
WHERE do you think you should get any kind of help? SERIOUSLY???
Linda Walker
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PMRNC

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Re: Out of Network Chiropractic Provider
« Reply #7 on: May 16, 2014, 01:11:12 AM »
Quote
doing your work for all I care, so long as you know what you are doing. Which, frankly, I don't know that you do, based on your previous posts at this forum.

YOU know what.. it does MATTER.. and until we stand up and fight and take charge for the dignity we deserve it will continue on.   IT DOES matter.
Linda Walker
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Sriram_Sub

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Re: Out of Network Chiropractic Provider
« Reply #8 on: May 16, 2014, 05:51:33 AM »
Hi Friends,

     I am just sharing my opinion about this. (Consciously typing to make sure my comments don't harm anybody).

     I am sure Reetu Singh would have done some ground work on her question, but as Kristin said, she could have included that piece on her first post so that this argument could have been avoided.

     About offshoring, I think we have to look at it as a globalization factor. We all know that, just like any other kind of business, offshoring this business has also been resulting in loss of job for native people (especially some with good years of experience). But that has never been AND will never be the intention of any Indian company / individual who approach Doctors to offer billing service. It's just a matter of cost, that the customers are focused on.

     Let us say, a shirt costs $24.99 at Walmart and if the same brand-similar piece-same quality shirt costs $14.99 at a store run by a non-american, obviously people would like to buy it from the cheaper guy.  In this case, no body looks at the origin of the shop owner or loss of business for Walmart.

     Microsoft has hired an Indian guy as the CEO.
     Microsoft sells Computers and software products across the globe.
     McDonalds, Subway, KFC have branches in India
     Walmart have facilities in India

     Likewise, this is also just a business. I would agree with your dislikes, if offshoring has affected the healthcare provided to the patients. But instead it has helped providers & hospitals to bring down their cost which in turn would help in improving healthcare.

     I am not making such a comment just because I am from India or I am into this offshore business. I would have had the same opinion even if I was not into such business. So, my request to everyone is, let us please share only knowledge and ideas here and not any grievances or hatred.

     Again, thanks for all the information you share.

Regards
Sriram

Sriram

Anand

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Re: Out of Network Chiropractic Provider
« Reply #9 on: May 16, 2014, 08:55:11 AM »
Hello ! I have utmost respect for all the veterans out there in billing and you guys are pretty helpful. Thank you! I am sure when Michelle & Alice created this forum, they just wanted a place where all the billers who has complete passion towards this industry should discuss and share things in a common place.  I think Sriram had covered most of my thoughts, so all I request is to have our conversations that enable the thought process and try not to connect and take the conversations to something which was never the actual subject of the post

Anand.

shanbull

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Re: Out of Network Chiropractic Provider
« Reply #10 on: May 16, 2014, 09:38:42 AM »
Man, this is a tough one. I have to say I can see both sides here. As an American in the midwest who watched our manufacturing sector fall apart due to offshoring and the subsequent suffering and poverty here that resulted, I am wary of exporting jobs, especially in the industry that I work in. On the other hand, people in these countries with fewer opportunities to advance economically are not meaning to personally take things from us and this is the simple reality whether we support it or not. Reetu did not cause this reality and is certainly only trying to live a comfortable life. Maybe she has family to support too. It would be difficult blame Reetu for masking her identity, knowing how vitriolic some people can become about this issue. It seems she did so out of fear of being rejected more than with a malicious intent, so I can look past it.

I remain hopeful that instead of allowing people to get rich off global inequity and exploiting weak labor laws elsewhere, we can all someday come together and insist that workers can't be paid less because of what area of the world they live in. A higher standard wage in developing countries and an equal playing field for those of us in the US benefits all of us. We should encourage this.

We also can't blame anyone who cannot in good conscience help someone who they feel has been deceptive and may contribute to job loss in our home country. Linda has a right to feel how she does as well. She is worried about economic consequences here and directly competes with offshore billing companies. It would not be in her best interest to offshore her own expertise too and we must respect both that fact and how she feels about it.

Above all, let us try to assume the best about others. We are the weakest when we divide ourselves into individual tribes and cannot affect change that way, and in fact there are a lot of people with a vested interest in preventing us from realizing this.
« Last Edit: May 16, 2014, 09:48:02 AM by shanbull »

Michele

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Re: Out of Network Chiropractic Provider
« Reply #11 on: May 16, 2014, 09:47:57 AM »
One of the things that makes America great is that there is a great mixture of people here.  We at Medical Billing Live have strong opinions about certain things as do most.  We would like to make the forum a place where all can come and learn regardless of personal opinions.  There is no rule on the forum where real names are required.  From a personal standpoint we don't like when people are purposely deceptive but I guess in certain cases we can understand why they wouldn't be more forthcoming. 

On a personal level we are opposed to offshore billing because in our cases we have had some bad experiences directly.  Also, I do believe that there are legal issues with the protection of the data, etc.  We are tired of people calling our business 800 line, barely able to speak English and asking us to give them our clients.  It is offensive.  We are a family business and their entire approach is that they will do it cheaper.  We come from the angle of 'you get what you pay for'.  We too are worried about the exporting of any more American jobs, but more than that it bothers us to see the money that providers lose to poor billing.  But that is a fact that happens here in the US as well as abroad.

BUT with that said, We do not oppose people from other countries learning the business and doing a good job. 

SnyderKristine, you have been asking a lot of questions and they are very basic in nature.   


I need help with this. Please pour in all the information you think I should know as a biller of a out of network chiropractor. Should I bill claims to all the insurance patient's provide, whether they have OON benefits or not. I am sure about Medicare that we do have to bill, but not about other payors.

I have so many questions in this. Please assist !!!

It would be helpful if your questions were a little more specific.  It would be impossible for someone to post how to bill for an OON chiropractor.  I think that your excitement probably took over when you were posting.   :)  People don't mind helping but like it has been said, we all are also working and doing many other things so researching on such a general basis for someone else is not practical. 

I did have two thoughts about your question:
1.  What was he doing prior to hiring you?  Was he billing the insurances that do not have OON benefits?  I would think it would be necessary for things like HSAs (Health Saving Accounts)
2.  I am always leery of chiropractors who do a 'payment plan'.
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SnyderKristine

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Re: Out of Network Chiropractic Provider
« Reply #12 on: May 16, 2014, 10:42:22 AM »
Finally, I am so glad that everything came down. I could not sleep last night, wondering about how me trying to do business or supporting my family is actually making someone lose their job. Well, Globalization has its own side effects and this is one of them.

We are also facing similar circumstances here in India. Now the only criteria recruiters look for while hiring someone for a job is "Speak English". There are so many BPOs around that you can barely think of anything else. Our entire youth generation is trapped in these call centers and BPOs, that they barely think of doing anything else of their own. Infact, it has some real adverse effects on very basic and historic things India has inherited from generations like culture, food, clothes, religion, etc. Owing to the price factor, Indian manufacturers choose to export the best quality product overseas, and distribute their cheapest quality product in India.

Let me not go beyond this, considering that everyone's opinion is byproduct of their experience and circumstances.

My intention is to simply run a Billing Company (not a BPO or call center), something that I cherish doing. I personally like this work, the feeling that I am able to  help physicians who take care of patients. I am a science student and wanted to become a doctor myself, but could not do it due to financial difficulties. But my spirit is still the same, helping others do it!!

I hope I will not be treated with racism or any such feeling on the blog  ::)

SnyderKristine

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Re: Out of Network Chiropractic Provider
« Reply #13 on: May 16, 2014, 11:01:05 AM »
Coming back to the main question about Out of Network Chiropractic Billing.

Michelle I just read the book co-authored by you and Alice about Chiropractic Billing. It was an old book though from 2010. But the information was pretty to the point.

What I have understood is that non-par providers:
1. can collect upfront payment from the patient at the time of service
2. Do not need to submit claims except in case of Medicare
3. Payment from insurance is normally made to the patient
4. Must verify insurance benefits prior to appointment, so as to determine the proper course of action required

What I don't understand is:
1. Is it really applicable, that we would be only submitting claims for Medicare patients?
2. If not, then how do I decide which insurance to submit claim to and which not? (My doctor does submit claims for patient as a courtesy)

Before I signed the contract, the billing was handled by a local lady, who moved to a full time job to support her house. In turn, she asked her son and his girlfriend to manage it. But they did not turn up and were not communicating properly with the Doctor.

Hence, she decide to move on!

I have never worked for this specialty before and that is the reason why I am feeling little nervous!!

And I ask basic questions just to keep things simple. If someone would have noticed, I have never answered or comment on any other questions, because I am too shy to put my opinion, at least at this point when i have so much to learn. I am mute learner, with no wrong intentions!!


Michele

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Re: Out of Network Chiropractic Provider
« Reply #14 on: May 16, 2014, 07:10:24 PM »

What I have understood is that non-par providers:
1. can collect upfront payment from the patient at the time of service

Yes

2. Do not need to submit claims except in case of Medicare

They do not need to however many do as a courtesy to their patients.  If the patients are getting paid they will keep coming.

3. Payment from insurance is normally made to the patient

Usually but it depends on the plan.

4. Must verify insurance benefits prior to appointment, so as to determine the proper course of action required

Not necessarily but it's a good idea.  They don't have to verify benefits if they are collecting up front, but if they want to advise the patient what their plan will or will not cover they may want verification done.

What I don't understand is:
1. Is it really applicable, that we would be only submitting claims for Medicare patients?

Not sure what you mean.  Are you saying would you only submit Medicare?  If so, it really depends on the dr.  What does he want done?  Does he want claims submitted to all insurance as a courtesy?  What will he pay you for? (to submit claims or not to submit claims)

2. If not, then how do I decide which insurance to submit claim to and which not? (My doctor does submit claims for patient as a courtesy)

Kinda the same answer as above.  The dr needs to decide what his policy will be and stick to it.

And I ask basic questions just to keep things simple. If someone would have noticed, I have never answered or comment on any other questions, because I am too shy to put my opinion, at least at this point when i have so much to learn. I am mute learner, with no wrong intentions!!

You should share when you feel that you have information that may be helpful.  That's what works on this forum.  Not all will give the same advice but that is why it is advice.  We all learn from each other.
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