Author Topic: Independent Review- Assistance needed (original issue in the 'No Preauth' thread  (Read 699 times)

PippiT

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Our standard rule is send three notices.  We send the first bill once we receive payment from the insurance carrier.  Then we send a 2nd notice 30 days later.  If no response to the 2nd notice we send out a final notice 30 days after the 2nd notice.  If they don't respond to the final notice within 10 days we send to collections.  However, we do have some providers who like to send anyone over $100 to Accelerator at 60 days.

That is what I do as well. On the 3rd one I let them know that if the balance is not paid rebilling fees will be added. If they don't pay again, I will call them and let them know this is the last time I can waive rebilling fees and the account will be forwarded to small claims.

PippiT

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I would remind them that to "threaten" collection actions w/out follow-through is a violation of the FDCPA. You would be amazed at how many consumers have become very savy when dealing with a lot of medical debt. ONE slip can cause you to lose the entire debt owed!

I was ready to sign a client a few years ago who had his OM always include the "stickers" saying it was going to collection after 90+ days, when I was reviewing the practice policies I had asked where the info was on their collection process and the OM simply responded "Oh we don't actually send them, the doctor doesn't want to get into that". Their bills did not even include the mini-Miranda. I didn't sign them as they decided to stay in-house but that same OM called me about 6 months later telling me she should have listened to me as they had a patient with a $7000 debt have it dismissed for violating the FDCPA because they 1) did not follow-through with threats 2) accepted a partial payment of $20 but demanded the full balance on the following statement and 3) Their bills did NOT include the mini-Miranda. This provider did not AUTOMATICALLY become a debt collector in the eyes of the FDCPA, they made themselves one by NOT having a collections practice in place.

If a practice does  not have a policy in place when trying to collect patient balances, there are both state and federal laws that physicians and medical practices have to abide by in communicating with patients because those practices don't have collection agency or policy in place.

Patient's with a lot of medical debt are turning to experts to help them resolve and even wipe out these debts because of FDCPA.

I will look into this. We have financial policies in place that clearly state that balances are due at the time of service that the patients sign. I have never been to a doctor that gave out a collections policy. Interesting. We have an internal policy, 3 statements and then rebills are added. Then several more chances are given before we proceed with small claims.

We recently took the first two rounds of delinquents to small claims and the judge had us mediate with them. We were able to obtain court ordered payment plans and can pursue judgment if they default. On 3 of the cases, we needed the court order because the statute of limitations were about to expire. To my knowledge we have not violated anything, but I certainly will look that up and ensure we are in compliance.

PMRNC

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You would only violate if you do not follow through with the threat. Sounds dumb really being penalized for putting your hands in the air and saying "oh well" but basically you MUST follow through with the action you threaten (small claims, collection agency, etc)   

My clients always had better luck with small claims than collection agencies. MOST times the patient gets the small claims notice and pays ;) so we are only out the filing fee.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PippiT

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You would only violate if you do not follow through with the threat. Sounds dumb really being penalized for putting your hands in the air and saying "oh well" but basically you MUST follow through with the action you threaten (small claims, collection agency, etc)   

My clients always had better luck with small claims than collection agencies. MOST times the patient gets the small claims notice and pays ;) so we are only out the filing fee.

I see! I honestly don't know if the person before me ever threatened. But since I took over, I have followed through. I have had a couple patients pay when they got the notice. That is certainly the goal/hope is that court can be avoided.

PMRNC

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I have never been to a doctor that gave out a collections policy. Interesting.

There should be a financial policy given to all patients which should be ONE policy for all patients and balances.


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We have an internal policy, 3 statements and then rebills are added. Then several more chances are given before we proceed with small claims.

"several more chances" may not be compliant with FDCPA. Most billers do not understand that once they send that one bill stating "further actions will be taken or anything similar that they are, from that moment on, bound by FDCPA. It only takes ONE patient to know consumer law to call you out on it and win.  All of my clients have policies in place that spell out what will happen after three billing notices.. we follow through with the action and follow that ONE procedure to the letter.

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We recently took the first two rounds of delinquents to small claims and the judge had us mediate with them. We were able to obtain court ordered payment plans and can pursue judgment if they default. On 3 of the cases, we needed the court order because the statute of limitations were about to expire. To my knowledge we have not violated anything, but I certainly will look that up and ensure we are in compliance.

Right, it's not the duty of small claims court or a judge within small claims to point out FDCPA, but if you get ONE patient that knows their rights under FDCPA and shows up in small claims, they will win HANDS down. The laws of the FDCPA are more to protect the consumer than the debtor. You are not a debtor until you make that initial threat to "proceed" whether it's small claims, a collection agency or direct credit reporting.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

rballinger1

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I reviewed Cigna's Medical Policy on substitute tissue.  The medical policy appearing on their website "specifically" states that the AmnioBand is considered "investigational for all purposes and not covered by Cigna.  If the customer service representative gave the provider an authorization, the provider's office is responsible for verifying if the product being used is classifi3ed as experimental in itself, or for the diagnosis being used.  When you read Cigna's policy it is not covered under any circumstance.  Your best hope is the sales representative providing you material to share with the AG, but I think it will end up being the provider's responsibility if he/she is contracted, unless the provider had the patient sign an advance notice that he/she would be responsible for any non-covered services/items.


CIGNA'S WEBSITE (https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0068_coveragepositioncriteria_woundhealing.pdf#search=Q4151)

Cigna does not cover ANY of the following products because each is considered experimental, investigational, or unproven for ANY indication (this list may not be all-inclusive):   Skin Substitute Reason(s) for Request (this list may not be all inclusive)

Application CPT/HCPCS Codes Product HCPCS Codes
ActiveBarrier® Wound care 15271-15278 C5271-C5278
Q4100 C9399
ActiveMatrix® flowable Connective tissue repair No specific code
Q4100 C9399
Acuseal Cardiovascular Patch Cardiovascular reconstruction No specific code
C1768
Adherus Dural Sealant® Dural repair  No specific code
Q4100 C9399
Affinity Wound care 15271-15278
 
Q4159
Allopatch HD™  Tendon augmentation No specific code
Q4128
AlloSkin™ Wound care 15271-15278 C5271-C5278
Q4115 Q4141
AlloSkin™ RT Wound care 15271-15278
 
Q4123
Allowrap™ Wound care
 
15271-15278 Q4150
AmnioBand/Guardian Wound care 15271-15278
 
Q4151
AmnioBand® Particulate Wound Care 15271-15278 C5271-C5278
Q4168
AmnioCare