General Category > General Questions

Incorrect Insurance Info-Who's responsibility?

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Chiro Billing Collect:
This seems to be an issue that keeps popping up for me.

The doctors' offices enter insurance info (or sends it over on a superbill) for a patient. I submit the bill and it comes back denied as either incorrect carrier or patient has other insurance has primary. Just wondering how everyone handles it from there. Do you call the patient yourself for the correct info? Or reach out to the Drs. office to have them contact the patient directly?

To add to that, I have a doctor who did not request verification services and he is paying a flat monthly fee. Unfortunately, I did not factor into his fee the time I would have to verify here and there for cases like this. Is it wrong to charge, in addition to the flat fee, for these times where insurance info was sent to me incorrectly and I am forced to verify the info that I have? Or refer it back to the office staff?

Thanks for your input.

Michele:

--- Quote from: Chiro Billing Collect on October 31, 2017, 08:34:40 AM ---The doctors' offices enter insurance info (or sends it over on a superbill) for a patient. I submit the bill and it comes back denied as either incorrect carrier or patient has other insurance has primary. Just wondering how everyone handles it from there. Do you call the patient yourself for the correct info? Or reach out to the Drs. office to have them contact the patient directly?

--- End quote ---

We don't have huge issues with this, but if we get a clearinghouse rejection stating "coverage terminated" or something similar we try to find out what the issue is by utilizing insurance web sites first.  If we can find the correct insurance information then we update and resubmit.  If we can't then we notify the office first.  Sometimes they have the correct information in the office but it didn't get input correctly into the computer or onto the superbill.  If they don't have it we send out a statement to the patient advising them we need correct insurance information or they are responsible for the bill.



--- Quote from: Chiro Billing Collect on October 31, 2017, 08:34:40 AM ---To add to that, I have a doctor who did not request verification services and he is paying a flat monthly fee. Unfortunately, I did not factor into his fee the time I would have to verify here and there for cases like this. Is it wrong to charge, in addition to the flat fee, for these times where insurance info was sent to me incorrectly and I am forced to verify the info that I have? Or refer it back to the office staff?

--- End quote ---

You can only charge for what you have in the contract.  You will need to add it to the contract and the provider would have to agree or notify the provider of the issue and have them implement something at their end to resolve the issue.

PMRNC:
If verification are not a part of your services, you don't do verification. However, what your describing is a claims denial or a rejection (clearinghouse level) and if claims follow-up and denials is a part of your service, it should be your responsibility to collect the correct information, even if not given to you at the time of initial submission. What you are describing really isn't a part of verification and eligibility but rather a follow-up/denial. It would also depend on your contract. My contract lists every single specific service I include for full practice management. I ALWAYS include verification/eligibility because then I know it's done right and how I want it which in turn keeps those rejections down.

To avoid this and any other services you might want to include but feel your not getting paid for, and you are doing a flat fee, why not base your flat fee on an hourly rate? For example if the client has you working an average of 30 hours a week on their account and you want $25 an hour, their flat fee would be $750 and then add expenses. A sliding scale to accommodate new patients (added work) could be based on an average of demographics/claims you can enter in an hour. If you can do 6 in an hour (demographics and claims) on an average, your sliding scale would be an additional $25 for every six new patients. Very easy. This is how I do it.

Chiro Billing Collect:
Is your sliding scale billed monthly, or something you evaluate every 6 months? Yearly? I am confused how it can be considered a flat fee if it changes based on the # of patients.

I actually charge a flat fee based on my hourly rate plus expenses which includes a max # of claims and if the doctor goes over that amount, I charge a per claim fee. This is my first time billing this way so I am not sure how it is going to pan out but we'll see. I have no clue how many hours his account would require but after asking a few questions from Michelle's book, I did the best I could in estimating.

PMRNC:
My flat fees are done MONTHLY along with sliding scale. If for example I set mine at 6 patients (because six patient's might be what I can enter in one hour from demographics to claims) the provider is billed an additional $25 for every new six patients. So if they add 3 new patient's one month and three the next, the $25 is added on that next invoice with the sixth patient. That is just an example. I do both pediatric and mental health so with mental health I can easily do 8 patient demographics and claims in an hour where as with Pediatric it takes me a bit longer. You set your sliding scale based on your hourly rate. If you are just doing the flat fee and NOT accommodating the growth of a practice you will lose money well within six months. If the practice is one that grows you want to make sure you have a sliding scale to accommodate the growth (and time for you).

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