Billing > Billing
usuall and customary charges
Pay_My_Claims:
--- Quote from: PMRNC on July 03, 2009, 08:02:20 PM ---Well .. actually I have never had a problem with it. Any of my clients that don't par I have them collect up front.
In EVERY SINGLE BCBS Policy Handbook and EVERY PROVIDER Contract.. they state this.. so it should never be a surprise, if the doctor is NON par with BCBS..the patient SHOULD be aware and the doctor should be prepared to collect up front. They also have an automated disclaimer when you verify benefits.
--- End quote ---
Unfortunately we deal with clients with ALS, MDA, Paraplegia, Quadriplegia etc. Our rehab chairs run from 20-40K. Most cases our clients have no problem signing the check over to us because they need their equipment. Its just a hassle, because you have to constantly check Blue-e for the payment, since we are not notified that payment has been made. There is a slight difference in paying for an office visit, and rehab equipment. We had a few clients that I had to collect from because they kept the BCBS payment(prior to me coming on doing the AR). If we turn them down, we lose a lot of business, because we are the #1 provider for the ALS & MDA clinic at one of the largest hospitals in NC. I keep on top of the payments!
Michele:
My docs who are oon (for smaller fee services) usually charge up front and reimburse the patient if and when they receive payment. For the larger fee services, they tell the patient if they get the money and they bring in the insurance check with the eob, they will give them a courtesy discount. But if they cash the check and don't sign it over and bring in eob, then they pay full price. That is incentive for the patient to bring in the money if it goes directly to them.
Michele
PMRNC:
Your high billing providers should par with BCBS it makes more sense to par than not. Your avg family practices and smaller practices have more practical choices to Not Par. In some cases a large dollar billing provider will be LOSING money NOT participating. On my consulting clients I run reports based on a 2 year period to determine gains and loss with par/non par carriers and almost always the larger practices are losing revenue from being non par with some carriers. There's not many con's for them NOT to par.
Pay_My_Claims:
--- Quote from: PMRNC on July 04, 2009, 11:51:01 AM ---Your high billing providers should par with BCBS it makes more sense to par than not. Your avg family practices and smaller practices have more practical choices to Not Par. In some cases a large dollar billing provider will be LOSING money NOT participating. On my consulting clients I run reports based on a 2 year period to determine gains and loss with par/non par carriers and almost always the larger practices are losing revenue from being non par with some carriers. There's not many con's for them NOT to par.
--- End quote ---
We can't because we are DME and they have closed their network to new providers. They are not accepting any more. This holds true for Cigna and UHC. They are not accepting any more DME providers. We have tried to become in net to benefit the clients. They prefer to par with the "scooter store" not realizing that they only market basic wheelchair supplies, and not high end rehab equipment. We do have an advantage of not being par, and being a custom rehab. We get to negotiate a lot of deals because nobody in net can provide the services we can. We are such a different egg, we don't follow the "model"
PMRNC:
Yeah if the network is closed it's more difficult.. Can you think of anything your practice has that others in same geographic location do NOT have? what about access.. If you can find a "niche" , "service" , or accessibility improvement you can get into a closed network. For example (not DME) I had a client who was a psychologist, we were able to get him into a few "closed" networks because he was doing a procedure called EMDR for PTSD and he was the only one in that geographical location to offer it. Another one of my clients catered to children with Downs Syndrome and Autism so we were able to get him also into some closed panels.
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