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personal injury/chiropractic

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ruthie72:
HI,
I was approached by a chiropractor to just do his personal injury patients billing, i am unclear on the process of this..Do i bill the health insurance or the auto insurance? Do i still do electronic claims? Thanks for any input. Also he says there is a time limit on how fast these claims must be submitted, can someone please tell me what that is? THANKs.... :)

DMK:
Depends on what state you're in. 

You should bill the patient's auto insurance 1st IF there's med pay on their policy and they've made a claim.  This will be the highest reimbursement for the doctor.  You may have to send treatment notes with each bill, and it will be a paper claim.  EVEN IF THE ACCIDENT WAS THE OTHER PERSON'S FAULT if there is med pay on the patient's policy bill it.  The two auto insurance companies will sort out the finances when the claim is settled.  Impress this upon the patient!  They will say "it was the other guy's fault, why should I have to pay?".  The patient pays for this coverage (med pay) on their policy so they can get the treatment they need, when they need it.  If the other guy has low limits on his policy, then the patient's uninsured/underinsured coverage should kick in. 

If there is NO MED PAY on their policy, you would bill their health insurance, electronically just like a normal claim. HOWEVER, the health insurance may want to know if there is other insurance responsible for paying this claim.  You would let them know there's no med pay, or it's 3rd party.  Some health insurance will expect to be reimbursed when the claim settles.

If it's a 3rd party claim (the patient has no insurance or med pay and they expect the other party to pay the bills) it's up to the doctor whether they get an attorney or sign a third party lien.  The doctor is under NO obligation to accept a 3rd party claim and can expect payment for services at time of service or he can set up a payment program.

We've found that when it's a 3rd party claim, either the attorney cuts the doctor's bill or the patient gets the money and doesn't pay the bill.  3rd party has been a losing scenario for us for years.

Hope this info helps.

ruthie72:
Thank you so much that was very helpful. I do have one more question, when you say bill the auto insurance..do i fill out a CMS 1500 and send to them as well? I have never billed an auto insurance before so unaware of the procedure, and i need to send forms for each claim? Every time the doctor sees the patient i need to do their claim and send notes with it to the auto insurance? thanks so much...I appreciate you taking the time out to help me. Ruth

bumbleb:
I bill PT only, but I hope this helps. I've found the different ins co have different requirements.

I usually contact them directly to let them know we are treating the patient and find out exactly what they want. Some want it on CMS-1500, others just an itemized bill.  Some want everything at the end of therapy (at discharge), others say to send it as you treat.  Just depends...

They all will require the notes as well as the billing, and I always send a copy of the Lien the patient signed. If they let you send the claims while treatment is still ongoing, I will bill every cpl of weeks, not after each session.

Like DMK mentioned, if a lawyer/3rd party is involved, it's a whole other thing...
Bren

QueenAlicia:
Hi Ruth ;)

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