Can a chiropractor sign in a patient and bill for services on a different day?

[Michele]

Question
Can a chiropractor sign in a patient and bill for services on a different day because a massage was done on that day even tho the patient does not come to office.

Also, what is the legal issue on waiving deductibles? Can a patient become a cash patient if he or she has a high deductible?
Thanks Jackie K

Answer
Hi Jackie,
It is illegal for a doctor to bill for services to a patient who was not seen at the date of service reported on the insurance claim. The patient really needs to come for massage on a different day than he or she does for a chiropractic manipulation in order for the insurance company to pay on the claim.
It is usually against the contract that the provider signs with the insurance company to waive the deductible. If the insurance company finds out they will most likely terminate their contract with the dr. I'm not sure on the legal aspect, but I know the insurance companies more than frown upon it. Their feeling is that if you are not going to charge the patient then you shouldn't be charging them. Also, a patient cannot be considered a 'cash patient' while their insurance is being billed. Even if the insurance is not paying anything (because it is being applied to a deductible) they are still allowing the charges. The patient's insurance policy is written so that they will be responsible for certain services, including those applied to the deductible. It is really unfair for a provider to "write off" or not charge the patient when they've billed the patient's insurance. I don't mean to sound like I am on the insurance companies side on these issues, but I've had it explained to me a few times. If the patient went to a hospital, or a medical specialist of some sort, they wouldn't expect them to 'waive' the deductible.
Thanks
Michele

[suzi7693]

THanks so much for that answer Michele. I need a little more clarification.  I'm a new doc and I'm really having trouble figuring out what to charge patients who are working on the deductible. 

I want to know if I can give someone a time of service discount even if they are going to apply it to their deductible.  I think that the deal with the time of service discount is that if the insurance companies were able to pay on the day of service then they would be eligable for that discount as well.  If this is true, then aren't the patient's paying their deductible at the time of service also going to be eligable for that discount?

I've been told by many that you can't give the TOS to people working on the deductible but I just don't understand why.  Also, if it is OK to give them the discount, then how do I note it on the HICF form so that they know that it is an intentional time of service discount and not a duel fee schedule.

thanks
 

[Michele]

Hi,
   If I understand what you are asking, I don't think it is ok.  You are basically saying that you are offering the patient a lower fee if they pay right then and there, and you would offer the same discount to the insurance company too, if they were going to pay.  That is not ok from the insurance company standpoint.  That is because when an insurance company processes a claim and applies it to the deductible, they are not denying the claim.  They are allowing their fee, and applying it to a deductible.  So even though they aren't paying out actual money, they are allowing the charges.  If they allow $100 for charges, and apply it to the deductible, but the patient only pays $75 (for the time of svc discount) then the patient's out of pocket is less than what the insurance is being informed.  The insurance calculates their fees (for the cost of the insurance) based partly on what the patient is responsible to pay out of pocket.  If you are only charging $75, but they are allowing $100, that confuses things greatly.  I know it's difficult to understand from your end, and it is very difficult to explain in words, but it really is charging two different fee schedules.  Insurance companies greatly frown on that.  There are creative ways around it but you need to make sure you are following insurance guidelines, or you may be removed from their panel.

[ShereeC]

I have just recently signed up and find this site so very useful!! Regarding this question of pt having a high deductible etc. When the pt has a high ded. and you know nothing will be paid by the insurance, you can collect up front and bill the insurance-correct? I may have read too much into the answers given here and want to be sure!

[Michele]

when the patient has a high deductible and you KNOW the charges you are billing for will be applied to the deductible then it is ok to collect up front.

Michele