Out of Network Coverage for Drug & Alcohol Rehab

We have gotten many phone calls from people who have had a family member that was in an inpatient drug and alcohol rehab facility that didn’t accept their insurance. Of course when the family member was admitted it was a crisis situation, and there was little choice as to what options were available. In many cases it is actually life or death. They certainly can’t be driving around looking for a participating facility.

The problem is that these out of network facilities require payment for the services up front. Since they do not participate with the insurance, they need to make sure they will be paid. The only real way for them to ensure payment is to get it in advance. Again, due to the situation, the family has no choice so they borrow, or charge, or whatever they need to do at the time.

A lot of times their insurance will have out of network benefits available and the patient (or family member with the insurance) can get reimbursed. The problem is that the facility doesn’t submit the claims. They usually provide the patient with a ‘walk out’ statement, or some other form that shows the charges.

The insurance companies usually require that the charges be submitted on a UB04 form, which is the universal claim form for facility billing. It isn’t that they don’t want to pay, but the information that they require is not on the walk out statement that the facility has provided to the patient. The facilities don’t know how to complete these UB04 forms, and they’ve already been paid. Many times they truly want to help the patient get reimbursed but they simply don’t know how.

We have found a way to help out both the patients and their families, and the facilities. Solutions Medical Billing Inc has teamed up with Xena health to provider a service of taking all of the necessary information from the facility and putting it on to a UB04 form to submit to the insurance carrier. Now patients have a way to get the proper forms filled out and submitted to their insurance carrier so that reimbursement can be made promptly. For more information on how this service works, visit www.facilitybilling.com

Misconceptions of Increasing Accounts Receivable

Misconception # 1

Alice and I had the honor of speaking at the Mid York monthly billing meeting in Syracuse last week. Our topic was “12 Misconceptions of Increasing Accounts Receivable”. We decided the topic was a good one and have decided to share the presentation in it’s entirety over the next couple of newsletters.

Since Alice and I are in a lot of medical offices we see a lot of different situations. Most providers are looking for ways to increase their accounts receivables. Whether they are just looking to make more money, or if they plan on expanding, or if they are not bringing in enough money to cover the expenses of the office, they all are looking to bring in more money. The problem is most of them have the wrong ideas on how to accomplish that.

The very first misconception we spoke on is one of my personal favorites. Many doctors will say to us “If I want more money, I need to see more patients.” What I say to them is that if they want more money, they need to make sure they are getting paid for all the patients they are already seeing and all the services that they are performing.

Many doctors are not even aware of how many patients they are seeing, how much is being billed out, how much is coming in, and how much is being written off. Are the write offs due to contractual adjustments? What percent of claims are being denied? Is their staff taking care of the claim denials, or just writing them off. A survey was done by the Medical Association of Billers in 2004 and they found that only 45% of respondents had ever appealed a denied claim. That means that 55% of respondents do not take care of denied claims. That can be a huge money loss for the provider.

Is your staff running and working regular aging reports? This is another area that much money can be lost. Are copays being collected? Is patient billing being done? If your claims are being submitted electronically, are the electronic reports being downloaded and handled.

As you can see there are many ways that money can be lost in a medical office. If a doctor wants to increase his/her accounts receivable they should first look into if they are collecting all they should be on the patients that they are currently seeing. If they are not collecting all that they should, bringing more patients into the system will just make it worse.