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Re: Medicare HMO question
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Doo
Re: Medicare HMO question
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Jun 11 07 1:00 PM
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My Recent Posts
You are right, I believe the doctor accepted all insurance types from the referring doctors in order to get there paying patients {ie Medicare non HMO's etc}. I will be getting with them to explain that we probably won't be able to collect most of it.
Okay, now you have pried open a much BIGGER Pandora's Box. Do you realize what you just said? In effect, you said that the doctor would see Medicare HMO patients for free in order to obtain other referrals from that doctor. I can't even begin to name all the laws/rules/regulations that just got thrown out the window, but suffice it to say that the Office of the Inspector General (the feds) don't look too kindly on that sort of thing.
Question: What about the "other insurances" PPO's etc that we are not contracted with, what is there responsibility in paying claims to out of network providers? Is it going to depend on the individual contract?
There is no contract to depend on when you are not contracted.
Some insurances always pay the doctor, some never pay the doctor (but pay the patient instead), some flip flop back and forth with no rhyme or reason. For non-contracted patients, I bill the insurance plan and then I turn it over to patient responsibility after a certain amount of time (say 21 days), UNLESS it is an insurance that I KNOW will not pay the doctor (either from experience or because they told me they would not, such as United) and then I bill the insurance plan then immediately turn around and bill the patient. The patient is ultimately responsible for the entire balance, no adjustments.
Sharon
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Association News
Medical Billing & Coding Education from the MAB
Continuing Education
Management Advice and Training
Questions Asked More Than Once
Help Wanted - Billing and Coding
Non Billing Talk
The Venting Area (Clean posts please)
Medical Coding and Billing News
Fraud and Abuse
Health Insurance - Provider Contracting
ERISA
Tricare
Workers' Compensation
General Medical Billing Questions
Appeals
Accounts Receivables (A/R)
Refunds
Auto Accident Issues
Medisoft Technical Support
Medical Software Technical Support Questions Other than Medisoft. No Investigation Questions!
General Medical Coding Forum
CPT Coding Questions
HCPCS Coding Questions
ICD-9-CM Coding Questions
Evaluation & Management Coding Questions
Acupuncture Billing and Coding
Ambulance Coding and Billing
Cardiology Coding and Billing
Chiropractic Coding and Billing
Dental Billing and Coding
DME Coding and Billing
Emergency Department Coding and Billing
Family Practice Coding and Billing
Hospital Inpatient and Outpatient Coding
Hospital Billing, Appeals and Collections
Internal Medicine Coding and Billing
Laboratory Coding and Billing
Ophthalmology Coding and Billing
OB-GYN Coding and Billing
Pain Management Coding and Billing
Pediatric Coding and Billing
Podiatry Coding and Billing
Physical Therapy Coding and Billing
Psychiatry Coding and Billing
Radiology Coding and Billing
Surgery Coding and Billing
Neurology Coding and Billing
Urgent Care Coding and Billing
Provider Compliance
Billing Center Compliance
HIPAA
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