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Sign off the contracts with insurance - PROS & CONS
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Re: Sign off the contracts with insurance - PROS & CONS
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Steve Verno
Re: Sign off the contracts with insurance - PROS & CONS
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Jan 23 07 2:22 PM
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There are pros and cons to everything.
Pros:
You are not obligated to send a claim. That is the patient's contractual responsibility outline in their contract with their insurance company. As I have said many times, if you send a claim, you are sending the patient's claim to have their benefits paid.
You can collect 100% at the time of service. It helps greatly if you tell the patient this before they come in. The patient has a right to be told this and has a right to make a freedom of choice decision to leave and seek care from a network provider.
As a non-contracted provider, any policy and procedure that the insurance company has, has no jurisdiction over you. Again, these are patient claims and patient benefit issues you are dealing with.
If the patient pays you and submits a bill for reimbursement and the insurance company sends you a letter asking for a claim, you can tell them to jump a rope or pay you an administrative fee for processing a claim. Again, you have no obligation to send them a claim. The contract with the patient makes it the patient's responsibility.
Cons:
If you do't ask for payment at the time of service and you choose to send a claim, the carrier can send the payment of the benefit to the member.
The carrier has no legal obligation to talk to you about the patient's claim.
The carrier might send you payment, but it may not be the amount of your charges. Now you have to fight with the patient to get the rest of your money.
You have no appeal rights. This is because it is the patient's benefit that needs to be appealed and the patient has the appeal rights not you.
If you play the claim game, the claim may be denied because the patient never obtained authorization to see you, now you are back to dealing with the patient again.
The insurance company can ask the patients not to use your services. The insurance company can say, Patient, if you go to Doctor X, we will not pay for the benefits or we will pay $X and you pay the balance.
If you elect to remain contracted, you have a case if the insurance company doesn't pay you correctly. You can take the insurance company to court and you have a contract to back up your case, that is, if you have a good contract.
If you elect to remain contracted, you do have appeal rights because it is a contract issue you are appealing. Hopefully the contract will outline and detail the appeals process.
Remaining contracted is only as good as the contract that was signed.
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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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Sign off the contracts with insurance - PROS & CONS
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