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Handling Courtesy Accounts and Non-Payment of Claims
By Angel Bean
This intel on filing medical billing claims is intended to help medical billing professionals and is not intended for patients or the general public. Sometimes a doctor will extend a patient a professional courtesy that can include giving the patient a payment plan instead of demanding payment in full or accepting their medical insurance as payment in full. Here are some issues with courtesy accounts and non payment of claims.
If you definitely know that the insurance company had sent money to the patient call the patient even on courtesy accounts because we need what money he received from the carrier along with the EOB or explanation of benefits. On a courtesy account we’ll accept the insurance carrier's determinations of how much money they want to pay us for this medical claim but we won't absorb the patient's deductibles as the patient must pay that. In one scenario we received X amount of money on a pain account and being that this was a courtesy but not insurance only surgeon and the anesthesia claim was being paid above the mac the result was that I offered the patient a split on the pain slip and told him to let me know when the anesthesia payment arrived. The mac stands for Medicare Administrative Contractor and a good place to find out more info on the mac is to go to http://www.medicarenhic.com/PA/PartA_whats_new.shtml. Handling Non-Payment of Claims Tell the patient to call the carrier to reprocess for a higher allowance. Or the medical biller can call the insurance company to see why wasn’t the balance fully covered if other linked accounts were paid. Sometimes the insurance company will pay another claim and not this one. Call the insurance company and ask why they paid a linked account and not this one? Also since the doctor is not negotiating his fees the insurance company should send this over to be reviewed for payment in full. Then get the inquiry number and ask how long to they take to do a review. The insurance company did not deny the claim if they applied money to the patient’s deductible. PHCS, Magnacare and Multiplan those are networks, not insurance companies. If the facility bill is at the carrier ask if the facility is in network because if the hospital facility is in network, then the anesthesia claim or our medical bill can be reprocessed by the insurance company in network. When the bill if processed in network the doctor receives more money. When Qualcare claims are in network the claim goes to Insurance Design Administrators, 169 Ramapo Valley Road, Piscataway, NJ 07436 Phone: 800-992-6613. When Qualcare claims are out of network you must call 800-225-1345 or 877-768-1968 extension 234 and the second phone number is answered PMS. All images on this intel are from Photobucket.com.
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Contributor's Note
Written by Angelique author of 91 Smart Sounding Phrases To Put In Your College Academic Papers and Other College Survival Tips https://www.createspace.com/3348044 DOWNLOAD College Academic Paper Writing Help and Other College Survival Tips http://linkbee.com/CollegeBook CEO of BusinessBuzzSEO Search Engine Optimization Services For Your Website http://businessbuzzseo.tripod.com/index.html AngelBean on Associated Content http://www.associatedcontent.com/user/241469/angelbean.html
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