Towards integrated-alternative med (was Superbill)

[Guest guest]

Dealing with insurance companies is not often easy. They will use

intimidation and scare tactics if you don't know what's going on. I

do know what I'm talking about, some 25 years after first doing

acupuncture under an MD.

 

A second location with different overhead can reasonably be stated to

have a different Practice Expense component of your professional fee.

Period.

 

The issue that will bring trouble is when a practitioner accepts a

discounted amount from the patient and then (someone) turns around and

sends insurance a claim for the full fee. It should be clear, on

whatever type of invoice you use, the actual amount paid. Just have a

line something like _less same day cash discount_. Hardball

collections tactics aren't for everybody, but I would tell the

insurance if they want to transfer funds to you on the same day of

service, you'll offer them the same discount. If they demand a full

fee schedule, tell them they're holding the invoice with your fees for

the patient account in question. Then suggest why don't they send YOU

their full schedule of fee payments for ALL CPT codes for ALL medical

specialties in your demographic region, because you need it for your

database. ( !!! )

 

(I'm not addressing the issue of ultimately accepting less from the

patient -on a routine basis- than you represent is your normal fee.

The old claim of writing off the difference as a loss has -in some

cases- apparently been ruled fraudulent)

 

Pre-printed CPT codes should have relative values in line with

demographics for your area, not dollar amounts. Pre-printed ICD codes

are not professional; they scream that you don't know how to diagnose.

 

Much of the above is irrelevent if you've made the mistake to join a

network or other type of managed care. But in any case, follow the

three steps I previously outlined (repeated below) and you should be

fine. Add in documentation of baseline status and functional

improvement post Tx, always strive to learn, improve and elevate your

knowledge, skills, and professionalism, and you'll be practising

integrated alternative healthcare, adding to a growing evidence base !

 

Joe Reid 12-10-06

That's all from me on this topic in a public online forum.

The above as well as the content below are copyrighted information

with all rights reserved.

Joe Reid copyright 2006

 

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Exactly what is or is not legal in any area must be determined only by

careful study of state and local statutes and regulations.

 

Do attorneys have absolute answers? NO! - that's why they argue their

points in court. Even State Boards only have attorneys issue legal

opinions that are just that - opinions - , but you should heed their

memos because they have power to suspend your license.

 

Insurance carriers, malpractise insurance carriers, reps for

malpractise insurance carriers who teach practise management and edit

acupuncture newspapers for chiropractor owners - none of them have

absolute answers either. In fact you could make a pretty strong

argument that their interest and livelyhoods conflict with your desire

to get paid for what you do. ( ! )

 

Specifically, you can certainly have different fees at different

locations where you reasonably have different expenses. You are only

bound to a set conversion value if working for Medicare, and we are

currently not. You can also change your fees as often as necessary,

although there may be advance notice required (see above mentioned

state and local regs). One way to find out if healthcare providers

are required to post a full fee schedule in your area is to walk into

the local hospital or MD's office and look. Just don't ask; they WILL

laugh. You haven't been in business too long if you automatically

accept as fact any communication from an insurance company.

 

You may very well benefit learning from people like AAC, but you

should not be so green as to think they are not playing both sides of

the fence. Before you do, if you want to be a medical professional

integrating / interfacing with the rest of the world of healthcare and

patients who pay into insurance entities, I suggest the following, IN

ORDER:

 

1) Learn enough modern western diagnostics to code - to - a - triage -

necessary - level - of - certainty, according to the International

Classification of Diseases. That is for mandatory safety.

 

2) Study / Learn what Evaluation and Management actually means as it

pertains to (the AMA's) Current Procedure Terminology. That is for

payment because all insurance entities use this alone.

 

3) Practice and bill according to Level of Service. That means that a

bandaid on a scratch gets documented and charged differently from a

complex history that needs records review or outside lab before you

even consider therapy. Learn how to establish and adjust Usual,

Customary, and Reasonable Fees specific to your practice and your area.

 

That's all for now, I have to go. As much as these issues don't seem

to relate to healing, they are inextricably bound, and with our future

as a profession as well.

 

Joe Reid 12-08-06

 

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